Eyeworld

63 EW GLAUCOMA September 2017 // INNOVATION MADE BY ZEISS Carl Zeiss Meditec, Inc. 800 342 9821 www.zeiss.com/med REL.9084 ©2017 Carl Zeiss Meditec, Inc. All copyrights reserved. Transforming your practice with technology that's easy on the eyes. ZEISS ReLEx SMILE ReLEx SMILE from ZEISS The fi rst minimally invasive laser vision correction solution ReLEx ® SMILE is the fi rst and only small incision lenticule extraction (SMILE) laser vision correction solution currently available. The VisuMax laser from ZEISS is the only femtosecond laser that can be used to perform SMILE in addition to creating LASIK fl aps. More options for you and your patients to SMILE about. www.zeiss.com/us/relex-smile Considering Trabodenoson Another agent under consideration is Trabodenoson (Inotek Pharmaceu- ticals, Lexington, Massachusetts), an adenosine cyclase agonist. "It's going to increase outflow again through the trabecular meshwork," Dr. Radcliffe said. Dr. Okeke pointed out that Trabodenoson uses a different mechanism of action from the rho kinase inhibitors. "In the trials so far, its pressure reduction has not been quite as robust as what has been seen with the rho kinase inhib- itors," she said. "Pressure reduction with Trabodenoson is more in the range of 3 to 5 mm Hg." That may be seen as more of an adjunctive medication than a first-line agent, Dr. Okeke noted, adding that this agent is not as far down the pipeline as the others. The fact that outflow is en- hanced with this (different from some of the other available drops) should not be overlooked, Dr. Okeke thinks. Keeping the trabecular mesh- work working is something that has been talked about in other circles. "One of the things that has been discussed recently is the concept of doing laser treatment first because of the effect of the laser treatment on the trabecular meshwork, allowing it to be utilized and enhanced," she said, adding that some aque- ous-inhibiting medications simply reduce the amount of aqueous humor going through the trabecular meshwork over time, which can lead to some level of debilitation. Drops that enhance outflow and keep the trabecular meshwork and Schlemm's canal moving, rather than taking an inhibitory path, may be more advantageous. Dr. Radcliffe views the new op- tions as exciting. "It doesn't take too much for a patient to not be able to use one or two of the medicines that we consider our staples," Dr. Radcliffe said. "Even though we may have five agents available right now, an asthmatic who develops an aller- gy to brimonidine, which would be 20% of asthmatics, would be down to three." It's not hard to see how a patient could end up needing these emerging new medications. Armed with good quality data from the manufacturers, Dr. Radcliffe thinks practitioners will be able to advocate for the use of these medications. Then it will be a question of doing comparative studies to determine which is best in what situation, he concluded. EW Editors' note: Dr. Okeke has no finan- cial interests related to her comments. Contact information Okeke: iglaucoma@gmail.com Radcliffe: drradcliffe@gmail.com

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