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12-02-2008, 01:27 PM
Treatment Advances

In recent years, there have been some exciting advances in glaucoma treatment.
Sep 2008

Micropulse Laser Trabeculoplasty (MLT)

Micropulse laser trabeculoplasty (MLT) provides the same IOP-lowering effects as argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT) with less energy and inflammation than the earlier procedures. MLT uses a specific diode laser (IQ 810, Iridex) with a much longer pulse length than SLT, but the temperature rises slowly, because laser energy is delivered in short microbursts over an extended period of time (milliseconds versus nanoseconds for SLT). The micropulse helps to minimize the IOP spikes that can sometimes occur after a laser procedure.
Important note: This technology is still being evaluated by glaucoma treatment professionals. MLT appears promising as a new technology, but there is no long-term, or even moderate-term follow-up to determine safety and efficacy as compared to existing, proven laser treatments for glaucoma.
reviewed 9-4-08

Jan 2008

Memantine Update

Allergan reports Memantine Phase 3 clinical trial results

Allergan, Inc. has reported findings from the second Phase 3 clinical trial examining the safety and efficacy of oral Memantine as a treatment for glaucoma.
Although the study showed that the progression of disease was significantly lower in patients receiving the higher dose of Memantine compared to patients receiving the low dose of Memantine, there was no significant benefit compared to patients receiving placebo. Therefore, the study failed to meet its primary endpoint and to sufficiently replicate the results of the first Phase 3 trial.
While additional analyses are ongoing, the company does not believe that these analyses will support an approval of the drug.

Nov 2007

Trabectome Surgery

Trabectome® is a minimally invasive procedure specifically designed to improve fluid drainage from the eye to balance intraocular pressure (IOP). By restoring the eye’s natural fluid balance, the Trabectome procedure stabilizes optic nerve health to minimize further visual field damage.
The surgery is performed through a small incision and does not require leaving a permanent hole in the eye wall or creation of an external filtering bleb (fluid collection on the outside of the eye) or an implant.
Following are steps for the Trabectome procedure:

A small (1/16 of an inch) incision is made on the affected eye.
A small strip of diseased tissue is removed with an electrosurgical pulse to open access to the drainage system of the eye.
The eye is irrigated with a saline solution to remove tissue debris, leaving the eye to recover almost immediately.
Trabectome is an out-patient surgery that allows the patient to go home the same day. It is particularly offered to patients who are allergic to medications or who prefer to use surgical interventions instead of other medical therapies. The Trabectome procedure is performed on glaucoma patients at many leading ophthalmic centers.
More information is available at www.neomedix.net (http://www.neomedix.net/)

Nov 2007

FDA Approves Allergan Combigan Eye Drop

Allergan, Inc. has announced that the U.S. Food and Drug Administration has approved Combigan™, an alpha adrenergic receptor agonist with a beta adrenergic receptor inhibitor, for the reduction of elevated intraocular pressure (IOP) in patients with glaucoma or ocular hypertension who require adjunctive or replacement therapy due to inadequately controlled IOP.
Combigan (brimonidine tartrate/timolol maleate ophthalmic solution) 0.2%/0.5%, is the newest addition to Allergan’s glaucoma portfolio, which also includes Lumigan® and Alphagan® P.
Combigan is a prescription eye drop that works in two ways to reduce elevated IOP and will be available to physicians in the fourth quarter of 2007. Elevated IOP is a leading risk factor for glaucoma, and the only risk factor that can currently be treated.
In the 12-month pivotal trials, Combigan significantly reduced mean IOP up to 7.6 mm Hg from baseline and was well tolerated. Clinical studies found that Combigan ophthalmic solution provided an additional IOP lowering versus either brimonidine or timolol, the two agents included in the formulation of Combigan, used alone.

Sep 2006

New Glaucoma Medication

In September 2006, the U.S. Food and Drug Administration (FDA) approved Travatan® Z, marketed by Alcon, Inc. in Fort Worth, TX.
The active ingredient in Travatan® Z is the same found in the original Travatan®: travoprost, a prostaglandin analog. Travatan® Z is a new formulation that replaces the preservative benzalkonium chloride (BAK) with Sofzia ™, a robust ionic buffered preservative system that is gentle to the ocular surface.
FDA approval of Travatan® Z was based on a double-masked, multi-center study which has been accepted for publication by the Journal of Glaucoma.

Feb 2006

Parkinson's Disease Drug May Work to Protect the Optic Nerve

Allergan is currently looking into a new drug called memantine. Researchers believe memantine may be able to protect the nerve from too much glutamate. It is taken orally and has been used for years to treat such diseases as Parkinson’s Disease, Alzheimer’s Disease, certain forms of dementia, and other nervous system disorders.
Memantine works by binding to the receptor molecule for glutamate on the cell surface. This prevents glutamate from being able to attach to the cell. Without glutamate, calcium cannot enter the nerve cell. Therefore, the nerve cells are protected from too much calcium, which can be toxic to the cell.
Memantine is able to accomplish this without interfering with the normal function of the cell. This ability to protect the cell from calcium and still allow normal cell function gives memantine a leg up on other drugs used for this purpose. So, it would seem that memantine may block the chain reaction of events that leads to cell death. If this is so, we may be able to preserve the RGC, the optic nerve, and one of our most important senses: sight.
A multi-center trial, looking at the long-term effects of memantine on patients with glaucoma, is currently in Phase 3.

Aug 2001

Multiple Sclerosis Drug May also Work to Protect the Optic Nerve

Researchers at the Weizmann Institute of Science in Rehovot, Israel, have shown that vaccination with a compound called Copaxone, normally used to treat multiple sclerosis, may be able to protect the optic nerve. This research, funded in part by the Glaucoma Research Foundation, was lead by Professor Michal Schwartz of the Weizmann Institute’s Neurobiology Department.
Dr. Schwartz and her colleagues found that vaccination with this synthetic compound protects the optic nerve from the effects of toxic levels of glutamate, sometimes produced by the death of cells from increased intraocular pressure (IOP) in people with glaucoma. Copaxone was developed by researchers at the Weizmann Institute to treat multiple sclerosis. A series of experiments on rats with high intraocular pressure, conducted with scientists from the United States, revealed very promising results. Rats with high IOP that were immunized with Copaxone showed only a 4% loss of cells as opposed to a 28% loss of cells in rats that did not receive Copaxone.
These results indicate that vaccination with Copaxone may some day be a viable treatment for people with glaucoma. Since Copaxone is already approved by the FDA, scientists are hopeful human trials can begin soon.
reviewed 9-4-08

Mar 2001

Selective Laser Trabeculoplasty (SLT)

Selective Laser Trabeculoplasty (SLT) is a type of laser surgery that uses a combination of frequencies allowing the laser to work at very low levels. It treats specific cells “selectively” and leaves untreated portions of the trabecular meshwork (the mesh-like drainage canals surrounding the iris) intact. For this reason, it is believed that SLT, unlike other types of laser surgery, may be safely repeated many times. SLT may also be an alternative for those who have been treated unsuccessfully with traditional laser surgery or with pressure lowering eye drops.
reviewed and updated 9-4-08