Glaucomatous Optic Neuropathy Associated with Nocturnal Dip in Blood Pressure: Findings from the Maracaibo Aging Study

Rho Kinase Inhibitors as a Novel Treatment for Glaucoma and Ocular Hypertension

In an elegant example of bench-to-bedside research, a hypothesis that cells in the outflow pathway actively regulate conventional outflow resistance was proposed in the 1990s and systematically pursued, exposing novel cellular and molecular mechanisms of intraocular pressure (IOP) regulation. The critical discovery that pharmacologic manipulation of the cytoskeleton of outflow pathway cells decreased outflow resistance placed a spotlight on the Rho kinase pathway that was known to regulate the cytoskeleton. Ultimately, a search for Rho kinase inhibitors led to the discovery of several molecules of therapeutic interest, leaving us today with 2 new ocular hypotensive agents approved for clinical use: ripasudil in Japan and netarsudil in the United States. These represent members of the first new class of clinically useful ocular hypotensive agents since the US Food and Drug Administration approval of latanoprost in 1996. The development of Rho kinase inhibitors as a class of medications to lower IOP in patients with glaucoma and ocular hypertension represents a triumph in translational research. Rho kinase inhibitors are effective alone or when combined with other known ocular hypotensive medications. They also offer the possibility of neuroprotective activity, a favorable impact on ocular blood flow, and even an antifibrotic effect that may prove useful in conventional glaucoma surgery. Local adverse effects, however, including conjunctival hyperemia, subconjunctival hemorrhages, and cornea verticillata, are common. Development of Rho kinase inhibitors targeted to the cells of the outflow pathway and the retina may allow these agents to have even greater clinical impact. The objectives of this review are to describe the basic science underlying the development of Rho kinase inhibitors as a therapy to lower IOP and to summarize the results of the clinical studies reported to date. The neuroprotective and vasoactive properties of Rho kinase inhibitors, as well as the antifibrotic properties, of these agents are reviewed in the context of their possible role in the medical and surgical treatment of glaucoma.

Effect of the level of effort during resistance training on intraocular pressure

BACKGROUND

We aimed to evaluate the influence of the level of effort during four basic resistance exercises leading to muscular failure on intraocular pressure (IOP) and ocular perfusion (OPP), as well as the role of exercise type and sex.

METHODS

Twenty-five young adults (12 women) performed 10 repetitions against their 10-RM (repetition maximum) load in the squat, military press, biceps curl and calf raise exercises. IOP was measured before, during and after exercise, whereas OPP was indirectly assessed before and after each exercise.

RESULTS

There was a progressive IOP rise during exercise (p < 0.001, η² = 0.531), which was dependent on exercise type (p = 0.020, η² = 0.125). The squat exercise induced higher IOP increments in comparison to the other exercises (corrected p-values < 0.001), and higher IOP values were found for the military press and biceps curl than for the calf raise exercise (corrected p-values = 0.012 and 0.002). OPP exhibited a significant reduction when leading to muscular failure (p = 0.001, η² = 0.364), being statistically significant for the squat and military press exercises (corrected p-values = 0.037 and 0.047). No effect of sex was found for IOP and OPP (p > 0.05).

CONCLUSIONS

A single set of resistance training leading to muscular failure causes an instantaneous and progressive IOP rise in healthy young individuals. These IOP rises depend on exercise type (squat > military press = biceps curl > calf raise), but not on participant´s sex. OPP diminished as a consequence of performing resistance training exercise, being statistically significant for the squat and military press exercises. Future studies should include glaucoma patients aiming to corroborate the generalizability of our findings.