News

Big Pharma is on the hunt for new glaucoma drugs. The pace of therapeutic development is picking up. The “New Horizons in Glaucoma Pharmaceuticals” highlighted four companies with strong new drug candidates.

Listen as Gil Kliman, MD, managing director of InterWest Partners, interviews Richard Lindstrom, MD, in a one-on-interview at the 2014 Glaucoma 360 meeting. Dr. Lindstrom recalls how he was primed as a boy for the construction business by his father, but decided to go to medical school. The decision catapulted Dr. Lindstrom’s career as ophthalmologist, surgeon, and product innovator.

Intraocular pressure (IOP) monitoring is based on fiction. Clinicians typically measure IOP over a single visit and extrapolate the value to the patient’s overall condition and the degree of control over their IOP. “New Horizons in IOP Monitoring and Digital Health” session showcased six companies trying to turn the IOP challenge into commercial success.

The search for glaucoma biomarkers is in high gear. Funded by Catalyst for a Cure, the research program has already produced new biomarker candidates and novel techniques that promise to advance research in glaucoma. Research is focusing on ways to diagnose glaucoma early and detect the specific, minute changes that could allow researchers to reduce vision loss.

The next decade will be a period of remarkable research discoveries for glaucoma and their translation into enhanced patient care, according to Robert N. Weinreb, MD. Glaucoma research will transform and will dramatically change the clinical practice. Dr. Weinreb discussed improvements in risk-prediction and risk-modification strategies, increased knowledge of glaucoma pathophysiology, the advent of 24-hour IOP monitoring, and advanced technologies for structural and functional imaging.

Micro-invasive glaucoma surgery (MIGS) devices for glaucoma were big news in 2013. In 2014, MIGS devices represent big dollars. Steven Vold, MD, moderated the panel on the “New Horizons in Glaucoma Devices” at the 2014 Glaucoma 360 meeting.

The availability of technologies for ambulatory IOP measurement will usher in a new era in glaucoma patient management. L. Jay Katz, MD, said the technologies will provide better understanding of IOP and patient adherence to topical medications and to make more timely adjustments in therapy while reducing the number of office visits.

Clinical registries can lead to better outcomes, better science, and better drug and device surveillance, reports William L. Rich, III, MD, FACS. Registry measures performance, both process measures in the office, and surgical interventions, and provides a forum to compare them and improve.

The glaucoma pharmaceutical sector alone is set to grow from $4 billion in 2013 to $5 billion by 2018. Innovation in glaucoma diagnosis and treatment is alive, well–and profitable. That was the upbeat report from Emmett Cunningham, Jr., MD, PhD, MPH, ophthalmologist and partner with venture capital firm Clarus Ventures, LLC.

Ruth D. Williams, MD, a glaucoma consultant and partner at the Wheaton Eye Clinic, Naperville, IL, explored the possible effects and correlations in concomitant treatment of hypertension and glaucoma.

Knowledge about the circadian pattern of IOP and the 24-hour efficacy of glaucoma medications is increasing, which is expected to improve medical management of glaucoma in the future, reported Sunita Radhakrishnan, MD.

New generation of surgical procedures for glaucoma are being performed with good facility and encouraging safety and efficacy results. Only time will tell whether these techniques will maintain their initial promise and how they impact the treatment for glaucoma.

Intraocular pressure (IOP) is only the starting point for glaucoma treatment. Successful treatment begins with establishing an IOP goal, but there are multiple considerations that affect treatment choices. Robert Stamper, MD, explored the considerations that go into drug selection. None of the factors that should influence drug selection are new, he said, but it is easy to forget that the patient with glaucoma likely has other medical problems and is taking other medications.

Future healthcare reform is not a luxury. Rather, it is a necessity, especially when the performance and costs of healthcare in the United States are considered.

Patients needing glaucoma surgery may also be candidates for a combined procedure with cataract removal and IOL implantation. For a variety of reasons, cataract surgery may present challenges in eyes with glaucoma. Alan S. Crandall, MD, provided cases to demonstrate the complexities encountered when performing cataract surgery in glaucoma patients and strategies for achieving successful outcomes.

Glaucoma care in the United States has changed very little over the past 20 years. Kuldev Singh, MD, outlined the state of glaucoma in 2014. Only 25% to 50% of Americans with glaucoma are aware that they have glaucoma, and there are many more who are aware and not under regular care. Then, there are patients who are under regular care, but they may not be compliant with prescribed therapy. The bottom line is there is much room for improvement in the diagnosis and treatment of this glaucomatous disease.

Negotiating the twists and turns that will be inherent to the Patient Protection and Affordable Care Act (PPACA)-commonly known as the Affordable Care Act (ACA) or “Obamacare”–could be tricky, said Terri Pickering, MD. In order to succeed, ophthalmologists must be aware of and ready for the inevitable changes.

IOP is the only proven modifiable risk factor for progression of normal-tension glaucoma (NTG). However, Shan Lin, MD, says there is some compelling evidence that a number of other variables play a role. Dr. Lin reviewed information from studies investigating cerebrospinal fluid (CSF) pressure, myopia, sleep apnea, low blood pressure (BP), oxidant minerals (calcium and iron), and oral contraceptive (OC) use, and found that these factors may contribute to NTG progression.

For many years, researchers have suspected and tried to prove a link between glaucoma and dementia, said Yvonne Ou, MD. Definitive answers, however, have been hard to come by. Glaucoma and dementia have several factors in common: both are neurodegenerative, chronic, and progressive diseases that are age-related and cause irreversible neuronal cell loss. They are both becoming a major public health concern as the U.S. population ages.

Physicians are taking pictures of eye problems with their personal smartphone, and smartphones are expected to have a tremendous impact in expanding telemedicine, reports Robert T. Chang, MD. However, while smartphone cameras may function well for pictures of the external eye, they lack the proper magnification and lighting to provide the necessary detail when capturing intraocular images. New adapters are addressing those limitations to enable smartphone fundus photography and acquisition of other high quality anterior segment images.

Identifying and managing the risk factors of glaucoma is key to its effective management. Andrew G. Iwach, MD, says ophthalmologists are not treating means or averages,but individuals, and this requires a customized approach for every eye and every patient.

Adding a dry eye center is not only beneficial to patients, but can also increase revenue to practices.

Blowing through a half-billion dollars is probably a lot harder than it seems

Controlling staff members’ attitudes may not seem important, but it is to patients who attend your practice. Make sure the overall atmosphere and experience for them is highly important or they will go elsewhere.

Patients with elevated tear osmolarity who underwent punctal occlusion showed rapid improvement in tear osmolarity and other features of dry eye disease.

Further distancing itself from Valeant Pharmaceuticals International’s unsolicited acquisition proposal, Allergan has filed an investor presentation with the Securities and Exchange Commission (SEC) and has posted the presentation to its website detailing its initial concerns about the sustainability of Valeant’s business model.

Allergan has received a strong outpour of support from its physician customers, their nurses, and office staff members, as well as from patient advocacy groups and medical associations following the company’s rejection of Valeant Pharmaceuticals International’s unsolicited acquisition proposal.

Value-based medicine analyses have indicated that glaucoma therapy has great patient benefits because it preserves their vision-which positively impacts their quality-of-life (QOL)-and it is cost effective with a high return on investment, according to Gary Brown, MD.

The FDA has granted AbbVie’s adalimumab (Humira) orphan drug designation for the treatment of non-infectious intermediate, posterior, or pan-uveitis, or chronic non-infectious anterior uveitis.

Ophthotech Corp. has entered into an ex-U.S. licensing and commercialization agreement with Novartis Pharmaceuticals that will focus on the treatment of wet age-related macular degeneration (AMD).