February 2018

Dear Glaucoma Section Members:

 

Wow! The Glaucoma Section had a very busy Academy meeting. I hope you were able to join us at one of our many events while in Chicago. From the diplomate prep course to the Bottoms Up research booth, it was great to see and meet so many Section members at the meeting. I would like to particularly thank our symposium speakers, Drs. Brett Bence, Sarah Wood and Madhu Gorla, and our Program Chair, Dr. Drew Rixon. It was their tireless efforts that made our symposium a highlight of the week.  Please feel free to email me feedback on our past events or suggestions for future program topics. I welcome your insights.

Our Section leadership is already hard at work planning Academy 2018 San Antonio. We look forward to seeing you there!

 

Lauren Ristin, OD, FAAO

Glaucoma Section Chair

[email protected]

 

-Programs Committee

How would you like to get another opinion on a challenging glaucoma case from your peers with similar interests and in similar situations? How about receiving regular access to trending discussion topics that are clinically relevant and evidenced-based? Or, do you have something that you have recently learned about glaucoma that you could share with the group for all of us to learn? These objectives are just some of the purposes of the Glaucoma Section Google Group site and, as such, we invite your observations, thoughts, and questions to help add breadth and depth to our unique discussions. Regardless of your current clinical situation, experience, or expertise, we welcome your contributions and we look forward to hearing from you soon! Please email [email protected] to join. 

The Glaucoma Section's Diplomate programs are designed to develop and recognize expertise in the field of glaucoma, with an emphasis on the development and promotion of evidence-based clinical care in patients with glaucoma-related diagnoses. Because not all evidence is created equal, clinicians need to foster their ability to critically assess the published literature. This piece will be the first in a series that identifies critical factors associated with this task.  

 

While several groups have published guidelines describing how to successfully accomplish critical literature review, perhaps the most robust and wide-ranging organization addressing this task is the "EQUATOR Network."  This group consists of a collaboration of researchers, medical journal editors, peer reviewers, developers of reporting guidelines, research funding bodies and other collaborators that all have a mutual interest in improving the quality and transparency of research publications.  

 

To help achieve their primary goal, the EQUATOR group has published a series of reporting guidelines that are not only valuable to authors but also to readers (i.e. critical reviewers) of research publications. These guidelines are available at no cost on their website:   http://www.equator-network.org/,   and include study-specific checklists for randomized trials, observational studies, diagnostic studies, systematic reviews, and other types of research publications.

 

Thus, if you are asked to provide or are interested in conducting a well-designed, comprehensive review of a clinical research paper, using the EQUATOR guideline specific to the study type is one way to confidently achieve this objective. Furthermore, if you are interested in or involved with developing and authoring a clinical research study, the EQUATOR guidelines can be very useful within that process. In fact, for some journals, completion of an EQUATOR checklist is a required submission element.  

 

I urge you to take a look at the EQUATOR website so you can familiarize yourself with some of the important principles involved in reliable, high-quality, transparent research reporting. In future pieces, we will review the mechanics of how to specifically use these guidelines to improve your ability to critically review clinical research studies. Once the basics are covered, we will discuss fast-lane "approaches" that may be more practically employed within our busy schedules.  

 

Michael Sullivan-Mee, OD, FAAO

Diplomate, Glaucoma

Chair, Glaucoma Section Diplomate Program

Leo Semes, OD, FAAO

 

January is Glaucoma Awareness Month (1) and optometry has the front line position.  The focus for managing glaucoma for over a century has been to lower IOP beginning with pilocarpine, designed to enhance access to the trabecular meshwork. Contemporary topical IOP-lowering is generally from the prostaglandin-analog class. Xalatan's (lananoprost 0.005%, Pfizer) introduction in 1996 was a revolution (2). Aside from once-daily dosing another advantage was significant IOP reduction. Alternative compounds have emerged recently. Vyzulta (latanoprostene bunod 0.024%, B&L) is a nitric oxide-donating compound dosed once daily to enhance trabecular outflow and perhaps increase blood flow (3). Impaired trabecular outflow as the primary insult in what we recognize as glaucoma has refocused attention to the trabecular meshwork (2, 4, 5). 

 

Another group of molecules targeting the TM are rho-kinase (ROCK) inhibitors. These selective agents relax the TM by inhibiting the actin cytoskeleton contractile tone of smooth muscle. The result is enhanced trabecular outflow with IOP lowering commensurate to prostaglandins (6). Chief among the members of this class is netarsudil. Rhopressa (netarsudil 0.02%, Aerie) was approved by the FDA in December, 2017 over 2 months ahead of its anticipated approval (7). Two clinical trials, using once-daily dosing, demonstrated superior IOP-lowering to timolol, the FDA's benchmark (8). Other mechanisms of Rhopressa may include decreasing episcleral venous pressure as well as suppressing aqueous production (9).

 

What an exciting time that our glaucoma patients have options far superior to those of a few decades ago. Once daily topical applications with enhanced efficacy represent another revolution in glaucoma management. 

 

References

1.  https://www.glaucoma.org/news/glaucoma-awareness-month.php .  Accessed January 5, 2018. 

 

2.https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=020597.  Accessed January 5, 2018. 

 

3. https://www.vyzulta.com .  Accessed January 5, 2018.

 

4.  https://www.aao.org/preferred-practice-pattern/primary-open-angle-glaucoma-ppp-2015 . Accessed January 5, 2018.

 

5.  Semes, L. Nitric oxide:  Historic perspective and recent developments.  In, Tsai JC, Gray MJ, Cavallerano AC, Nitric Oxide in glaucoma: What clinicians need to know. Candeo Clinical/Science Communications.  White Plains, NY.  2017.

 

6.  Wang SK, Chang RT. An emerging treatment option for glaucoma: Rho kinase inhibitors. Clin Ophthalmol. 2014 May 9;8:883-90. doi: 10.2147/OPTH.S41000. eCollection 2014.

 

7. http://investors.aeriepharma.com/news-releases/news-release-details/aerie-pharmaceuticals-announces-us-fda-approval-rhopressar . Accessed December 18, 2017.

 

8.Serle JB , Katz LJ , McLaurin E , et al,  ROCKET-1 and ROCKET-2 Study Groups.

Two Phase 3 clinical trials comparing the safety and efficacy of netarsudil to timolol in patients with elevated intraocular pressure. Am J Ophthalmol. 2017 Nov 30. pii: S0002-9394(17)30513-5. doi: 10.1016/j.ajo.2017.11.019.

 

9.  Brennan, K. Lowering IOP.  Will first-line options change? Rev Ophthalmol. Published online June 9, 2017.  https://www.reviewofophthalmology.com/article/lowering-iop-will-firstline-options-change ?  Accessed June 9, 2017.