Glaucoma News

ROCHESTER, N.Y., May 2008 — Mayo Clinic researchers have found new evidence that low cerebrospinal fluid (CSF) pressure may be significantly linked to optic nerve damage related to glaucoma, according to the May issue of Ophthalmology.

Fluids (CSF) within the spine and brain have many roles, including maintaining healthy neural or nerve function.

Investigators studied cases of 31,786 people who underwent procedures in which CSF samples were taken for analysis for various health reasons. In all 28 cases involving people who had primary open angle glaucoma, CSF pressure was found to be significantly lower compared with that of other individuals without glaucoma.

Scientists say this finding may indicate a connection between low CSF pressure and abnormally high internal or intraocular pressure that can lead to eye damage in glaucoma.

WASHINGTON, D.C., March 2008 — Promising results from a study of Alcon's experimental drug treatment for glaucoma, anecortave acetate, were reported at the American Glaucoma Society annual meeting.

The study was aimed at evaluating safety and effectiveness of anecortave acetate involving 89 people diagnosed with open-angle glaucoma, which often is linked to high intraocular pressure (IOP) that can damage the optic nerve.

After three months, more than half of the study participants who had received eye injections of anecortave acetate (7.5 mg or 15 mg) achieved normal levels of IOP, compared with only 6.4 percent of individuals who did not receive the same treatment.

Adverse events such as eye pain occurred in a small percentage of cases.

Alcon officials said these early findings now mean that late-stage clinical trials will continue during 2008 to evaluate results at higher dosages and frequencies.

FORT WORTH, February 2008 — Elevated eye pressures leading to glaucoma and potential vision loss may be linked to "over-expression" of a specific gene, according to a team of investigators led by Alcon Research.

"The cause of glaucoma and the resulting elevation of intraocular pressure has been poorly understood," said Abe Clark, PhD, vice president of discovery research and head of glaucoma research for Alcon. "This new discovery may allow researchers to develop therapies to treat the underlying cause of the disease."

Researchers from the University of Iowa and National Cancer Institute found that excessive activity of the gene sFRP1, found within eye cells, appears to contribute to higher eye pressure and damage to the optic nerve, which can cause glaucoma. Study results were published in the Feb. 14 online edition of Journal of Clinical Investigation.

TEMPLE, Texas, January 2008 — Annual costs of glaucoma medications vary widely depending on the type prescribed, according to a study by Texas A & M University System Health Science Center College of Medicine.

Researchers found that glaucoma medications controlling eye pressure account for roughly half of the $2.5 billion spent annually in the United States on managing the eye disease.

Annual costs per individual range from about $151 for generic timolol maleate 0.5% (beta-blocker) to about $874 for Alphagan P 0.15% (alpha-adrenergic agonist, Allergan), at three times daily dosing.

Study results were published in the January issue of American Journal of Ophthalmology.

IRVINE, Calif., November 2007 — Allergan has received U.S. Food and Drug Administration approval for Combigan, a combination of two eye drops (brimonidine tartrate/timolol maleate ophthalmic solution) that helps lower and control internal eye pressure to prevent damage from glaucoma.

Allergan officials said Combigan will be available for physicians to prescribe during the fourth quarter of 2007.

ISTANBUL, September 2007 — Turkish researchers have reported study results showing highly significant protective effects of the antioxidant, tocopherol, which appears to slow glaucoma-related damage to nerve cells in the eye's retina.

"Tocopherol deserves attention beyond its antioxidant properties for protecting the retina from glaucomatous damage," researchers concluded in a study reported in the September issue of the European Journal of Ophthalmology.

Tocopherol is found in vitamin E. One form, alpha-tocopherol, is common in foods such as avocados, peanuts and wheat germ oil.

LONDON, August 2007 — London researchers say they have identified a common cause of glaucoma eye disease and Alzheimer's, both of which cause nerve cell degeneration.

"We've seen for the first time that there is a clear link between what causes Alzheimer's disease and one of the basic mechanisms behind glaucoma," said study leader and glaucoma specialist Francesca Cordeiro, MD, of University College London and Western Eye Hospital. "However, this doesn't mean that everyone with Alzheimer's will develop glaucoma or vice versa. Glaucoma has a number of risk factors."

Study results demonstrate that the build-up of a protein known as beta-amyloid, causing brain lesions in individuals with Alzheimer's, also can lead to nerve cell death in the eye's retina, where vision processing occurs.

Typically, high intraocular pressure (IOP) in glaucoma is associated with optic nerve damage and vision loss in the "edges" of the visual field. But some people with glaucoma can have well controlled IOP and still develop vision loss.

Researchers say the link between glaucoma and Alzheimer's can be explained partly because the eye's retina is an extension of the brain.

Findings, reported in August in the online version of the U.S. Proceedings of the National Academy of Sciences, could have implications for use of Alzheimer's medications in treating glaucoma. Also, researchers say that new ways of visualizing retinal nerve cell damage, used during the study, also may represent a diagnostic tool for detecting Alzheimer's.

SINGAPORE, July 2007 — One injection of Alcon's anecortave acetate experimental glaucoma drug in many cases controlled intraocular pressure (IOP) for at least three months, according to study results reported at the World Glaucoma Congress in Singapore.

Experimental results demonstrated that about half of individuals with glaucoma who had the highest dose (30 mg) injected into the eye maintained stable IOP.

"The results of this first controlled clinical study of anecortave acetate for glaucoma are encouraging because they show that with one injection the drug works for at least three months in a significant number of glaucoma patients to lower pressure by clinically relevant amounts," said Scott Krueger, PhD, Alcon's vice president of research and development (pharmaceuticals).

Krueger said additional clinical studies will be developed with the goal of filing for a new drug application with the U.S. Food and Drug Administration in 2009.

FORT LAUDERDALE, Fla., May 2007 — Even though glaucoma may progress to blindness, researchers say almost one-third of older Americans diagnosed with this serious eye disease do not receive treatment.

"We need to do a better job of educating patients and their physicians, as well as health policymakers and insurance-industry leaders, of the benefits of consistent glaucoma therapy," said glaucoma researcher Joshua D. Stein, M.D, of Duke University in Durham, N.C. "If we do not learn this lesson, glaucoma will continue to be a leading cause of blindness in older populations."

Stein presented study results detailing the lack of treatment among older people diagnosed with primary open-angle glaucoma at the 2007 Association for Research in Vision and Ophthalmology (ARVO) annual meeting.
 

HALIFAX, Canada, March 2007 — People with glaucoma were about six times more likely to have been involved in a motor vehicle collision within the past five years than a control group, according to study results published in the March 2007 issue of Investigative Ophthalmology and Visual Sciences.

Dalhousie University researchers who studied 48 people with glaucoma also found that drivers with the eye disease were more likely to be at fault when a collision did occur.

Researchers also found that people with glaucoma were three times more likely than a control group to have experienced a fall within the previous 12 months.

Glaucoma can damage the eye's optic nerve, which may lead to narrowing of the visual field or "tunnel vision."

BOSTON, January 2007 — New understanding about how glaucoma causes blindness has led researchers at Children's Hospital Boston and the Massachusetts Eye and Ear Infirmary to suggest treatments aimed at certain targets, such as a type of inflammatory molecule known as tumor necrosis factor-alpha or TNF-alpha.

Researchers say they have found an association between elevated inner eye pressure (intraocular pressure) often caused by glaucoma and an increase in TNF-alpha, which sets off an immune response in the eye that damages cells within the optic nerve.

A healthy optic nerve is crucial for good vision, because it transmits visual signals from the eye to the brain for interpretation.

"In the clinic, lowering intraocular pressure is a reliable treatment for glaucoma, but sometimes it is hard to lower the pressure even after eyedrop treatment or surgery," researcher Toru Nakazawa, who now is at Japan's Tohoku University, said in a news release. "Here, we show that blocking TNF-alpha function may have a benefit as a neuroprotective treatment."

Results of the Boston study were published in the Dec. 6, 2006 online edition of Journal of Neuroscience.

IRVINE, Calif., November 2006 — Recent news and trade reports indicate that Allergan's experimental drug for glaucoma, memantine, has demonstrated effectiveness in stopping or slowing optic nerve damage and accompanying vision loss associated with the common eye disease.

News reports say memantine currently is in late-stage clinical trials and could be available pending necessary U.S. Food and Drug Administration approvals as soon as early 2008.

"In the battle against glaucoma, we are supporting the world's largest phase three clinical trial to investigate the potential use of a highly promising oral compound called memantine for protection against the damage caused by increased pressure on the back of the eye," a 2005 Allergan company report says. "If proven effective, memantine, in conjunction with current topical agents, would be the first and only oral medication that directly protects the optic nerve in the treatment of glaucoma."

Allergan currently markets memantine under the trade name of Namenda, FDA-approved for treatment of neurological damage associated with moderate to severe Alzheimer's disease.

Archives of Ophthalmology in February 2006 reported results of an experiment using monkeys that demonstrated memantine reduced atrophy or shrinkage of visual nerve cells (neurons) when glaucoma was present.

LAS VEGAS, November 2006 — Details about a method of calculating who might be most at risk of developing the potentially eye-damaging disease of glaucoma were presented at the 2006 American Academy of Ophthalmology conference.

Researchers from Washington University School of Medicine in St. Louis said identifying high-risk individuals and then treating them with medications that lower internal (intraocular pressure) eye pressure helped prevent or reduce effects of glaucoma, which can damage the eye's optic nerve.

The model predicting glaucoma risk was developed from data generated from two major clinical trials, said Washington University Department of Ophthalmology and Visual Sciences head Michael A. Kass, MD.

"We wanted to learn whether preventive treatment could reduce the incidence of glaucoma, and we also wanted to learn whether we could determine what risk factors might help us predict which patients will go on to develop glaucoma," Kass said.

The model assessing glaucoma risk is based on five factors that include age, intraocular pressure, appearance of the optic nerve head (cup/disc ratio), thickness of the eye's clear front surface (cornea) and results from computerized visual field tests.

BRASILIA, Brazil, September 2006 — Brazilian researchers have found that weight lifting maneuvers such as bench presses can temporarily boost internal (intraocular) eye pressure and increase risks associated with glaucoma, which can damage the eye's optic nerve.

"Prolonged weight lifting could be a potential risk factor for the development or progression of glaucoma," authors concluded in a study reported in the September 2006 issue of Archives of Ophthalmology.

Researchers say patients diagnosed with glaucoma in which eye pressure is not elevated (normal-tension glaucoma) should be questioned about possible involvement with exercises that involve weight lifting.

SUNDERLAND, England, August 2006 — British doctors report that a woman who illegally purchased oral steroids on-line from a company in Thailand now has serious vision problems as a side effect, including glaucoma that can permanently damage the optic nerve and cataracts that cause clouding of the eye's normally clear natural lens.

"The on-line availability of controlled and uncontrolled drug therapies needs to be carefully monitored," British ophthamologists Philip Severn, MD, and Scott Fraser, MD of Sunderland Eye Infirmary said in a commentary published in the August 2006 issue of the British medical journal, The Lancet.

The 64-year-old woman took oral steroids in the form of an anti-inflammatory medication (prednisolone) for four years, after self-diagnosing herself with chronic fatigue syndrome.

Severn and Fraser warn of other dangers involved with illegally purchasing drugs on-line, including risks that the substances are fake or could interact with other medications.

BOSTON, July 2006 — Boston medical researchers have uncovered a surprising link between people with type 2 diabetes and increased risk of developing the potentially damaging eye disease of glaucoma.

Even after excluding lifestyle factors such as alcohol use and exercise, researchers still found a significant relationship between presence of type 2 diabetes and development of glaucoma.

"The study supports the notion that type 2 diabetes is associated with an increased risk of glaucoma," lead study author Louis Pasquale, MD, said in a news release. Pasquale also is co-director of the Massachusetts Eye and Ear Infirmary Glaucoma Service and an assistant professor of ophthalmology at Harvard Medical School.

"While obesity fuels the type 2 diabetes epidemic, it appears that factors unrelated to obesity contribute to the positive association between type 2 diabetes and glaucoma," Pasquale said. "We were surprised to find this."

Researchers say findings suggest that people with Type 2 diabetes also should be screened for glaucoma. Study results were published in the July issue of Ophthalmology journal.

TOCHIGI, Japan, March 2006 — Japanese researchers report that people with glaucoma may experience increased eye pressure (intraocular pressure) during the night while they sleep, increasing the risk of eye damage associated with the disease.

Takeshi Hara, MD, of Jichi Medical School in Tochigi, Japan and colleagues demonstrated that significantly higher eye pressure at night occurred in more than 10 percent of 148 untreated individuals with glaucoma who were included in the study.

Researchers also noted that eye pressure peaked for almost all subjects while they slept. Details of the study were published in the February 2006 issue of Archives of Ophthalmology.

OXFORD, England, February 2006 — New findings regarding how glaucoma progresses suggest that certain intensities of light may be a risk factor for worsening of the eye disease, which can damage the optic nerve crucial for good vision.

Authors of research published in the February 2006 issue of the British Journal of Ophthalmology suggest that filters, protective eyewear or headgear, and other modifications of certain light sources, may be an appropriate safeguard for glaucoma patients. Individuals with other types of eye conditions that might damage the optic nerve also may benefit from these precautions.

The University of Oxford article suggests that, when glaucoma and other eye diseases affecting the optic nerve are present, damage may worsen with exposure to visible light wavelengths of 400-760nm (nanometers) under certain conditions.

NOTTINGHAM, England, February 2006 — If you have a sibling with glaucoma, studies demonstrate that you are significantly more likely to develop the eye disease that sometimes damages the optic nerve.

Queen's Medical Center University Hospital researchers in Nottingham, England noted in study results that inherited tendencies and environmental factors might help explain findings that show glaucoma is more common among siblings. Researchers concluded that siblings of glaucoma patients also were more likely to develop the eye disease as they age.

"An effective and repeated screening program should be considered for this high risk group," researchers said in the study published in the January 2006 issue of the British Journal of Ophthalmology.

ANN ARBOR, Michigan, August 2005 — Even if the out-of-pocket cost of their prescription medicines is high, people who trust their physicians are more likely to continue taking their medicines as directed, say researchers from the VA Ann Arbor Healthcare Center and the University of Michigan. But those who don't trust their doctors or who are depressed are more likely to skip doses or refills, especially when the cost is significant to them.

The study wasn't done on glaucoma patients, but rather on 912 people with diabetes — but the diseases are similar in that they require a strict, daily medication regimen to control or delay further deterioration. The researchers concluded that when doctors actively reach out to patients to create a bond of trust with them, and when patients in turn are honest with their doctors about medication cost and other concerns, then patient compliance is more likely to occur.

BOSTON, April 2005 — Surgeon training began in early 2005 for a new glaucoma treatment system that combines laser surgery with insertion of an ultra tiny device (shunt) to relieve internal eye pressure (intraocular pressure or IOP) typically associated with the disease.

The Boston firm of SOLX Inc. announced that surgeon training began in February in Madrid, Spain, where the DeepLight Glaucoma Treatment System has been approved as an investigational device. The glaucoma treatment system currently is undergoing clinical trials in the United States.

IOP control usually is necessary to prevent progression of glaucoma, which can damage the optic nerve that transmits images from the eye to the brain. SOLX officials say their new glaucoma therapy uses the system's Titanium Sapphire Laser and Gold Shunt in any combination the eye surgeon deems necessary to reach a targeted IOP.

"This gives physicians a wide range of [eye] pressure reduction options while reducing or eliminating the need for glaucoma medications," said Gabriel Simon, MD, in a company news release. Simon is director of ophthalmic research at the Boston University Photonics Center, which was the lead developer of technology creating the DeepLight Glaucoma Treatment System.

The SOLX laser system works on principles similar to Selective Laser Trabeculoplasty (SLT) by targeting specific pigmented cells to help open up the eye's drainage system to relieve IOP. But preliminary studies indicate the SOLX laser may have deeper penetration in targeting selected cells.

SANTA CLARA, Calif., March 2005 — Laser surgery to control internal eye pressure (intraocular pressure) is being considered in lieu of medications as a first line treatment for glaucoma, the Journal of the American College of Surgeons reported in its January 2005 issue.

The journal said a large clinical study began in early 2005 to evaluate whether Selective Laser Trabeculoplasty (SLT) should be the initial treatment for glaucoma, a disease that can damage the optic nerve crucial for transmitting images from the eye to the brain. Current glaucoma therapies typically are aimed at controlling intraocular pressure to help prevent or slow optic nerve damage associated with glaucoma.

The laser for SLT, marketed by Lumenis Inc., selectively targets tissue to alter the eye's drainage system and control internal eye pressure without the potential of heat damage. Other studies have noted that SLT can be repeated safely and has demonstrated effectiveness in controlling intraocular pressure. SLT received U.S. Food and Drug Administration approval in 2001.

SAN FRANCISCO, August 2004 — The Los Angeles Latino Eye Study (LALES) found the rate of open-angle glaucoma in Latinos age 40 and over comparable to that of African-Americans, with more than 75 percent of sufferers unaware that they even had glaucoma. The study was reported in Ophthalmology, the journal of the American Academy of Ophthalmology.

Also, half of the Latinos who had diabetes also had diabetic retinopathy. One in five had cataracts, and a high prevalence existed of early age-related macular degeneration (though not of advanced AMD).

Although study results were reported as applying to "Latinos," actually the 6,357 people studied were mainly Mexican-Americans, so other Latino population studies could produce different results.

LONDON, August 2004 — Surgery to create a channel in the eye to drain intraocular pressure-causing fluid is one strategy for treating glaucoma, especially in patients who don't respond well to pressure-reducing eye drops. But scarring sometimes occurs after the procedure, often blocking the very channel that was created.

Researchers in London have tested new drugs that mimic the body's immune defense actions on animals and have achieved a success rate of 80 percent, versus the 30 percent success rate they have seen in humans undergoing glaucoma surgery without the drugs. The scientists are planning human clinical trials now. They reported their study results in the journal Nature Biotechnology.

DETROIT, August 2004 — Despite opposition from community leaders and anti-drug groups, a proposal to legalize marijuana use for medical purposes in Detroit passed on August 3 with an approximate count of 38,600 to 26,500. But what many users may not understand is that while the measure allows for possession if a Detroit citizen has a physician-supplied prescription for marijuana, it doesn't change existing county, state and federal laws against possession. So users, even those with a prescription, are still subject to prosecution by county, state and federal authorities.

Marijuana advocates say the substance helps cancer and AIDS patients deal with pain and nausea. They also say it is a glaucoma treatment, but this is disputed by the American Academy of Ophthalmology and most eye doctors, who say that other medications work much better and have fewer side effects. (See October 2003 story below.)

IRVINE, Ca., June 2004 — Istalol, a new liquid topical version of the beta-blocker Timolol, has been FDA-approved for treatment of glaucoma. The drug is designed to be used once a day. ISTA Pharmaceuticals, who will distribute Istalol in the United States, plans to launch the product within a few months, once enough of it has been manufactured. According to ISTA, other Timolol formulations are either liquids that are administered twice a day or gels that may blur patients' vision. The new formulation was developed by Japan-based Senju Pharmaceutical Co.

ALEXANDRIA, Va., February 2004 — Up to 25 percent of the two million Americans with the most common form of glaucoma are under age 50, and as many as half of them may not realize they have the disease. This is according to analysis conducted by the Vision Council of America of published medical literature and data sets that include the 2000 U.S. Census.

This contradicts the common belief that glaucoma affects only elderly people. Researchers say that everyone should be aware of the possibility of glaucoma, including people in their 40s. Other risk factors include being female, African-American and/or Asian.

JACKSONVILLE, Fla., November 2003 — Dr. Rick Bendel, an ophthalmologist at the Mayo Clinic, found that among 83 of his patients who have sleep apnea, 33 percent also have glaucoma. Although the study is small, as a result ophthalmologists may begin to ask patients about sleep disorders on their medical questionnaires. Sleep apnea can affect oxygenation and blood circulation, which in turn can affect the optic nerve.

SAN FRANCISCO, October 2003 — Doctors in the nine states that allow the medical use of marijuana will not be punished for discussing marijuana with patients in the foreseeable future, since the Supreme Court decided not to review a 2002 appeals court ruling allowing such discussions.

Prosecutors had argued that since federal law prohibits growing, selling or owning marijuana and the government is conducting an anti-drug war, doctors should not be encouraging use of the drug. They also said that marijuana has no health benefit.

Some AIDS and cancer patients feel that marijuana relieves pain and fights nausea. While others use marijuana in an effort to lower their intraocular pressure (IOP) to stave off or treat glaucoma, research has not demonstrated that the drug is anywhere near as effective as available legal glaucoma medications. And most medical professionals, including the American Academy of Ophthalmology, say that marijuana's serious side effects (increased heart rate, impaired immune response, addictiveness, poor pregnancy outcomes, emphysema-like lung changes, higher cancer risk, etc.) do not justify its use in lowering IOP.

The California doctors who began the original suit a few years ago said the main issue was free speech; prosecutors said that it was a matter of public health.

NEW YORK, September 2003 — Wearing a tight necktie can raise your intraocular pressure (IOP) and thereby increase your risk for glaucoma, according to a recent study. It can also cause your doctor to diagnose you with ocular hypertension or even glaucoma when you don't actually have it, the study's authors reported in the August 2003 issue of British Journal of Ophthalmology.

They looked at 20 men with glaucoma and 20 without. With each patient, the researchers measured his IOP with an open shirt collar, then tightened the necktie to the point of "slight discomfort." After three minutes, they measured his IOP again. Then they loosened the tie, waited three more minutes and measured his IOP a third time. Sixty percent of those with glaucoma had increased IOP with the necktie on, and 70 percent of normal patients did as well. Loosening the necktie caused IOP to go down in most patients of both groups.

The researchers said that wearing a tight necktie "as a normal preference in daily life ... could lead to a sustained increase in IOP" and optic nerve damage due to glaucoma. In addition, wearing a tight necktie during your eye exam could temporarily elevate your IOP, leading to possible false diagnoses of ocular hypertension and glaucoma.

NEW BRUNSWICK, N.J., May 2003 — Inhibiting a gene called Factor 5A has the potential to prevent blindness from glaucoma, a recent study by Senesco Technologies suggests. Blindness results from damage to the optic nerve due to apoptosis (cell death); the study found that inhibiting Factor 5A reduced apoptosis by up to 70 percent in cells taken from human eyes.

IRVINE, Calif., March 2003 — The drug bimatoprost is more effective at lowering intraocular pressure (IOP) in patients with ocular hypertension and glaucoma than latanoprost, a recent study found.

Bimatoprost 0.03% and latanoprost 0.005% are doctors' leading choices for IOP reduction. Researchers randomly assigned the two to a total of 269 patients, who took the drugs for six months. The percentage of patients whose IOP decreased by 20 percent or more was 69 percent to 82 percent with bimatoprost and 50 percent to 62 percent with latanoprost.

The researchers, who reported their findings in the January 2003 issue of American Journal of Ophthalmology, noted that only 11 patients discontinued the drugs due to adverse events (six with bimatoprost; 5 with latanoprost).

The study was supported by Allergan, which sells bimatoprost under the brand name Lumigan. Investigators did not know which drugs the study participants were receiving.

BRESCIA, Italy, March 2003 — Gingko biloba seems to improve visual field damage in some patients with normal-tension glaucoma, according to a recent small study.

Some of the 27 study participants received capsules of Gingko biloba extract for four weeks, waited eight weeks, then received four weeks of placebo; the rest of the 27 participants took the placebo first, followed by the Gingko biloba. Some patients' scores on visual field tests improved following the Gingko biloba treatment.

The study researchers reported their results in the February 2003 issue of Ophthalmology.