Issue link: https://viewer.e-digitaledition.com/i/1082532
IN THE PA S T 18 months, the FDA has approved two new glaucoma eyedrop medications and certified two types of minimally invasive glaucoma surgeries (MIGS) to restore some functionality of the meshwork, says Anita Campbell, MD, a fellowship-trained glaucoma specialist at Grene Vision Group in Wichita. Dr. Campbell has started prescribing both new medica- tions — Vyzulta and Rhopressa — and performing both new MIGS procedures — called the Kahook Dual Blade and the OMNI system — to help reduce intraocular pressure (IOP) in the eyes of her glaucoma patients. Dr. Campbell uses a kitchen sink analogy to explain the eye's fluid dynamics to patients: The faucet is the ciliary body that produces fluid or aqueous humor, and the drain is the trabecular meshwork. In the most common form of glaucoma, called open angle, the meshwork gets blocked, leading to buildup of the aqueous humor. The fluid buildup leads to elevated pressure on the optic nerve. If left untreated, the elevated IOP can cause optic nerve damage and permanent blindness. Treatment for glaucoma patients involves medications or surgeries that either turn down aqueous humor production or increase aqueous fluid drainage through traditional or secondary pathways, Dr. Campbell says. HOW THE NEW MEDS WORK "What makes these new medications so exciting is that they salvage the primary drain, and we'd given up on that medicine-wise," Dr. Campbell says. "If there are new medications that can hold off on a patient needing surgery, that's good." Vyzulta, manufactured by Bausch + Lomb, was approved by the FDA in November 2017. A month later, the FDA approved Rhopressa, which was developed by an ophthalmologist and is made by Aerie Pharmaceuticals. There are six categories of glaucoma eyedrops, and these tend to be the first-line treatment for glaucoma patients. Some work by decreas- ing fluid production and others create a secondary drainage channel via the uveoscleral outflow, and some do both. The uveoscleral outflow allows the fluid to seep around the trabecular meshwork. In New Meds, Procedures Offer Bright Outlook for Glaucoma Patients BY AMY GEISZLER-JONES FOR A LONG TIME, OPHTHALMOLOGISTS HAD SORT OF GIVEN UP ON RECOVERING THE DR AINAGE FUNCTIONS OF THE TR ABECUL AR MESHWORK OF A GL AUCOMA PATIENT'S E YE. Ophthalmologist Anita Campbell, MD, is a fellowship- trained glaucoma specialist at Grene Vision Group. She provides the latest medical care and surgical techniques, including minimally invasive glaucoma surgery. 1 4 1 4❱❱❱❱❱ F E A T U R E