What Is Glaucoma?
Glaucoma is a chronic, progressive condition in which optic nerve damage occurs, typically due to pressure within the eye. Over time, the nerve damage can lead to vision loss. The risk for blindness in people with this condition depends on the degree of intraocular pressure, severity of disease, age of onset, and other determinants of susceptibility, such as family history of glaucoma.1 Glaucoma affects about 2% of US adults over age 40.2
In healthy eyes, a clear fluid normally flows continuously in and out of the anterior chamber, nourishing nearby tissues. This fluid exits the chamber at the “open angle” where the cornea and iris meet and then flows through a spongy meshwork, draining away from the eye.3
In open-angle glaucoma—the most common form—this drainage angle between the iris and cornea is wide open. However, fluid passes too slowly through the meshwork drain and builds up, increasing the pressure inside the eye and on the optic nerve.3 There is no identifying pathology for this “clogging” that occurs, and it is often silent and painless.1,3
Closed-angle glaucoma also involves intraocular pressure from fluid buildup in the eye, but this is caused by an anatomic narrowing of the drainage angle. This can suddenly close completely, causing a fast and steep increase in intraocular pressure that can pose a significant risk for vision loss.1,3Learn more about intraocular pressure reduction >
Learn more about neuroprotection >
Intraocular Pressure Reduction
Lowering intraocular pressure (IOP) is the only intervention proven to prevent vision loss from either open- or closed-angle glaucoma. Treatment typically starts with medications, such as drops, that reduce intraocular pressure.
Santen’s omidenepag isopropyl (DE-117) and sepetaprost (DE-126), which have novel mechanisms of action, are currently in development as potential treatment options for reducing elevated IOP in patients with open-angle glaucoma or ocular hypertension.
In patients at risk for nonadherence, laser therapy can be used as initial therapy instead. For patients who don’t respond to either of these, incisional surgery is an option, but success rates are highly variable and further therapy or surgery may be required.2
Santen’s current pipeline includes a medical device for minimally invasive glaucoma surgery (MIGS), Microshunt®, in Phase III development, designed to reduce intraocular pressure by creating an outflow path for aqueous humor.
Within the specialty of neuro-ophthalmology, Santen focuses on neuroprotection, which refers to therapeutic strategies for preventing neuronal death after injury. A wide variety of neuro-ophthalmic disorders, particularly those of the optic nerve, are characterized by neuronal death. Optic neuropathies irrevocably result in the death of retinal ganglion cells, which can lead to permanent vision loss. Most optic neuropathies do not have viable treatments at present, so neuroprotective strategies are an important need and area of focus.4
- International Council on Ophthalmology. ICO Guidelines for Glaucoma Eye Care: 2016. Available at: www.icoph.org/downloads/ICOGlaucomaGuidelines.pdf. Accessed on April 19, 2017.
- American Academy of Ophthalmology. Preferred Practice Pattern® Guidelines. Primary Open-Angle Glaucoma. San Francisco, CA: American Academy of Ophthalmology; 2015.
- National Institutes of Health. National Eye Institute. Facts about glaucoma. Available at: https://nei.nih.gov/health/glaucoma/glaucoma_facts. Accessed on June 28, 2017.
- Levin LA. Axonal loss and neuroprotection in optic neuropathies. Can J Ophthalmol 2007;42:403-408.