Glaucoma Drugs in the Pipeline

Glaucoma is a chronic disease that can be challenging to treat for both patients and physicians. Most patients will require more than 1 medication over time to maintain their intraocular pressure (IOP) at a physiologically benign level. Patients may become refractory to existing compounds and many struggle with adherence to multiple topical drop regimens. The field of glaucoma therapeutics has been advancing rapidly with an emphasis on compounds comprising multiple molecules/mechanisms of action that offer additivity and are complementary to current therapeutics. Several new topical drop compounds directly targeting the trabecular meshwork (TM)/Schlemm canal/conventional outflow pathway to reduce outflow resistance have obtained US Food and Drug Administration approval in the past year. These include rho kinase inhibitors and nitric oxide donating compounds. Alternative therapies that offer long-term IOP lowering while removing the patient from the drug delivery system are moving forward in development. These include gene therapy and stem cell strategies, which could ease or eliminate the burden of topical drop self-administration for several years. Additionally, a variety of novel formulations and devices are in development that aim for controlled, steady state delivery of therapeutics over periods of months. The future of glaucoma therapy is focusing on an increase in specificity for the individual patient: their type of glaucoma; underlying mechanisms; genetic make-up; comorbid conditions; and rate of progression. Maintaining functional vision and improving patient outcomes remains the goal in glaucoma therapeutics. The current collection of novel therapeutics offers an expanded set of tools to achieve that goal.

Exciting directions in glaucoma

Glaucoma is a complex, life-long disease that requires an individualized, multifaceted approach to treatment. Most patients will be started on topical ocular hypotensive eyedrop therapy, and over time multiple classes of drugs will be needed to control their intraocular pressure. The search for drugs with novel mechanisms of action, to treat those who do not achieve adequate intraocular pressure control with, or become refractory to, current therapeutics, is ongoing, as is the search for more efficient, targeted drug delivery methods. Gene-transfer and stem-cell applications for glaucoma therapeutics are moving forward. Advances in imaging technologies improve our understanding of glaucoma pathophysiology and enable more refined patient evaluation and monitoring, improving patient outcomes.

Ocular tolerance to a topical formulation of hyaluronic acid and chitosan-based nanoparticles

PURPOSE

Hyaluronic acid-chitosan nanoparticles (HA-CS NPs) have the potential to serve as a reliable drug delivery system to topically treat ocular surface disorders. We evaluated the in vivo uptake by ocular structures, the acute tolerance, and possible alterations of tear film physiology in rabbits.

METHODS

Fluorescent HA-CS NPs (fl-HA-CS NPs) were prepared by ionotropic gelation using fluoresceinamine-labeled hyaluronic acid and resuspended in buffer. fl-HA-CS NPs (30 microL, 0.5 mg/mL) and fluoresceinamine-HA conjugate (30 microL) were instilled into rabbit eyes every 30 minutes for 6 hours. In vivo uptake and acute tolerance were characterized 24 hours after the first instillation and compared with preinstillation measurements. Clinical signs, including tear production, lacrimal drainage system patency and reflux, and ocular surface pathology, were evaluated.

RESULTS

The rabbits showed no signs of ocular discomfort or irritation after exposure to HA-CS NPs. No macroscopic alteration in ocular surface structures was observed. fl-HA-CS NPs were present inside conjunctival and corneal epithelial cells, although the distribution within the cells was different. The fl-HA-CS NPs had no significant effects on tissue morphology and functionality, tear production, or drainage.

CONCLUSION

Taken together, these data demonstrate that HA-CS NPs are a safe drug carrier for ocular surface application.