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Highlights from AGS: New Surgical Devices,Novel TherapeuticsMarch 9, 2016 By Michelle Dalton

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This year’s American Glaucoma Society annual meeting feted novel medications designed to lowerintraocular pressure (IOP) in patients with glaucoma. To date, available medications and surgery aredesigned to treat one of the primary risk factors – elevated IOP. But they are not designed to directly targetthe underlying degeneration that’s causing the vision loss.

But a great deal of discussion also centered around the neurodegeneration of the retinal ganglion cellsleads that leads vision loss.

“We have this panoply of different drops, implants, surgeries, different ways to lower the eye pressure. Weknow that lowering the eye pressure, in the end, helps slow down the disease, slow down the degeneration.If there were an eye pressure drug, like an eye pressure drop, that in addition to lowering eye pressure, alsodirectly stimulated the survival and/or regeneration of the retinal ganglion cells and their axons, it wouldoffer a dual-mode effect, a belt-and-suspenders kind of approach,” said Jeffrey Goldberg, MD, professor andchair of ophthalmology, Stanford University, who presented on a combined Rho-associated protein kinase(ROCK) and norepinephrine transporter (NET) ophthalmic solution that is currently under FDA review: AeriePharmaceuticals’ Rhopressa (netarsudil ophthalmic solution 0.2%, formerly known as AR-13324). Dr.Goldberg’s research was supported in part by Aerie.

Goldberg noted that “it would be fantastic if we had any drug that directly treated the degeneration of the



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eyedrop also conferred a neuroprotective or even regenerative capacity, that compound would have a greatmarket advantage, and that’s what Aerie is banking on with Rhopressa.

Dr. Goldberg’s group performed an optic nerve crush on young rats and applied Rhopressa or placebo threetimes daily for 10 days. The researchers found the compound lowered IOP as expected, but that retinalganglion cell survival and optic nerve axon regeneration “were signi_cantly higher” in the treated groupcompared with placebo. The data also suggested that topical administration of Rhopressa may haveassociated molecular changes indicative of posterior drug activity, he said.

Goldberg cautioned that what works in animal studies may not work in humans. “We have to test these datain a larger animal with an eye more like a human; that would be the most plausible next step,” he said, todetermine if the rat _ndings can be con_rmed.

“Is this survival and regeneration effect in the optic nerve trauma model also seen in a glaucoma model?”Dr. Goldberg questioned, indicating a direction for future investigation. And researchers need to determinethe durability of the effect, he said.

“Our initial studies were short term. We really need to know about the long term. How long is the effectsustained?” he asked.

Is there a future to move such testing of neuroprotective or regenerative compounds to human trials?Goldberg believes there is.

“The time has arrived to start testing candidate neuroprotective therapies in glaucoma,” he said.

RReeffeerreennccee::Topical administration of a ROCK/NET inhibitor promotes retinal ganglion cell survival and axonregenerationhttp://ags.planion.com/Web.User/AbstractDet?ACCOUNT=AGS&CONF=ABS2016&ABSID=10959

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