By Michelle Dalton, ELS; Reviewed by Jason Bacharach, MD, and Calvin Roberts, MD
When it comes to treating open-angle glaucoma, the pendulum had been swinging back towards surgical options as earlier interventions in lieu of additional medications (especially in those patients who had concurrent cataract).
However, that may all change now that the FDA approved two new medications in 2017. The first of those, latanoprostene bunod 0.024% (Vyzulta, Bausch + Lomb & Nicox), is indicated for the reduction of IOP in patients with open-angle glaucoma or ocular hypertension. The drug was approved in November 2017.
In December 2017, the FDA also approved netarsudil ophthalmic solution 0.02% (Rhopressa, Aerie Pharmaceuticals). The drug was the second new therapy approved for the lowering of elevated intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension.
Latanoprostene bunod works by metabolizing into two moieties: latanoprost acid, which primarily works within the uveoscleral pathway to increase aqueous humor outflow, and butanediol mononitrate, which releases nitric oxide (NO) to increase outflow through the trabecular meshwork and Schlemm's canal.
“Vyzulta will have clinical use in a variety of applications,” said Jason Bacharach, MD, North Bay Eye Associates, Petaluma, CA. Although it is not completely clear what the dual mechanisms of action mean clinically, Dr. Bacharach said he is curious to find out how the drug will work “in the mix with other medications.”