If you are a glaucoma patient, you may be taking a prescription medication as treatment. Some patients have a positive experience with current treatments, but this is not the case for every person. Due to personal factors, like side effects or medication adherence, some glaucoma patients have not seen improvements. Learn more about the latest drugs in development to reduce intraocular pressure (IOP) in glaucoma patients.*

How do the main medications that are currently available work?

The main types of medications that are available to patients work by reducing IOP in either one of two ways: 

• Suppressing aqueous humour (AH) production
• Increasing AH outflow

What are the barriers associated with the current treatment?

Some barriers that apply to current glaucoma medications include:

• Lack of support for medication administration
• Poor understanding of management goals
• Competing health and life events
• Complicated medication regimens

What new glaucoma medications have been approved for use?

The following new medications are safe and effective for their use in glaucoma patients:

• Used in conjunction with a prostaglandin analogue (PGA), Rho kinase (ROCK) inhibitors are a class of medications with dual-benefits. ROCK inhibitors, such as Netarsudil and Ripasudil, are IOP-lowering and have neuroprotective properties. 
• With options to use alone or in conjunction with another glaucoma medication, latanoprostene bunod (LBN), an ophthalmic solution whose trade name is Vyzulta, falls into the class of nitric oxide donors. This medication has been shown to reduce IOP, but in one study, it did produce adverse reactions in 8% of participants.

What emerging drugs are in the pipeline?

Divided by drug classes, the following are experimental treatments, all of which are topical drugs, that are currently being studied:

• • Santen Pharmaceuticals is in the process of developing two different PGA medications, Sepetaprost and Omidenepag Isopropyl. The efficacy and overall safety of PGAs have led them to be popular as a first-line treatment in glaucoma. 
  • NCX 470 is a developing nitric oxide donor, which induces relaxation of the eye’s cells and increases AH outflow.
  • AKB-9778/Razuprotafib is a tyrosine-protein kinase receptor activator, which increases AH outflow. This medicine is being studied as a sole therapy or combined therapy option to reduce IOP.
  • A kinase inhibitor drug, H-1337, is being studied to help increase AH outflow and, so far, shows no side effects in animal studies. 
  • Some ROCK inhibitors have recently been approved for use, but SNJ-1656, PHP-201, ITRI-E-212 are still being studied. 
  • A C-type natriuretic peptide analogue, called TAK-639, is increasing AH outflow with only mild side effects in study participants. 
  • Bamosiran, a small interference RNA (siRNA), works on receptors of the eyes to reduce AH production.
  • An adenosine receptor modulator, FM101, is a drug being studied for multiple conditions, including glaucoma, as it modifies the regulator for inflammation and fibrosis. 

Beyond topical drugs, alternative drug delivery methods are also being studied, as adherence to eye drops can be difficult for some patients. There are research efforts dedicated to ocular implants, injections, and punctual plugs with a focus on improving previous side effects of these methods. Moreover, drug-eluting devices, like contact lenses, are also being studied for the duration effectiveness of this option. 

*Jayanetti V., Sandhu S., & Lusthaus, J.A. (2020, Nov. 20). The Latest Drugs in Development That Reduce Intraocular Pressure in Ocular Hypertension and Glaucoma. Journal of Experimental Pharmacology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7685378/

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