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Tripathi S, Yadav KS. Development of brimonidine niosomes laden contact lenses for extended release and promising delivery system in glaucoma treatment. Daru 2024; 32:161-175. [PMID: 38158475 PMCID: PMC11087387 DOI: 10.1007/s40199-023-00500-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Increased intraocular pressure is a common symptom of glaucoma. In severe circumstances, it may result in loss of eyesight. Glaucoma treatment is difficult due to ocular physiological barriers that prevent medications from reaching the afflicted area. Traditional formulations (eye drops) have a short residence period and are rapidly drained away via the nasolacrimal duct, resulting in increased adverse drug responses and lower efficacy. The usage of nanoparticles such as niosomes could be one potential answer to these problems. While niosomes improve drug penetration, they have little effect on ocular retention of the medication. Contact lenses containing niosomes can assist to overcome this disadvantage. OBJECTIVE This study aims to prepare and evaluate Brimonidine niosomes laden contact lenses for the treatment of Glaucoma. METHODS Brimonidine niosomes were prepared using thin film hydration method and evaluated. The contact lenses were soaked in the niosomal formulation at varying intervals (3-10 days). Thereafter, the contact lenses were evaluated for %transmittance, %swelling index, drug quantification and in vitro drug release. The pharmacodynamic studies were conducted to assess the reduction in intraocular pressure (IOP) in albino rabbits. The research compared the results of the reduction in intraocular pressure caused by Brimonidine niosomes laden contact lenses with a marketed preparation of niosomes. RESULTS Higher concentration of the drug was loaded in contact lenses loaded with Brimonidine niosomes compared to the marketed formulation, by soaking method. The contact lenses exhibited an optimal %transmittance of 98.02 ± 0.36 and %swelling index of 50.35 ± 0.57. Increase in the soaking time up to 7 days led to an increase in the drug concentration in the contact lenses. However, no further increase was observed after the 7th day due to saturation of the contact lenses. Brimonidine niosomes laden contact lenses provided a reduction in intraocular pressure that was similar to the marketed preparation. Further, the contact lenses provided extended release up to 20 h. CONCLUSION Brimonidine niosomes laden contact lenses exhibited superior drug loading through the soaking method, displaying optimal %transmittance and %swelling index. Soaking for 7 days increased drug concentration in contact lenses with no further increase due to saturation. These lenses reduced intraocular pressure like the marketed formulation, offering extended release for 20 h.
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Affiliation(s)
- Shresthi Tripathi
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKM'S NMIMS (Deemed to Be University), Mumbai, India
| | - Khushwant S Yadav
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKM'S NMIMS (Deemed to Be University), Mumbai, India.
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Xue X, Zhang D, Sun C, Shi Y, Wang R, Tan T, Gao P, Fan S, Zhai G, Hu M, Wu Y. Xiaoqing: A Q&A model for glaucoma based on LLMs. Comput Biol Med 2024; 174:108399. [PMID: 38615461 DOI: 10.1016/j.compbiomed.2024.108399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 03/06/2024] [Accepted: 04/01/2024] [Indexed: 04/16/2024]
Abstract
Glaucoma is one of the leading cause of blindness worldwide. Individuals affected by glaucoma, including patients and their family members, frequently encounter a deficit in dependable support beyond the confines of clinical environments. Seeking advice via the internet can be a difficult task due to the vast amount of disorganized and unstructured material available on these sites, nevertheless. This research explores how Large Language Models (LLMs) can be leveraged to better serve medical research and benefit glaucoma patients. We introduce Xiaoqing, a Natural Language Processing (NLP) model specifically tailored for the glaucoma field, detailing its development and deployment. To evaluate its effectiveness, we conducted two forms of experiments: comparative and experiential. In the comparative analysis, we presented 22 glaucoma-related questions in simplified Chinese to three medical NLP models (Xiaoqing LLMs, HuaTuo, Ivy GPT) and two general models (ChatGPT-3.5 and ChatGPT-4), covering a range of topics from basic glaucoma knowledge to treatment, surgery, research, management standards, and patient lifestyle. Responses were assessed for informativeness and readability. The experiential experiment involved glaucoma patients and non-patients interacting with Xiaoqing, collecting and analyzing their questions and feedback on the same criteria. The findings demonstrated that Xiaoqing notably outperformed the other models in terms of informativeness and readability, suggesting that Xiaoqing is a significant advancement in the management and treatment of glaucoma in China. We also provide a Web-based version of Xiaoqing, allowing readers to directly experience its functionality. The Web-based Xiaoqing is available at https://qa.glaucoma-assistant.com//qa.
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Affiliation(s)
- Xiaojuan Xue
- Shanghai Key Laboratory of Multidimensional Information Processing, East China Normal University, Shanghai, China.
| | - Deshiwei Zhang
- Shanghai Key Laboratory of Multidimensional Information Processing, East China Normal University, Shanghai, China; School of Civil Engineering, Southeast University, Jiangsu, China.
| | - Chengyang Sun
- Department of Ophthalmology, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Yiqiao Shi
- Shanghai Key Laboratory of Multidimensional Information Processing, East China Normal University, Shanghai, China.
| | - Rongsheng Wang
- Faculty of Applied Sciences, Macao Polytechnic University, Macao Special Administrative Region of China.
| | - Tao Tan
- Faculty of Applied Sciences, Macao Polytechnic University, Macao Special Administrative Region of China.
| | - Peng Gao
- Department of Ophthalmology, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China.
| | - Sujie Fan
- Department of Ophthalmology, Handan Eye Hospital (the Third Hospital of Handan), Hebei, China.
| | - Guangtao Zhai
- School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, China.
| | - Menghan Hu
- Shanghai Key Laboratory of Multidimensional Information Processing, East China Normal University, Shanghai, China.
| | - Yue Wu
- Department of Ophthalmology, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Fomo KN, Perumal N, Manicam C, Pfeiffer N, Grus FH. Neuroretinal Cell Culture Model as a Tool for the Development of New Therapeutic Approaches for Oxidative Stress-Induced Ocular Diseases, with a Focus on Glaucoma. Cells 2024; 13:775. [PMID: 38727311 PMCID: PMC11083839 DOI: 10.3390/cells13090775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/15/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024] Open
Abstract
Glaucoma is a heterogeneous group of optic neuropathies characterized by a progressive degeneration of the retinal ganglion cells (RGCs), leading to irreversible vision loss. Nowadays, the traditional therapeutic approach to glaucoma consists of lowering the intraocular pressure (IOP), which does not address the neurodegenerative features of the disease. Besides animal models of glaucoma, there is a considerable need for in vitro experimental models to propose new therapeutic strategies for this ocular disease. In this study, we elucidated the pathological mechanisms leading to neuroretinal R28 cell death after exposure to glutamate and hydrogen peroxide (H2O2) in order to develop new therapeutic approaches for oxidative stress-induced retinal diseases, including glaucoma. We were able to show that glutamate and H2O2 can induce a decrease in R28 cell viability in a concentration-dependent manner. A cell viability of about 42% was found after exposure to 3 mM of glutamate and about 56% after exposure to 100 µM of H2O2 (n = 4). Label-free quantitative mass spectrometry analysis revealed differential alterations of 193 and 311 proteins in R28 cells exposed to 3 mM of glutamate and 100 µM of H2O2, respectively (FDR < 1%; p < 0.05). Bioinformatics analysis indicated that the protein changes were associated with the dysregulation of signaling pathways, which was similar to those observed in glaucoma. Thus, the proteomic alteration induced by glutamate was associated with the inhibition of the PI3K/AKT signaling pathway. On the other hand, H2O2-induced toxicity in R28 cells was linked to the activation of apoptosis signaling and the inhibition of the mTOR and ERK/MAPK signaling pathways. Furthermore, the data show a similarity in the inhibition of the EIF2 and AMPK signaling pathways and the activation of the sumoylation and WNT/β-catenin signaling pathways in both groups. Our findings suggest that the exposure of R28 cells to glutamate and H2O2 could induce glaucoma-like neurodegenerative features and potentially provide a suitable tool for the development of new therapeutic strategies for retinal diseases.
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Affiliation(s)
| | | | | | | | - Franz H. Grus
- Experimental and Translational Ophthalmology, Department of Ophthalmology, University Medical Centre of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (K.N.F.); (N.P.); (C.M.); (N.P.)
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Wu LH, Cheng YW, Lin FL, Hsu KC, Wang MH, Yen JL, Wang TJ, Lin TE, Liu YC, Huang WJ, Hsiao G. A novel HDAC8 inhibitor H7E exerts retinoprotective effects against glaucomatous injury via ameliorating aberrant Müller glia activation and oxidative stress. Biomed Pharmacother 2024; 174:116538. [PMID: 38579401 DOI: 10.1016/j.biopha.2024.116538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/18/2024] [Accepted: 03/29/2024] [Indexed: 04/07/2024] Open
Abstract
Glaucoma is considered a neurodegenerative disease characterized by progressive visual field defects that may lead to blindness. Although controlling intraocular pressure (IOP) is the mainstay of glaucoma treatment, some glaucoma patients have unmet needs due to unclear pathogenic mechanisms. Recently, there has been growing evidence that neuroinflammation is a potential target for the development of novel antiglaucoma agents. In this study, we investigated the protective effects and cellular mechanisms of H7E, a novel small molecule inhibits HDAC8, using in vitro and in vivo glaucoma-like models. Importantly, H7E mitigated extracellular MMP-9 activity and MCP-1 levels in glutamate- or S100B-stimulated reactive Müller glia. In addition, H7E inhibited the upregulation of inflammation- and proliferation-related signaling pathways, particularly the ERK and JNK MAPK pathways. Under conditions of oxidative damage, H7E prevents retinal cell death and reduces extracellular glutamate released from stressed Müller glia. In a mouse model of NMDA-induced retinal degeneration, H7E alleviated functional and structural defects within the inner retina as assessed by electroretinography and optical coherence tomography. Our results demonstrated that the newly identified compound H7E protects against glaucoma damage by specifically targeting HDAC8 activity in the retina. This protective effect is attributed to the inhibition of Müller glial activation and the prevention of retinal cell death caused by oxidative stress.
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Affiliation(s)
- Liang-Huan Wu
- Ph.D. Program in Drug Discovery and Development Industry, College of Pharmacy, Taipei Medical University, 250 Wu-Hsing St., Taipei 110, Taiwan.
| | - Yu-Wen Cheng
- Ph.D. Program in Drug Discovery and Development Industry, College of Pharmacy, Taipei Medical University, 250 Wu-Hsing St., Taipei 110, Taiwan; Department of Pharmaceutical Sciences, School of Pharmacy, College of Pharmacy, Taipei Medical University, 250 Wu-Hsing St., Taipei 110, Taiwan.
| | - Fan-Li Lin
- Department of Pharmacology, School of Medicine, Kaohsiung Medical University, 100 Shih-Chuan 1st Rd., Kaohsiung 807, Taiwan.
| | - Kai-Cheng Hsu
- Ph.D. Program in Drug Discovery and Development Industry, College of Pharmacy, Taipei Medical University, 250 Wu-Hsing St., Taipei 110, Taiwan; Graduate Institute of Cancer Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, 301 Yuantong Rd., New Taipei 235, Taiwan.
| | - Mong-Heng Wang
- Independent Scholar, 3466 Rhodes Hill Drive, Martinez, GA 30907, USA.
| | - Jing-Lun Yen
- Graduate Institute of Medical Sciences and Department of Pharmacology, School of Medicine, College of Medicine, Taipei Medical University, 250 Wu-Hsing St., Taipei 110, Taiwan.
| | - Tsung-Jen Wang
- Department of Ophthalmology, Taipei Medical University Hospital, 252 Wu-Hsing St., Taipei 110, Taiwan; Department of Ophthalmology, School of Medicine, College of Medicine, Taipei Medical University, 250 Wu-Hsing St., Taipei 110, Taiwan.
| | - Tony Eight Lin
- Graduate Institute of Cancer Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, 301 Yuantong Rd., New Taipei 235, Taiwan.
| | - Yi-Chien Liu
- Ph.D. Program in Drug Discovery and Development Industry, College of Pharmacy, Taipei Medical University, 250 Wu-Hsing St., Taipei 110, Taiwan.
| | - Wei-Jan Huang
- Ph.D. Program in Drug Discovery and Development Industry, College of Pharmacy, Taipei Medical University, 250 Wu-Hsing St., Taipei 110, Taiwan; Department of Pharmaceutical Sciences, School of Pharmacy, College of Pharmacy, Taipei Medical University, 250 Wu-Hsing St., Taipei 110, Taiwan.
| | - George Hsiao
- Ph.D. Program in Drug Discovery and Development Industry, College of Pharmacy, Taipei Medical University, 250 Wu-Hsing St., Taipei 110, Taiwan; Graduate Institute of Medical Sciences and Department of Pharmacology, School of Medicine, College of Medicine, Taipei Medical University, 250 Wu-Hsing St., Taipei 110, Taiwan; Department of Ophthalmology, School of Medicine, College of Medicine, Taipei Medical University, 250 Wu-Hsing St., Taipei 110, Taiwan.
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Barathi VA, Katz A, Chaudhary S, Li HL, Tal DM, Marcovich A, Do CW, Karlish SJD. A digoxin derivative that potently reduces intraocular pressure: efficacy and mechanism of action in different animal models. Am J Physiol Cell Physiol 2024; 326:C1505-C1519. [PMID: 38557355 DOI: 10.1152/ajpcell.00617.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/04/2024]
Abstract
Glaucoma is a blinding disease. Reduction of intraocular pressure (IOP) is the mainstay of treatment, but current drugs show side effects or become progressively ineffective, highlighting the need for novel compounds. We have synthesized a family of perhydro-1,4-oxazepine derivatives of digoxin, the selective inhibitor of Na,K-ATPase. The cyclobutyl derivative (DcB) displays strong selectivity for the human α2 isoform and potently reduces IOP in rabbits. These observations appeared consistent with a hypothesis that in ciliary epithelium DcB inhibits the α2 isoform of Na,K-ATPase, which is expressed strongly in nonpigmented cells, reducing aqueous humor (AH) inflow. This paper extends assessment of efficacy and mechanism of action of DcB using an ocular hypertensive nonhuman primate model (OHT-NHP) (Macaca fascicularis). In OHT-NHP, DcB potently lowers IOP, in both acute (24 h) and extended (7-10 days) settings, accompanied by increased aqueous humor flow rate (AFR). By contrast, ocular normotensive animals (ONT-NHP) are poorly responsive to DcB, if at all. The mechanism of action of DcB has been analyzed using isolated porcine ciliary epithelium and perfused enucleated eyes to study AH inflow and AH outflow facility, respectively. 1) DcB significantly stimulates AH inflow although prior addition of 8-Br-cAMP, which raises AH inflow, precludes additional effects of DcB. 2) DcB significantly increases AH outflow facility via the trabecular meshwork (TM). Taken together, the data indicate that the original hypothesis on the mechanism of action must be revised. In the OHT-NHP, and presumably other species, DcB lowers IOP by increasing AH outflow facility rather than by decreasing AH inflow.NEW & NOTEWORTHY When applied topically, a cyclobutyl derivative of digoxin (DcB) potently reduces intraocular pressure in an ocular hypertensive nonhuman primate model (Macaca fascicularis), associated with increased aqueous humor (AH) flow rate (AFR). The mechanism of action of DcB involves increased AH outflow facility as detected in enucleated perfused porcine eyes and, in parallel, increased (AH) inflow as detected in isolated porcine ciliary epithelium. DcB might have potential as a drug for the treatment of open-angle human glaucoma.
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Affiliation(s)
- Veluchamy Amutha Barathi
- Translational Pre-Clinical Model Platform, Singapore Institute of Eye Research (SERI)
- ACP in Ophthalmology & Visual Sciences, DUKE-NUS Graduate Medical School, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Adriana Katz
- Department of Biomolecular Sciences, Weizmann Institute of Science, Rehovot, Israel
| | - Shashikant Chaudhary
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China
| | - Hoi-Lam Li
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China
| | - Daniel M Tal
- Department of Biomolecular Sciences, Weizmann Institute of Science, Rehovot, Israel
| | - Arie Marcovich
- Opthalmology Department, Kaplan Medical Center, Rehovot, Israel
- Hebrew University Medical School, Jerusalem, Israel
| | - Chi-Wai Do
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China
- Centre for Eye and Vision Research (CEVR), Hong Kong, People's Republic of China
- Research Institute for Smart Ageing (RISA), The Hong Kong Polytechnic University, Hong Kong, People's Republic of China
| | - Steven J D Karlish
- Department of Biomolecular Sciences, Weizmann Institute of Science, Rehovot, Israel
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Zhu J, Chen H, Wu J, Li S, Lin W, Wang N, Bai L. Ferroptosis in Glaucoma: A Promising Avenue for Therapy. Adv Biol (Weinh) 2024; 8:e2300530. [PMID: 38411382 DOI: 10.1002/adbi.202300530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/08/2024] [Indexed: 02/28/2024]
Abstract
Glaucoma, a blind-leading disease largely since chronic pathological intraocular high pressure (ph-IOP). Hitherto, it is reckoned incurable for irreversible neural damage and challenges in managing IOP. Thus, it is significant to develop neuroprotective strategies. Ferroptosis, initially identified as an iron-dependent regulated death that triggers Fenton reactions and culminates in lipid peroxidation (LPO), has emerged as a focal point in multiple tumors and neurodegenerative diseases. Researches show that iron homeostasis play critical roles in the optic nerve (ON) and retinal ganglion cells (RGCs), suggesting targeted treatments could be effective. In glaucoma, apart from neural lesions, disrupted metal balance and increased oxidative stress in trabecular meshwork (TM) are observed. These disturbances lead to extracellular matrix excretion disorders, known as sclerotic mechanisms, resulting in refractory blockages. Importantly, oxidative stress, a significant downstream effect of ferroptosis, is also a key factor in cell senescence. It plays a crucial role in both the etiology and risk of glaucoma. Moreover, ferroptosis also induces non-infectious inflammation, which exacerbate glaucomatous injury. Therefore, the relevance of ferroptosis in glaucoma is extensive and multifaceted. In this review, the study delves into the current understanding of ferroptosis mechanisms in glaucoma, aiming to provide clues to inform clinical therapeutic practices.
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Affiliation(s)
- Jingyun Zhu
- Department of Ophthalmology, Nanfang Hospital, Southern Medical University, No.1023-1063, Shatai South Road, Baiyun District, Guangzhou, Guangdong, 510515, China
| | - Hui Chen
- Department of Geriatrics, Hospital of Traditional Chinese Medicine Affiliated to Southwest Medical University, No.182, Chunhui Road, Longmatan District, Luzhou, Sichuan, 646000, China
| | - Jian Wu
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, No. 8, East Chongwenmennei Street, Dongcheng District, Beijing, 100005, China
| | - Sen Li
- Department of Spinal Surgery, Drum Tower Hospital, Nanjing University, No. 321 Zhongshan Road, Gulou District, Nanjing, Jiangsu, 210008, China
| | - Wanying Lin
- Department of Ophthalmology, Nanfang Hospital, Southern Medical University, No.1023-1063, Shatai South Road, Baiyun District, Guangzhou, Guangdong, 510515, China
| | - Ningli Wang
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, No. 8, East Chongwenmennei Street, Dongcheng District, Beijing, 100005, China
| | - Lang Bai
- Department of Ophthalmology, Nanfang Hospital, Southern Medical University, No.1023-1063, Shatai South Road, Baiyun District, Guangzhou, Guangdong, 510515, China
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Schehlein E, Robin A. Rho Kinase Inhibitors: Strategies in Glaucoma Treatment in Older Adults. Drugs Aging 2024; 41:399-406. [PMID: 38416395 DOI: 10.1007/s40266-024-01107-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 02/29/2024]
Abstract
Glaucoma is a leading cause of irreversible blindness which preferentially affects older individuals. No medications or therapies which are currently in our arsenal actually treat glaucoma itself. We know that intraocular pressure (IOP) is currently the only modifiable risk factor for glaucoma. The primary treatments for glaucoma include medications, laser therapies, and surgical therapies. The Rho kinase inhibitors are the newest class of medications currently on the market and in development for topical IOP-lowering therapy. Studies have shown their ability to lower eye pressure individually and in combination with other medications. Their ability to potentially provide neuroprotective effects for disease modification also gives this class exciting potential for glaucoma treatment.
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Affiliation(s)
| | - Alan Robin
- University of Michigan, Ann Arbor, MI, USA
- Johns Hopkins University, Baltimore, MD, USA
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Hou CH, Pu C. Long-Term Effect of Systemic Comorbidity on Glaucoma Medication Adherence. Am J Ophthalmol 2024; 261:132-140. [PMID: 38278203 DOI: 10.1016/j.ajo.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 01/28/2024]
Abstract
PURPOSE To determine whether systemic comorbidity is associated with reduced adherence to glaucoma medication and whether this decrease varies according to the number of comorbidity and the time after glaucoma onset. DESIGN Cohort study. METHODS Setting: Population-based. STUDY POPULATION All patients with confirmed newly diagnosed glaucoma in one or both eyes were identified using National Health Insurance (NHI) claims data from Taiwan. OBSERVATION PROCEDURE Individuals with newly diagnosed glaucoma were followed up for 5 years from onset. The study period was from January 1, 2011, to December, 31, 2020. Patient comorbidities were identified using the Deyo-Charlson Comorbidity Index. Adherence was measured using the medication possession ratio (MPR). The MPR was calculated by dividing the total number of days a patient had a supply of glaucoma medication by 365. Data for the MPR were extracted from NHI outpatient and drug records. RESULTS This study included a total of 50 408 patients. Compared with patients without comorbidity, patients with at least 1 comorbidity exhibited higher MPR in the first 2 years following glaucoma onset. However, their MPR decreased in the long term, specifically in the fourth and fifth years after onset. Additionally, the degree of nonadherence increased with the number of comorbidities. Patients with ≥4 comorbidities had significantly lower glaucoma medication adherence, with reductions of 6.4% (P = .033) and 11.8% (P < .001) in the fourth and fifth years after glaucoma onset, respectively. CONCLUSION The presence of comorbidity can reduce glaucoma medication adherence by up to 12% in the long term. More comorbidities may increase the burden of managing chronic diseases; as a result, treatment for glaucoma may not receive priority due to the absence of clear symptoms of the condition.
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Affiliation(s)
- Chiun-Ho Hou
- Department of Ophthalmology (C.H.H.), National Taiwan University Hospital, Taipei, Taiwan; Institute of Public Health, School of Medicine (C.H.H., C.P.), National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Christy Pu
- Institute of Public Health, School of Medicine (C.H.H., C.P.), National Yang Ming Chiao Tung University, Taipei, Taiwan.
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iDose TR - a travoprost implant for glaucoma. Med Lett Drugs Ther 2024; 66:70-1. [PMID: 38691647 DOI: 10.58347/tml.2024.1701d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
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Kim M, Kim JY, Rhim WK, Cimaglia G, Want A, Morgan JE, Williams PA, Park CG, Han DK, Rho S. Extracellular vesicle encapsulated nicotinamide delivered via a trans-scleral route provides retinal ganglion cell neuroprotection. Acta Neuropathol Commun 2024; 12:65. [PMID: 38649962 PMCID: PMC11036688 DOI: 10.1186/s40478-024-01777-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 04/10/2024] [Indexed: 04/25/2024] Open
Abstract
The progressive and irreversible degeneration of retinal ganglion cells (RGCs) and their axons is the major characteristic of glaucoma, a leading cause of irreversible blindness worldwide. Nicotinamide adenine dinucleotide (NAD) is a cofactor and metabolite of redox reaction critical for neuronal survival. Supplementation with nicotinamide (NAM), a precursor of NAD, can confer neuroprotective effects against glaucomatous damage caused by an age-related decline of NAD or mitochondrial dysfunction, reflecting the high metabolic activity of RGCs. However, oral supplementation of drug is relatively less efficient in terms of transmissibility to RGCs compared to direct delivery methods such as intraocular injection or delivery using subconjunctival depots. Neither method is ideal, given the risks of infection and subconjunctival scarring without novel techniques. By contrast, extracellular vesicles (EVs) have advantages as a drug delivery system with low immunogeneity and tissue interactions. We have evaluated the EV delivery of NAM as an RGC protective agent using a quantitative assessment of dendritic integrity using DiOlistics, which is confirmed to be a more sensitive measure of neuronal health in our mouse glaucoma model than the evaluation of somatic loss via the immunostaining method. NAM or NAM-loaded EVs showed a significant neuroprotective effect in the mouse retinal explant model. Furthermore, NAM-loaded EVs can penetrate the sclera once deployed in the subconjunctival space. These results confirm the feasibility of using subconjunctival injection of EVs to deliver NAM to intraocular targets.
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Affiliation(s)
- Myungjin Kim
- Department of Ophthalmology, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13496, Republic of Korea
| | - Jun Yong Kim
- Department of Biomedical Science, CHA University, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
- Department of Biomedical Engineering and Intelligent Precision of Healthcare Convergence, SKKU Institute for Convergence, Sungkyunkwan University (SKKU), Jangan-gu, Suwon-Si, Gyeonggi-do, Republic of Korea
| | - Won-Kyu Rhim
- Department of Biomedical Science, CHA University, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Gloria Cimaglia
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
| | - Andrew Want
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
| | - James E Morgan
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
- School of Medicine, Cardiff University, Cardiff, UK
| | - Pete A Williams
- Division of Eye and Vision, Department of Clinical Neuroscience, St. Erik Eye Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Chun Gwon Park
- Department of Biomedical Engineering and Intelligent Precision of Healthcare Convergence, SKKU Institute for Convergence, Sungkyunkwan University (SKKU), Jangan-gu, Suwon-Si, Gyeonggi-do, Republic of Korea
| | - Dong Keun Han
- Department of Biomedical Science, CHA University, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Seungsoo Rho
- Department of Ophthalmology, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13496, Republic of Korea.
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Wang Y, Brahma MM, Takahashi K, Hernandez ANB, Ichikawa K, Minami S, Goshima Y, Harada T, Ohshima T. Drug Treatment Attenuates Retinal Ganglion Cell Death by Inhibiting Collapsin Response Mediator Protein 2 Phosphorylation in Mouse Models of Normal Tension Glaucoma. Neuromolecular Med 2024; 26:13. [PMID: 38619671 PMCID: PMC11018674 DOI: 10.1007/s12017-024-08778-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 03/01/2024] [Indexed: 04/16/2024]
Abstract
Normal tension glaucoma (NTG) is a progressive neurodegenerative disease in glaucoma families. Typical glaucoma develops because of increased intraocular pressure (IOP), whereas NTG develops despite normal IOP. As a subtype of open-angle glaucoma, NTG is characterized by retinal ganglion cell (RGC) degeneration, gradual loss of axons, and injury to the optic nerve. The relationship between glutamate excitotoxicity and oxidative stress has elicited great interest in NTG studies. We recently reported that suppressing collapsin response mediator protein 2 (CRMP2) phosphorylation in S522A CRMP2 mutant (CRMP2 KIKI) mice inhibited RGC death in NTG mouse models. This study evaluated the impact of the natural compounds huperzine A (HupA) and naringenin (NAR), which have therapeutic effects against glutamate excitotoxicity and oxidative stress, on inhibiting CMRP2 phosphorylation in mice intravitreally injected with N-methyl-D-aspartate (NMDA) and GLAST mutant mice. Results of the study demonstrated that HupA and NAR significantly reduced RGC degeneration and thinning of the inner retinal layer, and inhibited the elevated CRMP2 phosphorylation. These treatments protected against glutamate excitotoxicity and suppressed oxidative stress, which could provide insight into developing new effective therapeutic strategies for NTG.
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Affiliation(s)
- Yuebing Wang
- Department of Life Science and Medical Bioscience, Waseda University, Shinjuku-ku, Tokyo, 162-8480, Japan
| | - Musukha Mala Brahma
- Department of Life Science and Medical Bioscience, Waseda University, Shinjuku-ku, Tokyo, 162-8480, Japan
| | - Kazuya Takahashi
- Department of Life Science and Medical Bioscience, Waseda University, Shinjuku-ku, Tokyo, 162-8480, Japan
| | | | - Koki Ichikawa
- Department of Life Science and Medical Bioscience, Waseda University, Shinjuku-ku, Tokyo, 162-8480, Japan
| | - Syuntaro Minami
- Nara Medical University, Kashihara City, Nara, 634-8521, Japan
| | - Yoshio Goshima
- Department of Molecular Pharmacology and Neurobiology, Yokohama City University Graduate School of Medicine, Yokohama, 236-0004, Japan
| | - Takayuki Harada
- Visual Research Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, 156-8506, Japan
| | - Toshio Ohshima
- Laboratory for Molecular Brain Science, Department of Life Science and Medical Bioscience, Waseda University, 2-2 Wakamatsu-cho, Shinjuku-ku, Tokyo, 162-8480, Japan.
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12
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Kolko M, Faergemann Hansen R, G Dal L, Sabelström E, Brandel M, Hoiberg Bentsen A, Falch-Joergensen AC. Predictors and long-term patterns of medication adherence to glaucoma treatment in Denmark-an observational registry study of 30 100 Danish patients with glaucoma. BMJ Open Ophthalmol 2024; 9:e001607. [PMID: 38626933 PMCID: PMC11029215 DOI: 10.1136/bmjophth-2023-001607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/25/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Self-treatment with glaucoma medication (eye drops) has been associated with adherence challenges. Poor adherence results in worse outcomes in terms of visual field loss. OBJECTIVE To investigate patterns in medication adherence among Danish patients with glaucoma in relation to selected predictors of adherence, long-term adherence patterns, and long-term societal economic consequences of poor adherence. METHODS AND ANALYSIS This register-based study included 30 100 glaucoma patients followed for 10 years between 2000 and 2018. Glaucoma was identified from the Danish national registers by diagnosis of Open Angle Glaucoma and/or by redeemed prescriptions of glaucoma medication. Logistic regression models were applied to estimate patient characteristics related to medical adherence. Diagnosis-related group fees were applied to estimate healthcare costs. RESULTS High adherence in the first year(s) of treatment was less likely among men (ORfirst year: 0.78, 95% CI: 0.75 to 0.82), younger individuals and among those with a positive Charlson Comorbidity Index (CCI) score (ORfirst year/CCI≥3: 0.71, 95% CI: 0.63 to 0.80). Adherence in the first year and in the first two years was associated with adherence in the fifth (ORfirst year: 4.55, 95% CI: 4.30 to 4.82/ORfirst two years: 6.47, 95% CI: 6.10 to 6.86) as with adherence in the 10th year with slightly lower estimates. Being medical adherent was related to higher costs related to glaucoma medication after 5 and 10 years comparing with poor adherence, whereas poor adherence was associated with a marked increase in long-term costs for hospital contacts. CONCLUSION Increasing age, female sex and low comorbidity score are correlated with better adherence to glaucoma treatment. Adherence in the first years of treatment may be a good predictor for future adherence. In the long term, patients with poor adherence are overall more expensive to society in terms of hospital contacts.
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Affiliation(s)
- Miriam Kolko
- Department of Drug Design and Pharmacology, University of Copenhagen Faculty of Health Sciences, Copenhagen, Denmark
- Department of Ophthalmology, Rigshospitalet Glostrup, Glostrup, Denmark
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13
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Schlote T, Chan E, Germann U. [Ophthalmic agents during pregnancy]. Ophthalmologie 2024; 121:333-348. [PMID: 38587538 DOI: 10.1007/s00347-024-02025-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/08/2024] [Indexed: 04/09/2024]
Abstract
The use of ophthalmic agents during pregnancy and breastfeeding always represents an off-label use. Therefore, the use of drugs must be particularly carefully assessed with respect to the risk-benefit assessment. In this overview the literature databank of the PubMed library, pharmaceutical lists (Red List, Swiss pharmaceutical compendium), guidelines of the specialist societies the German Society of Ophthalmology (DOG), the Swiss Society of Ophthalmology (SOG), the European Glaucoma Society (EGS), the American Academy of Ophthalmology (AAO) and internet portals (embryotox, reprotox) were inspected and recommendations for the use of ophthalmic agents during pregnancy and breastfeeding were derived. More attention should be dedicated to this topic in the specialist societies.
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Affiliation(s)
- Torsten Schlote
- Tagesklinik Ambimed, Klingentalstr. 9, 40457, Basel, Schweiz.
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14
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Liu W, Liu B. Efficacy of anti-vascular endothelial growth factor and mitomycin C on wound healing after trabeculectomy in glaucoma patients: A meta-analysis. Int Wound J 2024; 21:e14517. [PMID: 38087907 PMCID: PMC10961033 DOI: 10.1111/iwj.14517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 11/13/2023] [Indexed: 03/25/2024] Open
Abstract
Trabeculectomy is the main surgical treatment for glaucoma, but scar formation during wound healing may lead to surgical failure. In this study, we evaluated the efficacy of anti-vascular endothelial growth factor (anti-VEGF) and mitomycin C (MMC) on wound healing after glaucoma surgery. We have been looking for Pubmed, Embase and other databases. The last time we looked at an electronic database was August 2023. A case control study was conducted to compare the use of anti-VEGF and mitomycin C for the treatment of glaucoma. We used the Cochrane standard methodology for collecting and analysing the data. Based on the criteria of inclusion, we have determined 369 related papers and selected seven eligible trials for data analysis. Three hundred and twenty-six cases were treated with trabeculectomy, of which 166 were injected with anti-VEGF and 160 were given MMC for trabeculectomy. In six trials, anti-VEGF and MMC were not found to have any statistical significance on postoperative wound leakage after surgery (OR, 1.55; 95% CI, 0.71, 3.35 p = 0.27). The three trials showed that anti-VEGF and MMC did not differ in terms of reducing postoperative wound hypotony after surgery (OR, 0.78; 95% CI, 0.20, 3.11 p = 0.73). Five trials demonstrated that anti-VEGF and MMC were not associated with a lower incidence of shallow anterior chamber (OR, 1.17; 95% CI, 0.5, 2.76 p = 0.71). There is no significant difference in the effect of anti-VEGF and MMC on wound healing after glaucoma surgery. A multicentre randomized controlled trial with a larger sample size is needed to confirm this study.
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Affiliation(s)
- Wenlong Liu
- Department of OphthalmologyThe People's Hospital of Anshun CityAnshunChina
| | - Bang Liu
- Department of OphthalmologyThe People's Hospital of Anshun CityAnshunChina
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15
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Mathew DJ, Sivak JM. Lipid mediators in glaucoma: Unraveling their diverse roles and untapped therapeutic potential. Prostaglandins Other Lipid Mediat 2024; 171:106815. [PMID: 38280539 DOI: 10.1016/j.prostaglandins.2024.106815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 01/29/2024]
Abstract
Glaucoma is a complex neurodegenerative disease characterized by optic nerve damage and visual field loss, and remains a leading cause of irreversible blindness. Elevated intraocular pressure (IOP) is a critical risk factor that requires effective management. Emerging research underscores dual roles of bioactive lipid mediators in both IOP regulation, and the modulation of neurodegeneration and neuroinflammation in glaucoma. Bioactive lipids, encompassing eicosanoids, specialized pro-resolving mediators (SPMs), sphingolipids, and endocannabinoids, have emerged as crucial players in these processes, orchestrating inflammation and diverse effects on aqueous humor dynamics and tissue remodeling. Perturbations in these lipid mediators contribute to retinal ganglion cell loss, vascular dysfunction, oxidative stress, and neuroinflammation. Glaucoma management primarily targets IOP reduction via pharmacological agents and surgical interventions, with prostaglandin analogues at the forefront. Intriguingly, additional lipid mediators offer promise in attenuating inflammation and providing neuroprotection. Here we explore these pathways to shed light on their intricate roles, and to unveil novel therapeutic avenues for glaucoma management.
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Affiliation(s)
- D J Mathew
- Donald K Johnson Eye Institute, Krembil Research Institute, University Health Network, Toronto, Canada; Department of Ophthalmology and Vision Science, University of Toronto School of Medicine, Toronto, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto School of Medicine, Toronto, Canada
| | - J M Sivak
- Donald K Johnson Eye Institute, Krembil Research Institute, University Health Network, Toronto, Canada; Department of Ophthalmology and Vision Science, University of Toronto School of Medicine, Toronto, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto School of Medicine, Toronto, Canada.
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16
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Kailasam V, Kumara BN, Prasad KS, Nirmal J. Combination of self-assembling system and N,O-carboxymethyl chitosan improves ocular residence of anti-glaucoma drug. Eur J Pharm Biopharm 2024; 197:114208. [PMID: 38336235 DOI: 10.1016/j.ejpb.2024.114208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/16/2024] [Accepted: 02/02/2024] [Indexed: 02/12/2024]
Abstract
Glaucoma is known to be one of the principal causes of vision loss due to elevated intraocular pressure. Currently, latanoprost eye drops is used as first-line treatment for glaucoma; however, it possesses low bioavailability due to rapid precorneal clearance. A novel delivery system with a mucoadhesive property could overcome this problem. Therefore, we attempt to develop a combination of self-assembling latanoprost nanomicelles (Latcel) and a mucoadhesive polymer (N,O-carboxymethyl chitosan: N,O-CMC) to improve the corneal residence time. Latcel was developed using Poloxamer-407 by thin film hydration method, followed by the addition of N,O-CMC using simple solvation to obtain Latcel-CMC and characterized using various physicochemical characterization techniques. The particle size of Latcel-CMC was 94.07 ± 2.48 nm and a zeta potential of -16.03 ± 0.66 mV, with a sustained release for 24h whereas marketed latanoprost drops released 90 % of the drug within 1h. In vitro cytotoxicity studies, HET-CAM, and in vivo Draize test showed the biocompatibility of Latcel-CMC. Cellular uptake studies performed using fluorescein isothiocyanate (FITC) loaded nanomicelles in human corneal epithelial cells indicates the increased cellular uptake as compare to plain FITC solution. In vivo ocular residence time was evaluated in Wistar rats using Indocyanine green (ICG) loaded nanomicelles by an in vivo imaging system (IVIS), indicating Latcel-CMC (8h) has better residence time than plain ICG solution (2h). The Latcel-CMC showed improved corneal residence time and sustained release of latanoprost due to increased mucoadhesion. Thus, the developed N,O-Carboxymethyl chitosan based nanomicelles eye drop could be a better strategy than conventional eye drops for topical delivery of latanoprost to treat glaucoma.
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Affiliation(s)
- Velmurugan Kailasam
- Translational Pharmaceutics Research Laboratory (TPRL), Department of Pharmacy, Birla Institute of Technology and Sciences (BITS), Pilani, Hyderabad Campus, Hyderabad 500078, Telangana, India
| | - Bommanahalli Nagaraju Kumara
- Nanomaterial Research Laboratory [NMRL], Nano Division, Yenepoya Research Centre, Yenepoya [Deemed to be University], Deralakatte, Mangalore 575 018, India
| | - K Sudhakara Prasad
- Nanomaterial Research Laboratory [NMRL], Nano Division, Yenepoya Research Centre, Yenepoya [Deemed to be University], Deralakatte, Mangalore 575 018, India; Centre for Nutrition Studies, Yenepoya [Deemed to be University], Deralakatte, Mangalore 575 018, India.
| | - Jayabalan Nirmal
- Translational Pharmaceutics Research Laboratory (TPRL), Department of Pharmacy, Birla Institute of Technology and Sciences (BITS), Pilani, Hyderabad Campus, Hyderabad 500078, Telangana, India.
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17
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Ulhaq ZS, Bittencourt GB, Soraya GV, Istifiani LA, Pamungkas SA, Ogino Y, Nurputra DK, Tse WKF. Association between glaucoma susceptibility with combined defects in mitochondrial oxidative phosphorylation and fatty acid beta oxidation. Mol Aspects Med 2024; 96:101238. [PMID: 38215610 DOI: 10.1016/j.mam.2023.101238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 11/08/2023] [Accepted: 11/28/2023] [Indexed: 01/14/2024]
Abstract
Glaucoma is one of the leading causes of visual impairment and blindness worldwide, and is characterized by the progressive damage of retinal ganglion cells (RGCs) and the atrophy of the optic nerve head (ONH). The exact cause of RGC loss and optic nerve damage in glaucoma is not fully understood. The high energy demands of these cells imply a higher sensitivity to mitochondrial defects. Moreover, it has been postulated that the optic nerve is vulnerable towards damage from oxidative stress and mitochondrial dysfunction. To investigate this further, we conducted a pooled analysis of mitochondrial variants related to energy production, specifically focusing on oxidative phosphorylation (OXPHOS) and fatty acid β-oxidation (FAO). Our findings revealed that patients carrying non-synonymous (NS) mitochondrial DNA (mtDNA) variants within the OXPHOS complexes had an almost two-fold increased risk of developing glaucoma. Regarding FAO, our results demonstrated that longer-chain acylcarnitines (AC) tended to decrease, while shorter-chain AC tended to increase in patients with glaucoma. Furthermore, we observed that the knocking down cpt1a (a key rate-limiting enzyme involved in FAO) in zebrafish induced a degenerative process in the optic nerve and RGC, which resembled the characteristics observed in glaucoma. In conclusion, our study provides evidence that genes encoding mitochondrial proteins involved in energy metabolisms, such as OXPHOS and FAO, are associated with glaucoma. These findings contribute to a better understanding of the molecular mechanisms underlying glaucoma pathogenesis and may offer potential targets for therapeutic interventions in the future.
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Affiliation(s)
- Zulvikar Syambani Ulhaq
- Research Center for Pre-clinical and Clinical Medicine, National Research and Innovation Agency Republic of Indonesia, Cibinong, Indonesia; Laboratory of Developmental Disorders and Toxicology, Center for Promotion of International Education and Research, Faculty of Agriculture, Kyushu University, Fukuoka, Japan.
| | - Guido Barbieri Bittencourt
- Departamento de Psicologia Experimental, Instituto de Psicologia, Universidade de São Paulo, São Paulo, Brazil
| | - Gita Vita Soraya
- Department of Biochemistry, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Lola Ayu Istifiani
- Department of Nutrition, Faculty of Health Sciences, Brawijaya University, Malang, Indonesia
| | | | - Yukiko Ogino
- Laboratory of Aquatic Molecular Developmental Biology, Center for Promotion of International Education and Research, Faculty of Agriculture, Kyushu University, Fukuoka, Japan
| | | | - William Ka Fai Tse
- Laboratory of Developmental Disorders and Toxicology, Center for Promotion of International Education and Research, Faculty of Agriculture, Kyushu University, Fukuoka, Japan.
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18
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Doliszny K, Quinn MP, El-Defrawy SR, Gill SS, Whitehead M, Johnson D, Campbell RJ. Evolution of first-line glaucoma therapy, 2007-2018: a population-based analysis. Can J Ophthalmol 2024; 59:89-95. [PMID: 36493801 DOI: 10.1016/j.jcjo.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 10/21/2022] [Accepted: 11/09/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate the long-term evolution of first-line glaucoma therapy (FLGT) initiated by ophthalmologists and optometrists. DESIGN Retrospective population-based study using validated provincial health care databases. PARTICIPANTS 194,759 Ontario residents, 66 years of age or older, who received FLGT between 2007 and 2018. METHODS A total of 194,759 individuals from 12 annual cohorts were enrolled, and rates of first-line medical treatment (prostaglandin analogue [PGA], beta-blocker, alpha-2-agonist, and carbonic anhydrase inhibitor) and laser trabeculoplasty (LT) were calculated. Provider (ophthalmologist or optometrist) rates also were assessed. RESULTS Across the entire study period, of the 194,759 enrolled individuals who received FLGT, 60.2% initially received medical treatment and 39.8% underwent LT. Approximately 94.6% were treated by ophthalmologists. PGA therapy was the most common therapy prior to 2010, whereupon LT became the most common FLGT. By 2015, LT exceeded the total of all medications as FLGT. The annual rate of initial medication prescriptions by optometrists rose to 101.4 per 100,000 population between 2011 and 2018. In 2018, PGA and non-PGA prescription rates by ophthalmologists were 2.6 and 5.0 times higher, respectively, than prescription rates by optometrists. CONCLUSION LT therapy has become the most common FLGT for Ontario residents 66 years of age or older. PGAs remain the most frequently prescribed glaucoma medication. While ophthalmologists continue to provide the majority of FLGT, optometrists now provide a small but growing fraction of FLGT following the introduction of glaucoma medication prescribing privileges.
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Affiliation(s)
- Katharine Doliszny
- Department of Ophthalmology, Queen's University, Kingston, ON; Department of Ophthalmology, Kingston Health Sciences Centre, Kingston, ON
| | - Matthew P Quinn
- Department of Ophthalmology, Queen's University, Kingston, ON; Department of Ophthalmology, Kingston Health Sciences Centre, Kingston, ON
| | - Sherif R El-Defrawy
- Department of Ophthalmology, University of Toronto, Toronto, ON; Department of Ophthalmology, Kensington Eye Institute, Toronto, ON
| | - Sudeep S Gill
- ICES Queen's, Queen's University, Kingston, ON; Division of Geriatric Medicine, Queen's University, Kingston, ON; Division of Geriatric Medicine, Providence Care Hospital, Kingston, ON
| | - Marlo Whitehead
- ICES Queen's, Queen's University, Kingston, ON; Queen's University, Kingston, ON
| | - Davin Johnson
- Department of Ophthalmology, Queen's University, Kingston, ON; Department of Ophthalmology, Kingston Health Sciences Centre, Kingston, ON
| | - Robert J Campbell
- Department of Ophthalmology, Queen's University, Kingston, ON; Department of Ophthalmology, Kingston Health Sciences Centre, Kingston, ON.
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Hehr N, Barlow PB, Najdawi W, Reyes AG, Boese E, Fingert JH, Pouw AE. The Effect of Insurance Coverage Laws on Glaucoma Eyedrop Medication Usage. Ophthalmology 2024; 131:507-509. [PMID: 38142821 DOI: 10.1016/j.ophtha.2023.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/07/2023] [Accepted: 12/18/2023] [Indexed: 12/26/2023] Open
Affiliation(s)
- Nicole Hehr
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | | | - Wisam Najdawi
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | | | - Erin Boese
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - John H Fingert
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Andrew E Pouw
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
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20
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Liu W, Zhang W, Wang C, Song J, Li K, Zhang X, Wu X, Guo H. TRPV4 antagonist suppresses retinal ganglion cell apoptosis by regulating the activation of CaMKII and TNF-α expression in a chronic ocular hypertension rat model. Int Immunopharmacol 2024; 130:111811. [PMID: 38457929 DOI: 10.1016/j.intimp.2024.111811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 02/24/2024] [Accepted: 03/04/2024] [Indexed: 03/10/2024]
Abstract
Glaucoma is characterized by a progressive loss of retinal ganglion cells (RGCs), leading to irreversible visual function impairment. Sustained increase in intraocular pressure represents a major risk factor for glaucoma, yet the underlying mechanisms of RGC apoptosis induced by intraocular pressure remains unclear. This study aims to investigate the role of TRPV4 in RGC apoptosis in a rat model of chronic ocular hypertension (COH) and the underlying molecular mechanism. In the COH rat models, we evaluated the visual function, retinal pathological changes and RGC apoptosis. TRPV4 expression and downstream signaling molecules were also detected. We found that RGC density decreased and RGC apoptosis was induced in COH eyes compared with control eyes. TRPV4 expression increased significantly in response to elevated IOP. TRPV4 inhibition by the TRPV4 antagonist HC-067047 (HC-067) suppressed RGC apoptosis and protected visual function. HC-067 treatment upregulated the phosphorylation of CaMKII in both control and COH eyes. Finally, HC-067 treatment suppressed the production of TNF-α induced by ocular hypertension. The TRPV4 antagonist HC-067 might suppress RGC apoptosis by regulating the activation of CaMKII and inhibiting the production of TNF-α in the COH model. This indicated that TRPV4 antagonists may be a potential and novel therapeutic strategy for glaucoma.
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Affiliation(s)
- Wenhui Liu
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
| | - Wenzhe Zhang
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
| | - Chen Wang
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
| | - Jiarun Song
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
| | - Kaiyue Li
- Department of Nuclear Medicine, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
| | - Xia Zhang
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan 250014, China
| | - Xinyi Wu
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China.
| | - Hui Guo
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China.
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21
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Han JS, Park CK, Jung KI. Retinal Neurodegeneration in an Intraocular Pressure Fluctuation Rat Model. Int J Mol Sci 2024; 25:3689. [PMID: 38612500 PMCID: PMC11011540 DOI: 10.3390/ijms25073689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
Increased intraocular pressure (IOP) is the most important risk factor for glaucoma. The role of IOP fluctuation, independently from elevated IOP, has not yet been confirmed in glaucoma. We investigated the effects of IOP fluctuation itself on retinal neurodegeneration. Male rats were treated with IOP-lowering eyedrops (brinzolamide and latanoprost) on Mondays and Thursdays (in the irregular instillation group) or daily (in the regular instillation group), and saline was administered daily in the normal control group for 8 weeks. The IOP standard deviation was higher in the irregular instillation group than the regular instillation group or the control group. The degree of oxidative stress, which was analyzed by labeling superoxide, oxidative DNA damage, and nitrotyrosine, was increased in the irregular instillation group. Macroglial activation, expressed by glial fibrillary acidic protein in the optic nerve head and retina, was observed with the irregular instillation of IOP-lowering eyedrops. Microglial activation, as indicated by Iba-1, and the expression of TNF-α did not show a significant difference between the irregular instillation and control groups. Expression of cleaved caspase-3 was upregulated and the number of retinal ganglion cells (RGCs) was decreased in the irregular instillation group. Our findings indicate that IOP fluctuations could be induced by irregular instillation of IOP-lowering eyedrops and this could lead to the degeneration of RGCs, probably through increased oxidative stress and macrogliosis.
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Affiliation(s)
| | | | - Kyoung In Jung
- Department of Ophthalmology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (J.-S.H.); (C.K.P.)
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22
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Ji KB, Wan W, Yang Y, He XJ, Xing YQ, Hu Z. Ameliorative effect of resveratrol on acute ocular hypertension induced retinal injury through the SIRT1/NF-κB pathway. Neurosci Lett 2024; 826:137712. [PMID: 38447888 DOI: 10.1016/j.neulet.2024.137712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/28/2024] [Accepted: 03/03/2024] [Indexed: 03/08/2024]
Abstract
Glaucoma is a kind of neurodegenerative disorder characterized by irreversible loss of retinal ganglion cells (RGCs) and permanent visual impairment. It is reported that resveratrol (RES) is a promising drug for neurodegenerative diseases. However, the detailed molecular mechanisms underlying its protective potential have not yet been fully elucidated. The present study sought to investigate whether resveratrol could protect RGCs and retinal function triggered by acute ocular hypertension injury through the SIRT1/NF-κB pathway. An experimental glaucoma model was generated in C57BL/6J mice. Resveratrol was intraperitoneally injected for 5 days. Sirtinol was injected intravitreally on the day of retinal AOH injury. RGC survival was determined using immunostaining. TUNEL staining was conducted to evaluate retinal cell apoptosis. ERG was used to evaluate visual function. The proteins Brn3a, SIRT1, NF-κB, IL-6, Bax, Bcl2, and Cleaved Caspase3 were determined using western blot. The expression and localisation of SIRT1 and NF-κB in the retina were detected by immunofluorescence. Our data indicated that resveratrol treatment significantly increased Brn3a-labelled RGCs and reduced RGC apoptosis caused by AOH injury. Resveratrol administration also remarkably decreased NF-κB, IL-6, Bax, and Cleaved Caspase3 proteins and increased SIRT1 and Bcl2 proteins. Furthermore, resveratrol treatment obviously inhibited the reduction in ERG caused by AOH injury. Importantly, simultaneous administration of resveratrol and sirtinol abrogated the protective effect of resveratrol, decreased NF-κB protein expression, and increased SIRT1 protein levels. These results suggest that resveratrol administration significantly mitigates retinal AOH-induced RGCs loss and retinal dysfunction, and that this neuroprotective effect is partially regulated through the SIRT1/NF-κB pathway.
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Affiliation(s)
- Kai-Bao Ji
- Deparment of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Wei Wan
- Deparment of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yang Yang
- Deparment of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xue-Jun He
- Deparment of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yi-Qiao Xing
- Deparment of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China.
| | - Zhe Hu
- Deparment of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China.
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Yang H, Zhang F, Fan Y, Zhang J, Fang T, Xing D, Zhen Y, Nie Z, Liu Y, Wang D, Li J. Co-delivery of Brinzolamide and Timolol from Micelles-laden Contact Lenses: In vitro and In Vivo Evaluation. Pharm Res 2024; 41:531-546. [PMID: 38366235 DOI: 10.1007/s11095-024-03672-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/28/2024] [Indexed: 02/18/2024]
Abstract
PURPOSE Traditional eye drops exhibit a modest bioavailability ranging from 1 to 5%, necessitating recurrent application. Thus, a contact lens-based drug delivery system presents substantial benefits. Nonetheless, pharmaceutical agents exhibiting poor solubility may compromise the quintessential characteristics of contact lenses and are, consequently, deemed unsuitable for incorporation. To address this issue, the present study has engineered a novel composite drug delivery system that amalgamates micellar technology with contact lenses, designed specifically for the efficacious conveyance of timolol and brinzolamide. METHODS Utilizing mPEG-PCL as the micellar material, this study crafted mPEG-PCL micelles loaded with brinzolamide and timolol through the film hydration technique. The micelle-loaded contact lens was fabricated employing the casting method; a uniform mixture of HEMA and EGDMA with the mPEG-PCL micelles enshrouding brinzolamide and timolol was synthesized. Following the addition of a photoinitiator, 50 μL of the concoction was deposited into a contact lens mold. Subsequently, the assembly was subjected to polymerization under 365 nm ultraviolet light for 35 min, resulting in the formation of the micelle-loaded contact lenses. RESULTS In the present article, we delineate the construction of a micelle-loaded contact lens designed for the administration of brinzolamide and timolol in the treatment of glaucoma. The study characterizes crucial properties of the micelle-loaded contact lenses, such as transmittance and ionic permeability. It was observed that these vital attributes meet the standard requirements for contact lenses. In vitro release studies revealed that timolol and brinzolamide could be gradually liberated over periods of up to 72 and 84 h, respectively. In vivo pharmacodynamic evaluation showed a significant reduction in intraocular pressure and a relative bioavailability of 10.84 times that of commercially available eye drops. In vivo pharmacokinetic evaluation, MRT was significantly increased, and the bioavailability of timolol and brinzolamide was 2.71 and 1.41 times that of eye drops, respectively. Safety assessments, including in vivo irritation, histopathological sections, and protein adsorption studies, were conducted as per established protocols, confirming that the experiments were in compliance with safety standards. IN CONCLUSION The manuscript delineates the development of a safe and efficacious micelle-loaded contact lens drug delivery system, which presents a novel therapeutic alternative for the management of glaucoma.
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Affiliation(s)
- Hongyu Yang
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, No. 103, Wenhua Road, Shenyang, 110016, People's Republic of China
| | - Faxing Zhang
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, No. 103, Wenhua Road, Shenyang, 110016, People's Republic of China
| | - Yingzhen Fan
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, No. 103, Wenhua Road, Shenyang, 110016, People's Republic of China
| | - Jian Zhang
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, No. 103, Wenhua Road, Shenyang, 110016, People's Republic of China
| | - Ting Fang
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, No. 103, Wenhua Road, Shenyang, 110016, People's Republic of China
| | - Dandan Xing
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, No. 103, Wenhua Road, Shenyang, 110016, People's Republic of China
| | - Yanli Zhen
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, No. 103, Wenhua Road, Shenyang, 110016, People's Republic of China
| | - Zhihao Nie
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, No. 103, Wenhua Road, Shenyang, 110016, People's Republic of China
| | - Yaming Liu
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, No. 103, Wenhua Road, Shenyang, 110016, People's Republic of China
| | - Dongkai Wang
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, No. 103, Wenhua Road, Shenyang, 110016, People's Republic of China.
| | - Ji Li
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, No. 103, Wenhua Road, Shenyang, 110016, People's Republic of China.
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Shahid S, Rizvi SWA, Khan AA, Ashraf H, Akhter A. Comparison of safety and efficacy of Netarsudil 0.02% and Bimatoprost 0.01% monotherapy and combination therapy in primary open-angle glaucoma and ocular hypertension. Indian J Ophthalmol 2024; 72:427-431. [PMID: 38146971 PMCID: PMC11001237 DOI: 10.4103/ijo.ijo_1340_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 10/01/2023] [Accepted: 10/05/2023] [Indexed: 12/27/2023] Open
Abstract
PURPOSE To study and compare the efficacy and safety profile of Rho-kinase inhibitor (netarsudil 0.02%) and prostaglandin analog (bimatoprost 0.01%) both as monotherapy and in combination. DESIGN Prospective, randomized, monocentric, open-label clinical trial. METHODS Patients ≥20 years of age with primary open-angle glaucoma or ocular hypertension (IOP >21 mmHg) were recruited and randomized to receive either netarsudil 0.02%, netarsudil 0.02% + bimatoprost 0.01%, or bimatoprost 0.01% once daily for a period of 12 weeks. IOP and side effects were documented at 4, 8, and 12 weeks. RESULTS The mean treated IOP ranged 17.51-18.57 mmHg for netarsudil, 15.80-16.46 mmHg for bimatoprost, and 14.00-14.87 mmHg for the combination therapy group. The mean IOP reduction from baseline at 4, 8, and 12 weeks was found to be statistically significant ( P < 0.001) in all three groups. The safety profile of netarsudil/bimatoprost combination was consistent with each constituent individually. The only frequently observed ocular adverse event was conjunctival hyperemia, which was seen mostly in netarsudil and netarsudil + bimatoprost groups ( P < 0.001). CONCLUSION The IOP-lowering effect of netarsudil 0.02% once daily is non-inferior to bimatoprost 0.01% in patients with POAG and ocular hypertension with acceptable ocular safety, and the combination therapy achieved a higher IOP-lowering effect. This group of medications can be a useful adjunct in patients on maximal therapy.
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Affiliation(s)
- Saima Shahid
- Department of Ophthalmology, Institute of Ophthalmology, Jawaharlal Nehru Medical College, AMU, Aligarh, Uttar Pradesh, India
| | - Syed Wajahat A Rizvi
- Department of Ophthalmology, Institute of Ophthalmology, Jawaharlal Nehru Medical College, AMU, Aligarh, Uttar Pradesh, India
| | - Adeeb A Khan
- Department of Ophthalmology, Institute of Ophthalmology, Jawaharlal Nehru Medical College, AMU, Aligarh, Uttar Pradesh, India
| | - Humayoun Ashraf
- Department of Ophthalmology, Institute of Ophthalmology, Jawaharlal Nehru Medical College, AMU, Aligarh, Uttar Pradesh, India
| | - Afeefa Akhter
- Department of Ophthalmology, Institute of Ophthalmology, Jawaharlal Nehru Medical College, AMU, Aligarh, Uttar Pradesh, India
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Ahmed T, Islam MN, Monalisa R, Ehsan F, Huang SW. Polysaccharides polymers for glaucoma treatment-a review. Eur J Ophthalmol 2024; 34:338-356. [PMID: 37231538 DOI: 10.1177/11206721231178057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
One of the major challenges in preventing glaucoma progression is patient compliance with medication regimens. Since conventional ophthalmic dosage forms have numerous limitations, researchers have been intensively working on developing polymers-based delivery systems for glaucoma drugs. Specifically, research and development efforts have increased using polysaccharide polymers such as sodium alginate, cellulose, β-cyclodextrin, hyaluronic acid, chitosan, pectin, gellan gum, galactomannans for sustained release to the eye to overcome treatment challenges, showing promise in improving drug release and delivery, patient experience, and treatment compliance. In the recent past, multiple research groups have successfully designed sustained drug delivery systems, promoting the efficacy as well as the feasibility of glaucoma drugs with single/combinations of polysaccharides to eliminate the drawbacks associated with the glaucoma treatment. Naturally available polysaccharides, when used as drug vehicles can increase the retention time of eye drops on the ocular surface, leading to improved drug absorption and bioavailability. Additionally, some polysaccharides can form gels or matrices that can release drugs slowly over time, providing sustained drug delivery and reducing the need for frequent dosing. Thus, this review aims to provide an overview of the pre-clinical and clinical studies of polysaccharide polymers applied for glaucoma treatment along with their therapeutic outcomes.
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Affiliation(s)
- Tanvir Ahmed
- Food Engineering & Tea Technology, Shahjalal University of Science & Technology, Sylhet 3114, Bangladesh
| | - Md Nazmul Islam
- Deaprtment of Microbiology, Noakhali Science and Technology University, Noakhali 3814, Bangladesh
| | - Rina Monalisa
- Deaprtment of Microbiology, Noakhali Science and Technology University, Noakhali 3814, Bangladesh
| | - Feroz Ehsan
- Department of Medicine, Aziz Fatimah Hospital, Faisalabad 38000, Pakistan
| | - Shu-Wei Huang
- Department of Orthopedics, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
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26
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Ciociola EC, Fernandez E, Kaufmann M, Klifto MR. Future directions of glaucoma treatment: emerging gene, neuroprotection, nanomedicine, stem cell, and vascular therapies. Curr Opin Ophthalmol 2024; 35:89-96. [PMID: 37910173 DOI: 10.1097/icu.0000000000001016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
PURPOSE OF REVIEW The aim of this article is to summarize current research on novel gene, stem cell, neuroprotective, nanomedicine, and vascular therapies for glaucoma. RECENT FINDINGS Gene therapy using viral vectors and siRNA have been shown to reduce intraocular pressure by altering outflow and production of aqueous humor, to reduce postsurgical fibrosis with few adverse effects, and to increase retinal ganglion cell (RGC) survival in animal studies. Stem cells may treat glaucoma by replacing or stimulating proliferation of trabecular meshwork cells, thus restoring outflow facility. Stem cells can also serve a neuroprotective effect by differentiating into RGCs or preventing RGC loss via secretion of growth factors. Other developing neuroprotective glaucoma treatments which can prevent RGC death include nicotinamide, the NT-501 implant which secretes ciliary neurotrophic factor, and a Fas-L inhibitor which are now being tested in clinical trials. Recent studies on vascular therapy for glaucoma have focused on the ability of Rho Kinase inhibitors and dronabinol to increase ocular blood flow. SUMMARY Many novel stem cell, gene, neuroprotective, nanomedicine, and vascular therapies have shown promise in preclinical studies, but further clinical trials are needed to demonstrate safety and efficacy in human glaucomatous eyes. Although likely many years off, future glaucoma therapy may take a multifaceted approach.
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Affiliation(s)
| | | | | | - Meredith R Klifto
- Department of Ophthalmology, University of North Carolina, Chapel Hill, North Carolina, USA
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27
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Wong KY, Phan CM, Chan YT, Yuen ACY, Zhang H, Zhao D, Chan KY, Do CW, Lam TC, Qiao JH, Wulff D, Hui A, Jones L, Wong MS. A review of using Traditional Chinese Medicine in the management of glaucoma and cataract. Clin Exp Optom 2024; 107:156-170. [PMID: 37879342 DOI: 10.1080/08164622.2023.2246480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 08/06/2023] [Indexed: 10/27/2023] Open
Abstract
Traditional Chinese Medicine has a long history in ophthalmology in China. Over 250 kinds of Traditional Chinese Medicine have been recorded in ancient books for the management of eye diseases, which may provide an alternative or supplement to current ocular therapies. However, the core holistic philosophy of Traditional Chinese Medicine that makes it attractive can also hinder its understanding from a scientific perspective - in particular, determining true cause and effect. This review focused on how Traditional Chinese Medicine could be applied to two prevalent ocular diseases, glaucoma, and cataract. The literature on preclinical and clinical studies in both English and Chinese on the use of Traditional Chinese Medicine to treat these two diseases was reviewed. The pharmacological effects, safety profile, and drug-herb interaction of selected herbal formulas were also investigated. Finally, key considerations for conducting future Traditional Chinese Medicine studies are discussed.
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Affiliation(s)
- Ka-Ying Wong
- Centre for Eye and Vision Research Limited (CEVR), Hong Kong, China
- Department of Chemistry, Waterloo Institute for Nanotechnology, Water Institute, University of Waterloo, Waterloo, Canada
| | - Chau-Minh Phan
- Centre for Eye and Vision Research Limited (CEVR), Hong Kong, China
- Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, University of Waterloo, Waterloo, Canada
| | - Yat-Tin Chan
- Centre for Eye and Vision Research Limited (CEVR), Hong Kong, China
| | - Ailsa Chui-Ying Yuen
- Research Centre for Chinese Medicine Innovation, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Huan Zhang
- Research Centre for Chinese Medicine Innovation, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
- Department of Food Science and Nutrition, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Danyue Zhao
- Centre for Eye and Vision Research Limited (CEVR), Hong Kong, China
- Department of Food Science and Nutrition, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Ka-Yin Chan
- Centre for Eye and Vision Research Limited (CEVR), Hong Kong, China
| | - Chi-Wai Do
- Centre for Eye and Vision Research Limited (CEVR), Hong Kong, China
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Thomas Chuen Lam
- Centre for Eye and Vision Research Limited (CEVR), Hong Kong, China
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Joanne Han Qiao
- Centre for Eye and Vision Research Limited (CEVR), Hong Kong, China
- Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, University of Waterloo, Waterloo, Canada
| | - David Wulff
- Centre for Eye and Vision Research Limited (CEVR), Hong Kong, China
- Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, University of Waterloo, Waterloo, Canada
| | - Alex Hui
- Centre for Eye and Vision Research Limited (CEVR), Hong Kong, China
- Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, University of Waterloo, Waterloo, Canada
| | - Lyndon Jones
- Centre for Eye and Vision Research Limited (CEVR), Hong Kong, China
- Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, University of Waterloo, Waterloo, Canada
| | - Man-Sau Wong
- Centre for Eye and Vision Research Limited (CEVR), Hong Kong, China
- Research Centre for Chinese Medicine Innovation, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
- Department of Food Science and Nutrition, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
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Srivastava K, Bhatnagar KR, Shakrawal J, Tandon M, Jaisingh K, Pandey L, Roy F. Ocular surface changes in primary open-angle glaucoma on anti-glaucoma medications versus treatment-naïve patients. Indian J Ophthalmol 2024; 72:374-380. [PMID: 38099355 PMCID: PMC11001248 DOI: 10.4103/ijo.ijo_618_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/23/2023] [Accepted: 08/05/2023] [Indexed: 12/19/2023] Open
Abstract
PURPOSE To examine the ocular surface disease in primary open-angle glaucoma (POAG) patients already on treatment versus POAG patients without treatment. METHODS A prospective cohort study was conducted on 120 eyes of 60 POAG patients: 60 treatment-naïve eyes (group I) and 60 eyes already on topical anti-glaucoma medications (AGMs) (group II). All patients had filled out the Ocular Surface Disease Index (OSDI) questionnaire and underwent a comprehensive glaucoma workup. Tear break-up time (TBUT) test, Schirmer's test (type I), corneal sensitivity, anterior segment-optical coherence tomography (AS-OCT), and corneal and conjunctival staining were done at day 1, 1 month, 3 months, 6 months, and 12 months follow-up. RESULTS On presentation, TBUT, Schirmer's test, tear meniscus height (TMH), and tear meniscus depth (TMD) were significantly higher in group I compared to group II. No significant difference was noted in OSDI score, corneal sensitivity, and tear meniscus area (TMA) between the groups on presentation. Both, lissamine green and rose bengal staining, had higher grades in group II compared to group I. Worsening of ocular surface disease was noted in both groups on follow-up. OSDI score, TBUT, Schirmer's test, TMH, and TMD had better values in group I in comparison to group II on follow-up. CONCLUSION The study has identified glaucoma patients on AGMs to be more affected by dry eye disease (DED) compared to treatment-naive glaucoma patients. We found statistically significant differences in values of TBUT, Schirmer tests, lissamine and rose bengal staining, and AS-OCT parameters at baseline and 3, 6, and 12 months follow-up. OSDI scores showed significant differences at 6 and 12 months of follow-up. We recommend consideration of evaluation and management of DED/ocular surface disease in glaucoma patients on topical AGMs, particularly multiple drugs and doses.
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Affiliation(s)
| | | | - Jyoti Shakrawal
- Department of Ophthalmology, AIIMS, Jodhpur, Rajasthan, India
| | - Manjari Tandon
- Department of Ophthalmology, AIIMS, Jodhpur, Rajasthan, India
| | - Kirti Jaisingh
- Department of Ophthalmology, AIIMS, Jodhpur, Rajasthan, India
| | - Latika Pandey
- Department of Ophthalmology, AIIMS, Jodhpur, Rajasthan, India
| | - Falguni Roy
- Department of Ophthalmology, AIIMS, Jodhpur, Rajasthan, India
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29
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Montolío-Marzo E, Fernández-Narros R, Morales-Fernández L, García-Bella J, Sáenz-Francés F, García-Feijoo J, Martínez-de-la-Casa JM. Improvement of objective ocular redness measured with Keratograph 5M in glaucoma patients after instilling brimonidine drops. Eur J Ophthalmol 2024; 34:480-486. [PMID: 37661653 DOI: 10.1177/11206721231199122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
OBJECTIVE To compare objective ocular redness measured using OCULUS Keratograph 5 M before and after 0.2% brimonidine instillation in glaucoma patients under topical hypotensive treatment. METHODS 60 eyes from 60 subjects diagnosed with glaucoma or ocular hypertension under hypotensive ocular topical treatment were analyzed. Basal Ophthalmological examination was performed.Outcome variables were OCULUS Keratograph 5 M redness scores (RS) before and after 0.2% brimonidine instillation; overall, bulbar temporal (BT), bulbar nasal (BN), limbar temporal (LT), and limbar nasal (LN); non-invasive average tear film breakup time (Nia-BUT), non-invasive first tear film breakup time (Nif-BUT) and meibography. In addition, the following clinical data were collected: intraocular pressure, type, duration, amount, and preservatives/or not of hypotensive treatment, fluorescein corneal staining score and lower tear meniscus height. RESULTS All eyes were under topical medication. All redness scores were reduced after brimonidine instillation, mean RS differences were BT 0.82 ± 0.62, BN hyperemia 1.03 ± 0.55, LN hyperemia 0.84 ± 0.49, LT hyperemia 0.71 ± 0.50 and total hyperemia 0.91 ± 0.52 (all p < 0.001). 30 min after brimonidine instillation mean overall RS reduction was 47.97 ± 12.39% (p < 0.001) and after 1 h there was a persistent reduction of overall RS of 45.92 ± 14.27% (p < 0.001). Hyperemia reduction was significant and comparable between preservative and preservative-free group 0.12 ± 0.14 (p > 0.392) and between patient with combination therapy and monotherapy 0.16 ± 0.14 (p > 0.258). CONCLUSION A significant reduction of conjunctival hyperemia was objectively found in glaucoma patients under topical hypotensive treatment before and after brimonidine instillation. Its fast and long-lasting effect may be useful preoperatively in glaucoma patients to reduce intraoperative bleeding and associated complications.
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Affiliation(s)
- Elena Montolío-Marzo
- Ophthalmology Unit, Department of Ophthalmology and ORL, Faculty of Medicine, Hospital Clínico San-Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San-Carlos (IdISSC), Madrid, Spain
| | - Rodrigo Fernández-Narros
- Ophthalmology Unit, Department of Ophthalmology and ORL, Faculty of Medicine, Hospital Clínico San-Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San-Carlos (IdISSC), Madrid, Spain
| | - Laura Morales-Fernández
- Ophthalmology Unit, Department of Ophthalmology and ORL, Faculty of Medicine, Hospital Clínico San-Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San-Carlos (IdISSC), Madrid, Spain
| | - Javier García-Bella
- Ophthalmology Unit, Department of Ophthalmology and ORL, Faculty of Medicine, Hospital Clínico San-Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San-Carlos (IdISSC), Madrid, Spain
| | - Federico Sáenz-Francés
- Ophthalmology Unit, Department of Ophthalmology and ORL, Faculty of Medicine, Hospital Clínico San-Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San-Carlos (IdISSC), Madrid, Spain
| | - Julián García-Feijoo
- Ophthalmology Unit, Department of Ophthalmology and ORL, Faculty of Medicine, Hospital Clínico San-Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San-Carlos (IdISSC), Madrid, Spain
| | - Jose María Martínez-de-la-Casa
- Ophthalmology Unit, Department of Ophthalmology and ORL, Faculty of Medicine, Hospital Clínico San-Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San-Carlos (IdISSC), Madrid, Spain
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30
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Kaufman AR, Ali Al-Djasim L, Rivkin AC, Al-Futais M, Venkataraman G, Vimalanathan M, Sahu A, Ahluwalia NS, Shakya R, Vajaranant TS, Wilensky JT, Edward DP, Aref AA. Pregnancy outcomes in the medical management of glaucoma: An international multicenter descriptive survey. Eur J Ophthalmol 2024; 34:471-479. [PMID: 37671417 DOI: 10.1177/11206721231199774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
PURPOSE To determine if glaucoma medications are associated with pregnancy and/or postnatal complications. METHODS Multicenter descriptive survey. Subjects were female patients 18-45 years who were previously pregnant with a diagnosis of glaucoma or ocular hypertension prior to pregnancy. Chart review queried diagnosis, glaucoma severity, and race. Survey questions were asked for each pregnancy and queried pregnancy age, medications used, and pregnancy outcomes/complications. RESULTS 114 pregnancies of 56 patients (mean 2.0 pregnancies per patient) were included. Three pregnancies with therapeutic abortion were excluded from further analysis. Mean age during pregnancy was 29.1 ± 5.7 years. Of the 111 pregnancies, 20 (18.0%) used no medications and 91 (82.0%) used at least one medication. Medications were topical carbonic anhydrase inhibitors (n = 45), beta-blockers (n = 55), alpha-agonists (n = 56), and prostaglandin analogues (n = 28). Outcomes were: preterm contractions/labour (6.3%), miscarriage (4.5%), stillbirth (4.5%), induction of labour (11.9%), emergency/unplanned caesarean delivery (13.9%), neonatal intensive care unit (NICU) stay (15.8%), congenital anomalies (8.1%), and low birth weight (10.9%). Fisher exact test assessed outcome associations with individual agents, use of any agent, and different number of agents. Alpha-agonist use was associated with NICU stay: 25.5% rate (p = 0.012) in alpha-agonist use. Most of the alpha-agonist use NICU stays occurred in pregnancies with third trimester use. All other associations were not statistically significant. CONCLUSIONS The data from this survey suggest an overall favourable safety profile for topical glaucoma medications in pregnancy, but further investigation is needed. Caution should be employed regarding third trimester alpha-agonist use owing to association with NICU stay.
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Affiliation(s)
- Aaron R Kaufman
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USA
| | - Leyla Ali Al-Djasim
- Department of Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Angeline C Rivkin
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USA
| | - Muneera Al-Futais
- Department of Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | | | | | - Abhipsa Sahu
- Department of Ophthalmology, Aravind Eye Hospital, Coimbatore, India
| | - Navjot Singh Ahluwalia
- Department of Ophthalmology, Shri Sadguru Seva Sangh Trust, Chitrakoot Centre, Chitrakoot, India
| | - Rakesh Shakya
- Department of Ophthalmology, Shri Sadguru Seva Sangh Trust, Chitrakoot Centre, Chitrakoot, India
| | - Thasarat Sutabutr Vajaranant
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USA
| | - Jacob T Wilensky
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USA
| | - Deepak P Edward
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USA
| | - Ahmad A Aref
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USA
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Iorga RE, Moraru AD, Costin D, Munteanu-Dănulescu RS, Brănișteanu DC. Current trends in targeting the oxidative stress in glaucoma (Review). Eur J Ophthalmol 2024; 34:328-337. [PMID: 37974458 DOI: 10.1177/11206721231214297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Glaucoma is a progressive optic neuropathy characterised by retinal ganglion cell degeneration and visual field loss. Glaucoma is considered to be the leading cause of blindness in the industrialised countries. Oxidative damage is an important pathogenic factor in glaucoma, which triggers trabecular meshwork (TM) degeneration, which then leads to intraocular hypertension. Neurodegenerative insults during glaucomatous neurodegeneration initiate an immune response to restore tissue homeostasis. However, the oxidative stress (OS) that develops during the pathogenic processes of glaucoma, along with the agerelated OS, plays a critical role in shifting the physiological equilibrium. In the TM from glaucoma donors, proinflammatory markers were found, which were induced by the activation of a stress response. Chronic changes in the composition of antioxidants found in aqueous humour may induce alterations in TM as well as in the optic nerve head cells. Highlighting the pathogenic role of reactive oxygen species (ROS) in glaucoma has implications in preventing this disease. Various clinical trials are available to test the efficacy of antioxidant drugs in glaucoma management. In this review, we discuss the OS as a therapeutic target, suggesting that the modulation of a pro-oxidant/antioxidant status might be a relevant target for glaucoma prevention and therapy.
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Affiliation(s)
- Raluca Eugenia Iorga
- Department of Ophthalmology, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Andreea Dana Moraru
- Department of Ophthalmology, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Dănuț Costin
- Department of Ophthalmology, "N. Oblu" Clinical Hospital, Iasi, Romania
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Weisser B, Erb C. Neuroprotective Effects of Anti-diabetic Drugs in the Treatment of Patients with Diabetes and Glaucoma or at High Risk for Glaucoma. Klin Monbl Augenheilkd 2024; 241:302-307. [PMID: 37336238 DOI: 10.1055/a-2066-3389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
There is an association between glaucoma and several risk factors and metabolic diseases, such as type 2 diabetes mellitus. Diabetes mellitus leads to neurodegenerative changes, both peripherally and in the brain. This might be a shared pathophysiology and etiology for both glaucoma and diabetes. It is interesting that drugs for the treatment of diabetes seem to have neuroprotective properties independent of their blood sugar reduction. Although prospective, randomized, clinical studies are still missing, particularly metformin and glucagon-like peptide receptor agonists (GLP 1 RA) seem to have neuroprotective effects. Sulphonylureas (e.g., glibenclamide, glimepiride) are still used. They frequently potently reduce blood pressure but may be less neuroprotective. In the present review, the evidence for neuroprotective effects of the different antidiabetic drugs is presented and a possible differential therapy for patients with diabetes and glaucoma, or at high risk of glaucoma, will be discussed.
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Affiliation(s)
| | - Carl Erb
- Augenklinik am Wittenbergplatz, Berlin, Deutschland
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Singh K, Singh A, Jain D, Verma V. Factors affecting adherence to glaucoma medication: Patient perspective from North India. Indian J Ophthalmol 2024; 72:391-396. [PMID: 38099369 PMCID: PMC11001247 DOI: 10.4103/ijo.ijo_806_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 07/14/2023] [Accepted: 08/01/2023] [Indexed: 12/19/2023] Open
Abstract
PURPOSE Adherence to glaucoma medical therapy is a key factor in achieving target intraocular pressure to prevent glaucoma progression. To determine factors affecting medication adherence in glaucoma patients in an urban population belonging to poor socioeconomic status. METHODS A cross-sectional study was conducted on 200 patients attending glaucoma services in a tertiary referral hospital of North India. Adherence to medication was determined subjectively by questionnaire and objectively by counting the number of used bottles at the end of a month or during refill, whichever was earlier. Patient-related parameters in adherence toward glaucoma medication were studied based on demography, knowledge, attitudes, and practices (KAP). The statistical techniques of bivariate and multivariate logistic regression were adopted to test the objective. RESULTS The population was statistically homogeneous based on gender and income in both groups. A large proportion of patients had bilateral disease (87%) and were on two or more medications (62.5%). Adherence to glaucoma medical therapy was seen in 68% of patients, with knowledge about glaucoma present in 58% of patients. Deterrents to drug adherence were identified as forgetfulness (71%), unavailability of drugs (19%) or funds to purchase the same (26%), polypharmacy (21%), and side effects (5%). Dependence on an escort by 44% and dependence on hospital supply of medications by 60% emerged as the contextual factors requiring scrutiny while prescribing lifelong glaucoma medications. Disease misconceptions (53%) were prevalent and drug instillation practices were unsatisfactory (57%). CONCLUSION The study offers insight into patients' perspectives regarding the lifetime use of antiglaucoma medications and focuses on key issues linked to drug nonadherence.
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Affiliation(s)
- Kirti Singh
- Professor of Ophthalmology and Director GNEC, Maulana Azad Medical College and Assoc Hosp, New Delhi, India
| | - Arshi Singh
- Department of Ophthalmology, Guru Nanak Eye Center, Maulana Azad Medical College and Assoc Hosp, New Delhi, India
| | - Divya Jain
- Department of Ophthalmology, Postgraduate Institute of Child Health, Noida, Uttar Pradesh, India
| | - Vivek Verma
- Department of Statistics, Assam University, Silchar, Assam, India
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Philip R, Vijaya L, Balekudaru S, Panda S, Khurana M, David RL, Asokan R, George R. Effect of beta blockers on optical coherence tomography angiography in normal, suspect, and glaucomatous eyes: A prospective study. Indian J Ophthalmol 2024; 72:432-438. [PMID: 38153967 PMCID: PMC11001229 DOI: 10.4103/ijo.ijo_1654_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 10/04/2023] [Accepted: 10/22/2023] [Indexed: 12/30/2023] Open
Abstract
PURPOSE The study aimed to assess the effect of hypertension, and use of systemic beta blockers (BB) and other antihypertensives on ocular perfusion by optical coherence tomography angiography (OCTA) in normal, suspect, and glaucomatous eyes. METHODS Cross-sectional study in tertiary eye care center. Prospectively recruited consenting subjects between 18 and 90 years with or without glaucoma. Measured the optic nerve peripapillary perfusion and flux and macular vessel density (MVD: 6 × 6 and 3 × 3 mm) in the superficial retinal layer using OCTA. RESULTS Included 200 eyes (112 patients). Compared to nonhypertensives or those on non-BB antihypertensives (NBB), hypertensives on BB had lower peripapillary perfusion (43.45,43.40, 42.05%, P = 0.003), and MVD (6 × 6 mm: 16.65, 16.70,15.75 mm/mm 2 , P = 0.002; 3 × 3 mm: 18.70, 18.50, 18.00 mm/mm 2 , P = 0.025). Those on systemic BB with vasodilatory properties had similar perfusion parameters as nonhypertensives and NBB. Those on systemic BB without vasodilating properties had significantly lower peripapillary perfusion (42.05 vs 43.30%, P = 0.011) and MVD (6 × 6 mm: 15.15 vs 16.60 mm/mm 2 , P < 0.001; 3 × 3 mm: 17.40 vs 18.70 mm/mm 2 , P = 0.005) compared to nonhypertensives. On multivariate analysis, peripapillary perfusion increased with increase in diastolic blood pressure (β:0.051, p: 0.04) and increasing age was the only factor found to be significantly associated with decreased peripapillary and macular perfusion parameters. CONCLUSION Systemic BB users have worse ocular perfusion parameters compared to those on other medications or nonhypertensives on univariate analysis but similar perfusion on multivariate analysis. Those on BB with vasodilation have better ocular perfusion parameters. All BB cannot be considered equally detrimental to ocular perfusion. Further well-controlled prospective studies are needed to reassess the effects of BB with or without vasodilation on ocular perfusion.
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Affiliation(s)
- Reni Philip
- Smt. Jadhavbai Nathamal Singhvee Glaucoma Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Lingam Vijaya
- Smt. Jadhavbai Nathamal Singhvee Glaucoma Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Shantha Balekudaru
- Smt. Jadhavbai Nathamal Singhvee Glaucoma Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Smita Panda
- Smt. Jadhavbai Nathamal Singhvee Glaucoma Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Mona Khurana
- Smt. Jadhavbai Nathamal Singhvee Glaucoma Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Rathini L David
- Smt. Jadhavbai Nathamal Singhvee Glaucoma Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Rashima Asokan
- Smt. Jadhavbai Nathamal Singhvee Glaucoma Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
- Occupational Optometry Services, Elite School of Optometry, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Ronnie George
- Smt. Jadhavbai Nathamal Singhvee Glaucoma Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Borrás T, Stepankoff M, Danias J. Genes as drugs for glaucoma: latest advances. Curr Opin Ophthalmol 2024; 35:131-137. [PMID: 38117663 DOI: 10.1097/icu.0000000000001025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
PURPOSE OF REVIEW To provide the latest advances on the future use of gene therapy for the treatment of glaucoma. RECENT FINDINGS In preclinical studies, a number of genes have been shown to be able to reduce elevated intraocular pressure (IOP), and to exert neuroprotection of the retinal ganglion cells. These genes target various mechanisms of action and include among others: MMP3 , PLAT, IκB, GLIS, SIRT, Tie-2, AQP1. Some of these as well as some previously identified genes ( MMP3, PLAT, BDNF, C3, TGFβ, MYOC, ANGPTL7 ) are starting to move onto drug development. At the same time, progress has been made in the methods to deliver and control gene therapeutics (advances in these areas are not covered in this review). SUMMARY While preclinical efforts continue in several laboratories, an increasing number of start-up and large pharmaceutical companies are working on developing gene therapeutics for glaucoma ( Sylentis, Quetera/Astellas, Exhaura, Ikarovec, Genentech, Regeneron, Isarna, Diorasis Therapeutics ). Despite the presence of generic medications to treat glaucoma, given the size of the potential world-wide market (∼$7B), it is likely that the number of companies developing glaucoma gene therapies will increase further in the near future.
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Affiliation(s)
- Teresa Borrás
- University of North Carolina at Chapel Hill, North Carolina
| | | | - John Danias
- Downstate Health Science University, SUNY, New York, USA
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Cordeiro MF, Gandolfi S, Gugleta K, Normando EM, Oddone F. How latanoprost changed glaucoma management. Acta Ophthalmol 2024; 102:e140-e155. [PMID: 37350260 DOI: 10.1111/aos.15725] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 06/02/2023] [Accepted: 06/12/2023] [Indexed: 06/24/2023]
Abstract
Glaucoma is currently considered one of the leading causes of severe visual impairment and blindness worldwide. Topical medical therapy represents the treatment of choice for many glaucoma patients. Introduction of latanoprost, 25 years ago, with an entirely new mechanism of action from that of the antiglaucoma drugs used up to that time was a very important milestone. Since then, due mainly to their efficacy, limited systemic side effects and once daily dosing, prostaglandin analogues (PGAs) have become as the first-choice treatment for primary open-angle glaucoma. PGAs are in general terms well tolerated, although they are associated with several mild to moderate ocular and periocular adverse events. Among them, conjunctival hyperemia, eyelash changes, eyelid pigmentation, iris pigmentation and hypertrichosis around the eyes are the most prevalent. The objective of this paper is to review the role of PGAs in the treatment of glaucoma over the 25 years since the launch of Latanoprost and their impact on clinical practice outcomes.
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Affiliation(s)
- Maria Francesca Cordeiro
- Imperial College Healthcare NHS Trust, Western Eye Hospital, London, UK
- UCL Institute of Ophthalmology, London, UK
- Department of Surgery & Cancer, Irish Clinical Oncology Research Group, Imperial College London, London, UK
| | | | | | - Eduardo M Normando
- Department of Surgery & Cancer, Irish Clinical Oncology Research Group, Imperial College London, London, UK
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Paganini V, Chetoni P, Di Gangi M, Monti D, Tampucci S, Burgalassi S. Nanomicellar eye drops: a review of recent advances. Expert Opin Drug Deliv 2024; 21:381-397. [PMID: 38396342 DOI: 10.1080/17425247.2024.2323208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 02/21/2024] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Research on nanotechnology in medicine has also involved the ocular field and nanomicelles are among the applications developed. This approach is used to increase both the water solubility of hydrophobic drugs and their penetration/permeation within/through the ocular tissues since nanomicelles are able to encapsulate insoluble drug into their core and their small size allows them to penetrate and/or diffuse through the aqueous pores of ocular tissues. AREAS COVERED The present review reports the most significant and recent literature on the use of nanomicelles, made up of both surfactants and amphiphilic polymers, to overcome limitations imposed by the physiology of the eye in achieving a high bioavailability of drugs intended for the therapeutic areas of greatest commercial interest: dry eye, inflammation, and glaucoma. EXPERT OPINION The results of the numerous studies in this field are encouraging and demonstrate that nanomicelles may be the answer to some of the challenges of ocular therapy. In the future, new molecules self-assembling into micelles will be able to meet the regulatory requirements for marketing authorization for their use in ophthalmic formulations.
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Affiliation(s)
| | - Patrizia Chetoni
- Department of Pharmacy, University of Pisa, Pisa, Italy
- Inter-University Center for the Promotion of the Rs Principles in Teaching & Research (CentroR), Pisa, Italy
| | | | - Daniela Monti
- Department of Pharmacy, University of Pisa, Pisa, Italy
- Inter-University Center for the Promotion of the Rs Principles in Teaching & Research (CentroR), Pisa, Italy
| | - Silvia Tampucci
- Department of Pharmacy, University of Pisa, Pisa, Italy
- Inter-University Center for the Promotion of the Rs Principles in Teaching & Research (CentroR), Pisa, Italy
| | - Susi Burgalassi
- Department of Pharmacy, University of Pisa, Pisa, Italy
- Inter-University Center for the Promotion of the Rs Principles in Teaching & Research (CentroR), Pisa, Italy
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Amiri D, Sessa M, Andersen M, Kolko M. Persistence and adherence with Latanoprost: A Danish register-based cohort study in older patients with glaucoma. Acta Ophthalmol 2024; 102:172-178. [PMID: 37249088 DOI: 10.1111/aos.15715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 05/31/2023]
Abstract
PURPOSE This study aims to assess the association between switching patterns and adherence/persistence in Danish patients over the age of 65, who started their first-ever glaucoma treatment with latanoprost eye drops. METHODS Patients were assigned to three different cohorts: (1) switchers, (2) non-switchers, and (3) preservative-free latanoprost (Monoprost®) users. Patients were followed for 1 year until the end of data coverage or censoring. Study covariates were used to compute the propensity score. In the adjusted analysis, the propensity score was added to the model as an independent variable. The Cox regression model was used to calculate the hazard ratio (HR) of discontinuation for the three cohorts (the non-switchers cohort was the reference level) in both adjusted and unadjusted analyses. RESULTS Non-switchers had a statistically significant lower adherence (proportion of days covered, PDC 92%) than switchers (PDC 96%; p < 0.001) and users of Monoprost® (PDC 99%; p < 0.001). Switchers had a 53% lower risk of treatment discontinuation compared to the reference group within 1 year after the first redemption of latanoprost in both unadjusted (HR 0.47; 95% Confidence interval, 95% CI: 0.41-0.53; p < 0.001) and adjusted (HR 0.47; 95% CI: 0.42-0.53; p < 0.001) analyses. In comparison to the non-switchers, Monoprost® users had a 78% lower risk for the above result in both unadjusted (HR 0.22; 95% CI: 0.17-0.28; p < 0.001) and adjusted (HR 0.22; 95% CI: 0.17-0.29; p < 0.001) analyses. CONCLUSION This study found increased adherence and persistence in latanoprost users among those who redeemed preservative-free latanoprost (Monoprost®) and among those who switched between different latanoprost formulations.
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Affiliation(s)
- Diva Amiri
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Maurizio Sessa
- Pharmacovigilance Research Centre, Geriatric Pharmacoepidemiology Team, Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Morten Andersen
- Pharmacovigilance Research Centre, Geriatric Pharmacoepidemiology Team, Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Miriam Kolko
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
- Department of Ophthalmology, Copenhagen University Hospital, Glostrup, Denmark
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Motta GS, da Costa Andrade J, Kasahara N. How glaucoma patients balance between the advantages and disadvantages of acceptance to the recommended treatment regimen in real-life: Perspectives from a middle-income country. Pharmacoepidemiol Drug Saf 2024; 33:e5771. [PMID: 38419142 DOI: 10.1002/pds.5771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 02/01/2024] [Accepted: 02/05/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE Patients with primary open-angle glaucoma (POAG) are required to take long-term treatments with topical medications to halt disease progression. This cross-sectional survey aimed to describe the level of acceptance of Brazilian patients toward the long-term treatment with eyedrops and to find possible correlates of high acceptance. METHODS POAG patients were recruited from the Glaucoma Service-Santa Casa of Sao Paulo, Sao Paulo, Brazil. Clinical and demographic data were retrieved from participants' electronic records. All patients answered the ACCEPT© questionnaire. This is a generic patient-reported outcome questionnaire specifically developed to assess patients' acceptance of long-term medications and not adherence. Summed scores and those for each domain were calculated to range from 0 to 100 with a higher score indicating greater acceptance. RESULTS The sample comprised 96 patients with POAG. The mean age was 63.2 ± 8.9 years; 48 were male and 48 female; 55 (57.3%) were white, 36 (37.5%) African-Brazilian, and 5 (5.2%) were of mixed color; most patients (97.9%) had less than high school degree and all had a family income CONCLUSIONS In this cohort of Brazilian patients with glaucoma, acceptance of treatment was high. Patients seems to have noticed more benefits than risks to the recommended treatment regimen.
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Affiliation(s)
- Guilherme Samomiya Motta
- Department of Ophthalmology, Irmandade da Santa Casa de Misericordia de Sao Paulo, Sao Paulo, Brazil
| | - Julia da Costa Andrade
- Department of Ophthalmology, Irmandade da Santa Casa de Misericordia de Sao Paulo, Sao Paulo, Brazil
| | - Niro Kasahara
- Department of Ophthalmology, Irmandade da Santa Casa de Misericordia de Sao Paulo, Sao Paulo, Brazil
- Department of Ophthalmology, Santa Casa de Sao Paulo School of Medical Sciences, Sao Paulo, Brazil
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Honjo J, Mukai R, Itagaki K, Tanaka K, Norikawa K, Kato Y, Kasai A, Sugano Y, Sekiryu T. Intraocular pressure changes during intravitreal aflibercept injection based on treat-and-extend regimen in Japanese patients with neovascular age-related macular degeneration and glaucoma. Jpn J Ophthalmol 2024; 68:91-95. [PMID: 38316703 DOI: 10.1007/s10384-023-01041-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 11/29/2023] [Indexed: 02/07/2024]
Abstract
PURPOSE To assess the changes in intraocular pressure (IOP) after intravitreal aflibercept injections in Japanese patients with neovascular age-related macular degeneration (nAMD) complicated by glaucoma. STUDY DESIGN Retrospective observational study. METHODS We retrospectively reviewed 27 eyes of 25 Japanese patients diagnosed with nAMD complicated by glaucoma. The patients were treated with 2 mg/0.05 ml of aflibercept and followed for 52 weeks according to a treat-and-extend (TAE) regimen after 3 consecutive monthly injections. The IOP of each eye was measured at each visit using non-contact tonometry. IOP changes as well as additional glaucoma treatments during 52 weeks were recorded. RESULTS The mean of aflibercept injections was 8.3 ± 1.9. The mean IOP at baseline was 14.0 ± 3.1 mmHg, and the mean IOP after aflibercept therapy was 13.0 ± 2.4 mmHg at the final visit (P = 0.0463). No patients received additional glaucoma treatment of eye drops or surgery. CONCLUSION Our results suggest that intravitreal aflibercept injections may be beneficial for patients with nAMD complicated by glaucoma.
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Affiliation(s)
- Junichiro Honjo
- Department of Ophthalmology, Fukushima Medical University, 1-Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan
| | - Ryo Mukai
- Department of Ophthalmology, Fukushima Medical University, 1-Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan
| | - Kanako Itagaki
- Department of Ophthalmology, Fukushima Medical University, 1-Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan
| | - Keiichiro Tanaka
- Department of Ophthalmology, Fukushima Medical University, 1-Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan
| | - Koki Norikawa
- Department of Ophthalmology, Fukushima Medical University, 1-Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan
| | - Yutaka Kato
- Department of Ophthalmology, Fukushima Medical University, 1-Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan
| | - Akihito Kasai
- Department of Ophthalmology, Fukushima Medical University, 1-Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan
| | - Yukinori Sugano
- Department of Ophthalmology, Fukushima Medical University, 1-Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan
| | - Tetsuju Sekiryu
- Department of Ophthalmology, Fukushima Medical University, 1-Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan.
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Kumara BN, Velmurugan K, Ghate MV, Shambhu R, Nirmal J, Prasad KS. A promising 'single' and 'dual' drug-nanocomposite enriched contact lens for the management of glaucoma in response to the tear fluid enzyme. J Mater Chem B 2024; 12:2394-2412. [PMID: 38349383 DOI: 10.1039/d3tb02624h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Glaucoma is a neurodegenerative condition that results in the damage of retinal ganglion cells due to elevated intraocular pressure (IOP). To curtail the limitations associated with conventional treatments such as eye drops and ocular suspensions, we have developed 'single' and 'dual' drug delivery contact lenses (CLs), that is, latanoprost (LP) and latanoprost-timolol (LP-TM) deliverable CLs, in response to lysozyme (Lyz), which is abundant in the lacrimal fluid. Since chitosan (CS) can entrap more of the drug and also undergo hydrolysis in the presence of Lyz, we have employed CS for the composite preparation. The CL fabrication was performed by free radical copolymerization of poly(2-hydroxyethyl methacrylate) (pHEMA) in the presence of the drug-loaded nanocomposite with UV-curing initiators using the pre-drug loading strategy. The surface morphological, optical and mechanical investigations confirmed the presence of the drugs, ≥80% transparency, the adequate flexibility and biocompatibility of both the CLs. The in vitro release experiments showed the release of 95.86% LP from LP-CL, and 83.87% LP and 86.70% TM from LP-TM-CL in the presence of 1.5 mg mL-1 of Lyz in 72 h. In vitro biocompatibility assay against human corneal epithelial (HCE) cells and ex vivo experiments on HET-CAM confirmed that the fabricated LP-CL and LP-TM-CL are well tolerated. Moreover, in vivo safety evaluations of CLs on New Zealand white rabbit eyes suggest no sign of irritation to the ocular tissues within 72 h of observation. Hence, the study suggests that the 'single' and 'dual' drug-loaded CLs could open a new avenue to manage glaucoma by maintaining mean diurnal IOP.
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Affiliation(s)
- B N Kumara
- Nanomaterial Research Laboratory [NMRL], Smart Materials And Devices, Yenepoya Research Centre, Yenepoya [Deemed to be University], Deralakatte, Mangalore 575 018, India.
| | - K Velmurugan
- Translational Pharmaceutics Research Laboratory (TPRL), Department of Pharmacy, Birla Institute of Technology and Sciences (BITS), Pilani, Hyderabad Campus, Hyderabad, 500 078, Telangana, India.
| | - M Vivek Ghate
- Yenepoya Technology Incubator, Yenepoya [Deemed to be University], Deralakatte, Mangalore 575 018, India
| | - R Shambhu
- Department of Ophthalmology, Yenepoya Medical College, Yenepoya [Deemed to be University], Deralakatte, Mangalore, 575 018, India
| | - Jayabalan Nirmal
- Translational Pharmaceutics Research Laboratory (TPRL), Department of Pharmacy, Birla Institute of Technology and Sciences (BITS), Pilani, Hyderabad Campus, Hyderabad, 500 078, Telangana, India.
| | - K Sudhakara Prasad
- Nanomaterial Research Laboratory [NMRL], Smart Materials And Devices, Yenepoya Research Centre, Yenepoya [Deemed to be University], Deralakatte, Mangalore 575 018, India.
- Centre for Nutrition Studies, Yenepoya [Deemed to be University], Deralakatte, Mangalore 575 018, India
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Ogata G, Yoneda M, Ogawa R, Hanawa A, Asai K, Yamagishi R, Honjo M, Aihara M, Einaga Y. Real-Time Measurement of Antiglaucoma Drugs in Porcine Eyes Using Boron-Doped Diamond Microelectrodes. ACS Sens 2024; 9:781-788. [PMID: 38244038 DOI: 10.1021/acssensors.3c02088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
The primary treatment for glaucoma, the most common cause of intermediate vision impairment, involves administering ocular hypotensive drugs in the form of topical eye drops. Observing real-time changes in the drugs that pass through the cornea and reach the anterior chamber of the eye is crucial for improving and developing safe, reliable, and effective medical treatments. Traditional methods for measuring temporal changes in drug concentrations in the aqueous humor employ separation analyzers such as LC-MS/MS. However, this technique requires multiple measurements on the eyes of various test subjects to track changes over time with a high temporal resolution. To address this issue, we have developed a measurement method that employs boron-doped diamond (BDD) microelectrodes to monitor real-time drug concentrations in the anterior chamber of the eye. First, we confirmed the electrochemical reactivity of 13 antiglaucoma drugs in a phosphate buffer solution with a pH of 7.4. Next, we optimized the method for continuous measurement of timolol maleate (TIM), a sympathetic beta-receptor antagonist, and generated calibration curves for each BDD microelectrode using aqueous humor collected from enucleated porcine eyes. We successfully demonstrated the continuous ex vivo monitoring of TIM concentrations in the anterior chambers of these enucleated porcine eyes. The results indicate that changes in intracameral TIM concentrations can be monitored through electrochemical measurements using BDD microelectrodes. This technique holds promise for future advancements in optimizing glaucoma treatment and drug administration strategies.
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Affiliation(s)
- Genki Ogata
- Department of Chemistry, Keio University, 3-14-1 Hiyoshi, Yokohama 223-8522, Japan
| | - Mao Yoneda
- Department of Chemistry, Keio University, 3-14-1 Hiyoshi, Yokohama 223-8522, Japan
| | - Risa Ogawa
- Department of Chemistry, Keio University, 3-14-1 Hiyoshi, Yokohama 223-8522, Japan
| | - Ai Hanawa
- Department of Chemistry, Keio University, 3-14-1 Hiyoshi, Yokohama 223-8522, Japan
| | - Kai Asai
- Department of Chemistry, Keio University, 3-14-1 Hiyoshi, Yokohama 223-8522, Japan
| | - Reiko Yamagishi
- Department of Ophthalmology, School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan
| | - Megumi Honjo
- Department of Ophthalmology, School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan
| | - Makoto Aihara
- Department of Ophthalmology, School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan
| | - Yasuaki Einaga
- Department of Chemistry, Keio University, 3-14-1 Hiyoshi, Yokohama 223-8522, Japan
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Angeli A, Chelli I, Lucarini L, Sgambellone S, Marri S, Villano S, Ferraroni M, De Luca V, Capasso C, Carta F, Supuran CT. Novel Carbonic Anhydrase Inhibitors with Dual-Tail Core Sulfonamide Show Potent and Lasting Effects for Glaucoma Therapy. J Med Chem 2024; 67:3066-3089. [PMID: 38266245 DOI: 10.1021/acs.jmedchem.3c02254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
Glaucoma, a leading cause of irreversible vision loss worldwide, is characterized by elevated intraocular pressure (IOP), a well-established risk factor across all its forms. We present the design and synthesis of 39 novel carbonic anhydrase inhibitors by a dual-tailed approach, strategically crafted to interact with distinct hydrophobic and hydrophilic pockets of CA active sites. The series was investigated against the CA isoforms implicated in glaucoma (hCA II, hCA IV, and hCA XII), and the X-ray crystal structures of compounds 25a, 25f, and 26a with CA II, along with 14b in complex with a hCA XII mimic, were determined. Selected compounds (14a, 25a, and 26a) underwent evaluation for their ability to reduce IOP in rabbits with ocular hypertension. Derivative 26a showed significant potency and sustained IOP-lowering effects, surpassing the efficacy of the drugs dorzolamide and bimatoprost. This positions compound 26a as a promising candidate for the development of a novel anti-glaucoma medication.
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Affiliation(s)
- Andrea Angeli
- NEUROFARBA Department, Sezione di Scienze Farmaceutiche, University of Florence, Via Ugo Schiff 6, 50019 Florence, Italy
| | - Irene Chelli
- NEUROFARBA Department, Sezione di Scienze Farmaceutiche, University of Florence, Via Ugo Schiff 6, 50019 Florence, Italy
| | - Laura Lucarini
- NEUROFARBA Department, Pharmaceutical and Nutraceutical Section, University of Florence, 50139 Florence, Italy
| | - Silvia Sgambellone
- NEUROFARBA Department, Pharmaceutical and Nutraceutical Section, University of Florence, 50139 Florence, Italy
| | - Silvia Marri
- NEUROFARBA Department, Pharmaceutical and Nutraceutical Section, University of Florence, 50139 Florence, Italy
| | - Serafina Villano
- NEUROFARBA Department, Pharmaceutical and Nutraceutical Section, University of Florence, 50139 Florence, Italy
| | - Marta Ferraroni
- Department of Chemistry "Ugo Schiff", University of Florence, Via della Lastruccia 3-13, 50019 Florence, Italy
| | - Viviana De Luca
- Istituto di Bioscienze e Biorisorse, CNR, 80131 Naples, Italy
| | | | - Fabrizio Carta
- NEUROFARBA Department, Sezione di Scienze Farmaceutiche, University of Florence, Via Ugo Schiff 6, 50019 Florence, Italy
| | - Claudiu T Supuran
- NEUROFARBA Department, Sezione di Scienze Farmaceutiche, University of Florence, Via Ugo Schiff 6, 50019 Florence, Italy
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Van Eijgen J, Melgarejo JD, Van Laeken J, Van der Pluijm C, Matheussen H, Verhaegen M, Van Keer K, Maestre GE, Al-Aswad LA, Vanassche T, Zhang ZY, Stalmans I. The Relevance of Arterial Blood Pressure in the Management of Glaucoma Progression: A Systematic Review. Am J Hypertens 2024; 37:179-198. [PMID: 37995334 PMCID: PMC10906067 DOI: 10.1093/ajh/hpad111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Glaucoma is one of the leading causes of global blindness and is expected to co-occur more frequently with vascular morbidities in the upcoming years, as both are aging-related diseases. Yet, the pathogenesis of glaucoma is not entirely elucidated and the interplay between intraocular pressure, arterial blood pressure (BP) and ocular perfusion pressure is poorly understood. OBJECTIVES This systematic review aims to provide clinicians with the latest literature regarding the management of arterial BP in glaucoma patients. METHODS A systematic search was performed in Medline, Embase, Web of Science and Cochrane Library. Articles written in English assessing the influence of arterial BP and systemic antihypertensive treatment of glaucoma and its management were eligible for inclusion. Additional studies were identified by revising references included in selected articles. RESULTS 80 Articles were included in this systemic review. A bimodal relation between BP and glaucoma progression was found. Both high and low BP increase the risk of glaucoma. Glaucoma progression was, possibly via ocular perfusion pressure variation, strongly associated with nocturnal dipping and high variability in the BP over 24 h. CONCLUSIONS We concluded that systemic BP level associates with glaucomatous damage and provided recommendations for the management and study of arterial BP in glaucoma. Prospective clinical trials are needed to further support these recommendations.
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Affiliation(s)
- Jan Van Eijgen
- Department of Ophthalmology, University Hospitals UZ Leuven, Leuven, Belgium
- Research Group Ophthalmology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Jesus D Melgarejo
- Institute of Neurosciences, School of Medicine, University of Texas Rio Grande Valley, Harlingen, Texas, USA
- Rio Grande Valley Alzheimer’s Disease Resource Center for Minority Aging Research (RGV AD-RCMAR), University of Texas Rio Grande Valley, Brownsville, Texas, USA
| | - Jana Van Laeken
- Department of Ophthalmology, University Hospitals UZ Leuven, Leuven, Belgium
| | - Claire Van der Pluijm
- Research Group Ophthalmology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Hanne Matheussen
- Research Group Ophthalmology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Micheline Verhaegen
- Department of Ophthalmology, University Hospitals UZ Leuven, Leuven, Belgium
- Research Group Ophthalmology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Karel Van Keer
- Research Group Ophthalmology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Gladys E Maestre
- Institute of Neurosciences, School of Medicine, University of Texas Rio Grande Valley, Harlingen, Texas, USA
- Rio Grande Valley Alzheimer’s Disease Resource Center for Minority Aging Research (RGV AD-RCMAR), University of Texas Rio Grande Valley, Brownsville, Texas, USA
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, Texas, USA
| | - Lama A Al-Aswad
- Department of Ophthalmology, New York University (NYU) School of Medicine, NYU Langone Health, New York, USA
| | - Thomas Vanassche
- Centre for Molecular and Vascular Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Zhen-Yu Zhang
- Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Ingeborg Stalmans
- Department of Ophthalmology, University Hospitals UZ Leuven, Leuven, Belgium
- Research Group Ophthalmology, Department of Neurosciences, KU Leuven, Leuven, Belgium
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Lee TE, Cho Y, Yoo HH. The effects of self-video feedback on the eyedrop instillation techniques of glaucoma patients: a prospective randomized controlled trial. Int Ophthalmol 2024; 44:7. [PMID: 38316676 PMCID: PMC10844463 DOI: 10.1007/s10792-024-02941-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 12/16/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND To evaluate the effectiveness of instillation technique education using self-video feedback in glaucoma patients. METHODS Sixty-two patients who self-instilled glaucoma eyedrops were randomly assigned to the self-video feedback and control groups according to the block randomization. Each group of the patient was asked to instill eyedrops, and videos were recorded. For the control group, only an educational video was provided. In the self-video feedback group, the patients provided educational video and feedback using a recorded video of their own instillation. After 1 month of education, the patient's instillation techniques were video-recorded again. We divided the steps of instilling eyedrops into ten steps and evaluated whether each step was properly performed using the recorded images from each patient. The main outcome was the proportion of patients who properly instilled their eyedrops in each step. RESULTS Before education, there was no significant difference in the proportion of patients who were properly instilled between the two groups. In the group that received video feedback, the proportion of patients who instilled the eyedrops correctly after education in some items was significantly higher than that of the control group, and in particular, the educational effect of 'avoids touching dropper to eyelid or eyelash' was superior. CONCLUSIONS In patients with glaucoma, education on the method of instillation was effective in improving the techniques of instillation. In the items that required accurate actions, the video feedback that allowed the patient to observe themselves had a better improvement effect compared to the traditional education method. TRIAL REGISTRATION NUMBER KCT0008090 (09/01/2023, retrospectively registered).
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Affiliation(s)
- Tae-Eun Lee
- Department of Ophthalmology, Jeonbuk National University Medical School, 20, Geonjiro Deokjin gu, Jeonju-si, Jeollabuk do, 54907, Korea.
| | - Youngri Cho
- Department of Ophthalmology, Jeonbuk National University Medical School, 20, Geonjiro Deokjin gu, Jeonju-si, Jeollabuk do, 54907, Korea
| | - Hyo Hyun Yoo
- Department of Medical Education, Jeonbuk National University Medical School, 20, Geonjiro Deokjin gu, Jeonju-si, Jeollabuk do, 54907, Korea
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Beznos B, Sayner R, Carpenter DM, Budenz DL, Muir KW, Annis IE, Romero MS, Tudor G, Garcia N, Robin AL, Sleath B. Do African American patients with glaucoma ask their eye providers the questions they have? Eye (Lond) 2024; 38:279-283. [PMID: 37524828 PMCID: PMC10811192 DOI: 10.1038/s41433-023-02674-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 08/02/2023] Open
Abstract
PURPOSE The objective of this study was to describe what questions patients checked on a glaucoma question prompt list and how often patients asked the same checked questions during medical visits. DESIGN A randomized controlled trial was conducted to test the effectiveness of a pre-visit video/glaucoma question prompt list intervention to increase African American patient question-asking during medical visits. METHODS Adult African American patients with glaucoma and a history of non-adherence to glaucoma medications were enrolled and randomized into intervention and usual care groups from three glaucoma practices. Visits were audio-recorded, transcribed, and coded for the questions patients asked during their visits. Researchers collected the pre-visit question prompt lists from the intervention group and compared their checked questions to the questions patients asked during their visit. RESULTS Ninety-three subjects were randomized to the question prompt list intervention group. Subjects checked an average of 6.77 questions on the prompt list. Of the subjects who checked at least one question, 54.8% asked their provider at least one of the questions they checked. The most common questions asked about glaucoma medications that they had checked were "What time(s) of day should I take my drops?" (50.0%, 9 out of 18) and "How many times a day do I use my glaucoma medicines?" (50.0%, 3 out of 6). CONCLUSION Although African American subjects with glaucoma have questions about glaucoma and their medications, few asked all their questions during visits. Future research should focus on how to improve question asking using a question prompt list.
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Affiliation(s)
- Bethany Beznos
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Robyn Sayner
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Delesha M Carpenter
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Donald L Budenz
- Department of Ophthalmology, UNC school of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kelly W Muir
- Department of Ophthalmology, School of Medicine, Duke University, Durham, NC, USA
- Durham VA Medical Center, Health Services Research and Development, Durhaml, NC, USA
| | - Izabela E Annis
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Gail Tudor
- Health Professions, Southern New Hampshire University, Manchester, NH, USA
| | - Nacire Garcia
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alan L Robin
- Ophthalmology, University of Michigan, Ann Arbor, MI, USA
- Ophthalmology and International Health, Johns Hopkins University, Baltimore, MD, USA
| | - Betsy Sleath
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Sleath B, Beznos B, Carpenter DM, Budenz DL, Muir KW, Romero MS, Lee C, Tudor G, Garcia N, Robin AL. African American patient-provider communication about glaucoma vision quality-of-life. Eye (Lond) 2024; 38:343-348. [PMID: 37580416 PMCID: PMC10810853 DOI: 10.1038/s41433-023-02693-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 07/22/2023] [Accepted: 08/02/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND/OBJECTIVES Little is known about African American patient-provider communication about glaucoma-related quality-of-life. The objectives of this study were to: (a) examine associations between patient socio-demographics and vision quality-of-life, (b) describe the extent to which eye care providers and patients discuss glaucoma-related quality-of-life, and (c) examine associations between patient and provider characteristics, whether the patient was in the intervention or usual care group, and whether the patient and provider discuss one or more glaucoma-related quality-of-life domains. METHODS Adult African American patients with glaucoma who reported non-adherence to glaucoma medications were enrolled from three sites. Patients completed a vision quality-of-life VFQ-25 assessment. Patients were randomized into intervention and control groups with intervention group members receiving a glaucoma question prompt list and watching a video before a provider visit. Audio recordings from these visits were transcribed and assessed for glaucoma-related quality-of-life discussions. RESULTS One hundred and eighty-nine patients were enrolled. Glaucoma-related quality-of-life was discussed during 12.3% of visits (N = 23). Patients initiated discussion 56.5% (N = 13) of the time and providers 43.5% (N = 10) of the time. Patients with worse health literacy (p < 0.001), more depressive symptoms (p < 0.05), and more severe glaucoma (p < 0.001) were significantly more likely to have worse vision-related quality-of-life. Glaucoma-related quality-of-life was significantly more likely to be discussed when African American patients saw African American providers (p < 0.05). CONCLUSION Patients and providers rarely discussed the patient's glaucoma-related quality-of-life. The intervention did not significantly increase communication about glaucoma-related quality-of-life. Residency programs should consider enhancing training regarding discussing patients' quality-of-life.
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Affiliation(s)
- Betsy Sleath
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Bethany Beznos
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Delesha M Carpenter
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Donald L Budenz
- Department of Ophthalmology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kelly W Muir
- Department of Ophthalmology, School of Medicine, Duke University, Durham, NC, USA
- Durham VA Medical Center, Health Services Research and Development, Durham, NC, USA
| | | | | | - Gail Tudor
- Southern New Hampshire University, Manchester, NH, USA
| | - Nacire Garcia
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alan L Robin
- Wilmer Institute, Johns Hopkins University, Baltimore, MD, USA
- American Glaucoma Society, San Francisco, CA, USA
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Sharif NA. Human experience and efficacy of omidenepag isopropyl (Eybelis®; Omlonti®): Discovery to approval of the novel non-prostaglandin EP2-receptor-selective agonist ocular hypotensive drug. Curr Opin Pharmacol 2024; 74:102426. [PMID: 38168596 DOI: 10.1016/j.coph.2023.102426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/11/2023] [Indexed: 01/05/2024]
Abstract
More than 75 million people worldwide suffer from ocular hypertension (OHT)-associated retinal and optic nerve degenerative diseases that cause visual impairment and can lead to blindness. In an effort to find novel pharmaceutical therapeutics to combat OHT with reduced side-effect potential, several emerging drug candidates have advanced to human proof-of-concept in recent years. One such compound is a nonprostaglandin (non-PG) EP2-receptor-selective agonist (omidenepag isopropyl ester). Omidenepag (OMD; free acid form) is a novel non-PG that selectively binds to and activates the human EP2-prostglandin receptor (EP2R) with a high affinity (Ki = 3.6 nM) and which potently generates intracellular cAMP in living cells (EC50 = 3.9-8.3 nM). OMD significantly downregulated COL12A1 and COL13A1 mRNAs in human trabecular meshwork (TM) cells, a tissue involved in the pathogenesis of OHT. Omidenepag isopropyl (OMDI) potently and efficaciously lowered intraocular pressure (IOP) in ocular normotensive rabbits, dogs, and monkeys, and also in ocular hypertension (OHT) Cynomolgus monkeys, after a single topical ocular (t.o.) instillation at doses of 0.0001-0.01%. No reduction in IOP-lowering response to OMDI was observed after repeated t.o. dosing with OMDI in dogs and monkeys. Additive IOP reduction to OMDI was noted with brinzolamide, timolol, and brimonidine in rabbits and monkeys. OMDI 0.002% t.o. decreased IOP by stimulating the conventional (TM) and uveoscleral (UVSC) outflow of aqueous humor (AQH) in OHT monkeys. In a Phase-III clinical investigation, 0.002% OMDI (once daily t.o.) reduced IOP by 5-6 mmHg in OHT/primary open-angle glaucoma (POAG) patients (22-34 mmHg baseline IOPs) that was maintained over 12-months. In an additional month-long clinical study, 0.002% OMDI induced IOP-lowering equivalent to that of latanoprost (0.005%), a prostanoid FP-receptor agonist, thus OMDI was noninferior to latanoprost. Additive IOPreduction was also noted in OHT/OAG patients when OMDI (0.002%, once daily t.o.) and timolol (0.05%, twice daily t.o.) were administered. Patients with OHT/POAG who were low responders or nonresponders to latanoprost (0.005%, q.d.; t.o.) experienced significant IOP-lowering (additional approximately 3 mmHg) when they were switched over to OMDI 0.002% (q.d.; t.o.). No systemic or ocular adverse reactions (e.g. iris color changes/deepening of the upper eyelid sulcus/abnormal eyelash growth) were noted after a year-long, once-daily t.o. dosing with 0.002 % OMDI in OHT/POAG patients. However, OMDI caused transient conjunctival hyperemia. These characteristics of OMDI render it a suitable new medication for treating OHT and various types of glaucoma, especially where elevated IOP is implicated.
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Affiliation(s)
- Najam A Sharif
- Eye-ACP Duke-National University of Singapore Medical School, Singapore; Singapore Eye Research Institute (SERI), Singapore; Institute of Ophthalmology, University College London (UCL), London UK; Imperial College of Science and Technology, St. Mary's Campus, London UK; Department of Pharmacy Sciences, Creighton University, Omaha, NE USA; Department of Pharmacology and Neuroscience, University of North Texas Health Sciences Center, Fort Worth, Texas USA; Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX USA.
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Kiyota N, Shiga Y, Ninomiya T, Tsuda S, Omodaka K, Himori N, Yokoyama Y, Pak K, Nakazawa T. The Effect of β-Blocker Eye Drops on Pulse Rate, Ocular Blood Flow, and Glaucoma Progression: A Retrospective Longitudinal Study. Adv Ther 2024; 41:730-743. [PMID: 38169060 PMCID: PMC10838819 DOI: 10.1007/s12325-023-02762-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION Our study was conducted to determine factors associated with the effectiveness of a β-blocker eye drop add-on in altering pulse rate (PR) in glaucoma patients. METHODS This retrospective study examined 236 eyes of 138 patients who received a β-blocker eye drop add-on during follow-up. Patients were included if at least one PR measurement was available both before and after the add-on was started. We collected data on ophthalmic parameters: longitudinal PR; longitudinal choroidal blood flow, represented by laser speckle flowgraphy-measured mean blur rate (MBR); and diacron-reactive oxygen metabolites (d-ROMs). We used a multivariable linear mixed-effects model to investigate the effectiveness of the β-blocker eye drop add-on in altering PR and examined factors contributing to a larger PR alteration after the add-on was started by analyzing the effect on PR of the interaction term between the add-on and clinical factors. We used the k-means method to classify the patients. RESULTS The β-blocker eye drop add-on reduced PR (- 7.61 bpm, P < 0.001). Female gender, higher PR when the add-on was started, lower central corneal thickness, and a higher d-ROM level were associated with greater reduction in PR (P < 0.05). In a cluster of patients with these clinical features, choroidal MBR increased by + 3.42% when we adjusted for change over time; MD slope, which represents the speed of glaucoma progression, improved by + 0.64 dB/year (P < 0.05). CONCLUSIONS We identified a glaucoma subgroup in which PR decreased, choroidal blood flow increased, and glaucoma progression slowed after a β-blocker eye drop add-on was started.
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Affiliation(s)
- Naoki Kiyota
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Yukihiro Shiga
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Takahiro Ninomiya
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Satoru Tsuda
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Kazuko Omodaka
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Noriko Himori
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
- Department of Aging Vision Healthcare, Tohoku University Graduate School of Biomedical Engineering, Sendai, Japan
| | - Yu Yokoyama
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Kyongsun Pak
- Division of Biostatistics, Department of Data Management, Center for Clinical Research, National Center for Child Health and Development, Tokyo, Japan
| | - Toru Nakazawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
- Department of Ophthalmic Imaging and Information Analytics, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
- Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
- Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
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Bowers ME, Wong MK, Ventimiglia J, Nicknam RM, Moster MR, Pro MJ, Dale E, Kolomeyer NN, Lee D, Zheng CX. Effect of bimatoprost sustained-release intracameral implant on intraocular pressure and medication burden in patients with prior glaucoma surgery. J Fr Ophtalmol 2024; 47:103996. [PMID: 37926661 DOI: 10.1016/j.jfo.2023.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/01/2023] [Accepted: 07/03/2023] [Indexed: 11/07/2023]
Abstract
The present retrospective study evaluated intraocular pressure (IOP) and medication burden after bimatoprost sustained-release (bimatoprost SR, Durysta, Allergan) implantation in patients with glaucoma. A secondary objective was to examine an effect of bimatoprost SR in a subset of patients with prior minimally invasive and incisional glaucoma surgery. A retrospective chart review of 122 eyes that received bimatoprost SR by 6 glaucoma specialists at Wills Eye Hospital between March 2020 and September 2021 was performed. One hundred and eighteen eyes from 84 patients had a reduction in IOP (18.5±5.7mmHg vs. 16.0±5.4mmHg, P<0.01) and required fewer glaucoma medications (2.1±1.4 vs. 1.2±1.2, P<0.01) after bimatoprost SR implantation. In 41 eyes from 31 patients who previously underwent glaucoma surgery (including iStent, goniotomy, trabeculectomy, Xen Gel Stent, or tube shunt surgery), medication burden was decreased after bimatoprost SR implantation (1.9±1.3 vs. 1.0±1.0, P<0.001). These data suggest that bimatoprost SR is an efficacious treatment modality for glaucoma, even in post-surgical patients.
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Affiliation(s)
- M E Bowers
- Sidney-Kimmel Medical College, Thomas Jefferson University, 1025, Walnut Street, Suite 100, 19107 Philadelphia, PA, United States.
| | - M K Wong
- Sidney-Kimmel Medical College, Thomas Jefferson University, 1025, Walnut Street, Suite 100, 19107 Philadelphia, PA, United States
| | - J Ventimiglia
- University of Maryland at College Park, 20742 College Park, MD, United States
| | - R M Nicknam
- Sidney-Kimmel Medical College, Thomas Jefferson University, 1025, Walnut Street, Suite 100, 19107 Philadelphia, PA, United States; Glaucoma Service, Wills Eye Hospital, 840, Walnut Street, Suite 1140, 19107 Philadelphia, PA, United States
| | - M R Moster
- Sidney-Kimmel Medical College, Thomas Jefferson University, 1025, Walnut Street, Suite 100, 19107 Philadelphia, PA, United States; Glaucoma Service, Wills Eye Hospital, 840, Walnut Street, Suite 1140, 19107 Philadelphia, PA, United States
| | - M J Pro
- Sidney-Kimmel Medical College, Thomas Jefferson University, 1025, Walnut Street, Suite 100, 19107 Philadelphia, PA, United States; Glaucoma Service, Wills Eye Hospital, 840, Walnut Street, Suite 1140, 19107 Philadelphia, PA, United States
| | - E Dale
- Sidney-Kimmel Medical College, Thomas Jefferson University, 1025, Walnut Street, Suite 100, 19107 Philadelphia, PA, United States; Glaucoma Service, Wills Eye Hospital, 840, Walnut Street, Suite 1140, 19107 Philadelphia, PA, United States
| | - N N Kolomeyer
- Sidney-Kimmel Medical College, Thomas Jefferson University, 1025, Walnut Street, Suite 100, 19107 Philadelphia, PA, United States; Glaucoma Service, Wills Eye Hospital, 840, Walnut Street, Suite 1140, 19107 Philadelphia, PA, United States
| | - D Lee
- Sidney-Kimmel Medical College, Thomas Jefferson University, 1025, Walnut Street, Suite 100, 19107 Philadelphia, PA, United States; Glaucoma Service, Wills Eye Hospital, 840, Walnut Street, Suite 1140, 19107 Philadelphia, PA, United States
| | - C X Zheng
- Sidney-Kimmel Medical College, Thomas Jefferson University, 1025, Walnut Street, Suite 100, 19107 Philadelphia, PA, United States; Glaucoma Service, Wills Eye Hospital, 840, Walnut Street, Suite 1140, 19107 Philadelphia, PA, United States
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