Future glaucoma medical therapies: What's in the pipeline?

There are a number of limitations with our current glaucoma therapies. All available current therapies are directed at lowering intraocular pressure (IOP), an important risk factor for the development and progression of glaucoma. However, IOP lowering only treats a symptom of glaucoma and does not address the underlying pathogenic pathways. Current agents lower IOP by suppressing aqueous humor formation or by enhancing aqueous humor outflow, without modifying the disease process(es) responsible for glaucomatous damage to the outflow facility. Clinical efforts to lower IOP only indirectly protect the retina, optic nerve head, and optic nerve. There are currently no approved therapies that directly neuroprotect these tissues. Some glaucoma patients continue to progress despite receiving IOP-lowering therapy, suggesting that factors other than IOP may be involved. In addition, in many patients, there is a progressive loss of therapeutic efficacy, which often leads to patients being on multiple medications. Another challenge is adherence to therapy, as the majority of patients do not take all their prescribed medications at all times.