Part 12 of 14 of “Adjusting the Faucet or Opening the Drain – Currently Available Methods to Treat the Plumbing Problem of Open Angle Glaucoma” | A San Gabriel Valley Optometric Society (SGVOS) Continuing Education Dinner Event – 2 hours CE | Featured Speaker: Dr. David Richardson, MD | April 12, 2017

Next Generation Plumbing | What’s “In the Pipeline” of Medications and Surgery

So what’s in the pipeline? Next-generation medications and surgeries in the pipe line.


Quickly, the medications that are—that you’re going to see—some of these are already available say in Japan and elsewhere but hopefully we’ll see these in the US. There’s essentially three new classes of medications:

ROCK & NET Inhibitors

The Rho-Kinase or the ROCK inhibitors—they open the drain by relaxing the trabecular meshwork. The Norepinephrine Transporter Inhibitors or the NET Medications—they “turn on the faucet”. There’s one an FDA trials right now, which is a ROCK/NET. So it uses both of these. Just like the alpha-2 agonists, you could potentially get both a reduction in the flow (reduction in the production of fluid) as well as an improvement in the outflow—so that’s very exciting.

Adenosine Receptor Agonists

They work by increasing the outflow through the trabecular meshwork.

Modified Prostaglandin Analogs

Now, these are basically Prostaglandin Analogue plus a Nitric Oxide. So they’re generally (you can think of some of these as) Prodrugs. They enter the anterior chamber, they’re split up into the prostaglandin and a nitric oxide. Nitric oxide relaxes the trabecular meshwork and Schlemm’s canal increasing outflow.

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