Promising new treatments aimed at controlling glaucoma — and thus reducing the risk of vision loss — were a hot topic at the recent annual meeting of the American Society of Cataract and Refractive Surgery, reports Dr. Lee Wan, who attended the gathering in Washington, D.C.
Newly approved and ready to roll out are two types of treatment innovations: powerful new eyedrops; and new glaucoma stents, which are surgically implanted drains that can help release fluid from the eye. Both therapies are targeted at the classic glaucoma treatment goal: controlling eye pressure to prevent damage to the optic nerve.
Dr. Wan says the two new eyedrops represent new classes of glaucoma drugs, but experience with them is limited at this point. “But according to initial reports, they are as effective or perhaps even more effective than the other drops we’ve had available up to now,” he says.
The newer stents now available also offer significant promise to selected patients, says Dr. Wan. In many cases, if the stents are successful, they may eliminate the need for eyedrops, and their associated cost, inconvenience, and side effects. The stents are considered microinvasive, and appear to have less risk, and easier recovery, than traditional glaucoma surgeries.
The newer stents are similar to the iStent, which has been available and widely used for the past few years. The iStent is a very tiny implant that goes into the drainage canal. Approved for use only in conjunction with cataract surgery, the device is has been highly successful for selected patients. The newer stents expand the applicability and effectiveness of these microinvasive options, especially for those who need additional pressure lowering.
Among the newer devices is the Cypass, which is covered only for use at the same time as cataract surgery. The Cypass is placed just behind the normal drainage canal at the base of the iris, creating an alternative drainage pathway that is highly effective for certain patients.
Another new device called a XEN Stent enables the surgeon to create a new drainage pathway under the eyelid. This is more similar to the traditional glaucoma surgeries that involve cutting a new opening or implanting a tube, but is less invasive. The XEN can be used on its own, independent of cataract surgery.
Dr. Wan says that these new drop and implant options open up new alternatives to many patients, especially those who have difficulty with their current drops, or are not well controlled with their current regimen. Selecting the best option for each patient depends on many factors, which must be carefully considered by patient and doctor.