Glaucoma drug therapy continues to evolve with Rho kinase inhibitors that specifically target glaucomatous abnormalities such as trabecular meshwork outflow.
Aerie Pharmaceuticals announced in March 2019 that the FDA approved Rocklatan (netarsudil and latanoprost ophthalmic solution) 0.02%/0.005% to reduce elevated IOP in patients with open-angle glaucoma or ocular hypertension. The once-daily eye drop is a fixed-dose combination of latanoprost and netarsudil.
Netarsudil 0.02% ophthalmic solution (Rhopressa, Aerie Pharmaceuticals), a ROCK inhibitor and norephinephrine transport (NET) inhibitor, lowers IOP by relaxing the trabecular meshwork and thus increasing the trabecular outflow. In addition to acting on the trabecular meshwork, the ROCK/NET inhibitor has multiple mechanisms of action in that it also decreases both the episcleral venous pressure and aqueous production.
“Most of our glaucoma drugs either increase uveoscleral outflow or decrease production of aqueous humor,” Dr. Ou said. “Until recently, no drug has been available that works directly on trabecular meshwork outflow.”
In addition, a recent addition to the armamentarium that targets the trabecular meshwork is latanoprostene bunod 0.024% ophthalmic solution (Vyzulta, Bausch + Lomb). This drug is a novel nitric oxide (NO)-donating prostaglandin prostaglandin F2-alpha analog. NO is thought to relax the trabecular meshwork and increase trabecular outflow, while the latanoprost component increases uveoscleral outflow.
Yvonne Ou, MD
E: [email protected]
Dr. Ou is a consultant and advisor to Merck & Co. Inc.