Open-Angle Glaucoma: Burden of Illness, Current Therapies, and the Management of Nocturnal IOP Variation

Abstract

Glaucoma is a chronic, debilitating disease and a leading cause of global blindness. Despite treatment efforts, 10% of patients demonstrate loss of vision. In the US, [ 80% of glaucoma cases are classified as open-angle glaucoma (OAG), with primary open-angle (POAG) being the most common. Although there has been tremendous innovation in the surgical treatment of glaucoma as of late, two clinical variants of OAG, normaltension glaucoma (NTG) and severe POAG, are especially challenging for providers because patients with access to care and excellent treatment options may progress despite achieving a ''target'' intraocular pressure value. Additionally, recent research has highlighted the importance of nocturnal IOP control in avoiding glaucomatous disease progression. There remains an unmet need for new treatment options that can effectively treat NTG and severe POAG patients, irrespective of baseline IOP, while overcoming adherence limitations of current pharmacotherapies, demonstrating a robust safety profile, and more effectively controlling nocturnal IOP.

Computational Analysis of Clinical and Molecular Markers and New Theranostic Possibilities in Primary Open-Angle Glaucoma

“…These drugs exert its function by decreasing the synthesis of the aqueous humor and/or increasing the aqueous humor elimination by classical or alternative pathways. The mechanism of lowering IOP for the PA is through facilitating the uveo-scleral aqueous humor outflow and for the BB by decreasing the aqueous humor production [3,[6][7][8]. Both products are the most commonly used in POAG treatment.…”

“…Trabeculectomy is the most common surgery choice for reducing the IOP. However, MIGS is less effective, but safer than trabeculectomy [3,4,6]. Therefore, no cure exists for glaucoma neurodegeneration [56].…”

“…); (2) electrophysiological testing of the retina and optic pathway (flash electroretinogram (ERG), electro-oculography (EOG), multifocal ERG (mfERG), multifocal visual evoked potential (mfVEP), oculo pattern ERG (PERG), visual evoked potential (VEP), etc. ); and (3) emerging medical and surgical treatments (calcium channel blockers, a wide variety of potential neuroprotective natural products/drugs, small guanosine triphosphatase (GTPase) RHO-associated protein kinase inhibitors, new nano-based drug delivery approaches, contact lenses drug reservoir prototypes, and the challenging minimally invasive glaucoma surgery (MIGS) devices) [3][4][5][6].…”

“…Glaucoma biomarkers are directed to predict risk factors, to classify the stage of disease, to detail pathogenic mechanisms, to evaluate the progression as well as to monitor the therapeutics [3,[6][7][8]. However, a variety of questions are currently difficult to ascertain when managing the disease.…”

“…Comprehensive neuroprotection/neuroregeneration and other promising discoveries are the ultimate frontier in glaucoma treatment. In addition, an important inconvenience of glaucoma surgery is the uncontrolled wound healing process and related complications [3][4][5][6][7][8].…”