Page 42 - 21st Century Perspective - Glaucoma Supplement
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Carbonic anhydrase inhibitors, like beta-blockers, and to some degree, alpha-2 adrenergic receptor
agonists, all suppress aqueous production at the ciliary body. Carbonic anhydrase inhibitors
ultimately reduce IOP about 15%, which is the reason they are used as third- or fourth-tier therapy
options. Like the alpha-2 adrenergic agents, carbonic anhydrase inhibitors are also FDA-approved
for three-times-daily administration, but they are commonly prescribed twice daily, since the third
drop would be instilled near bedtime. There is some evidence of a weak reduction in IOP during the
sleep cycle, but without solid evidence as to optimum dosing, we question the wisdom of an
encumbering third dose and attending expense balanced against efficacy.
Rho-kinase inhibitor
The final category contains a single-entity drug, Rhopressa (netarsudil ophthalmic solution 0.02%,
Aerie Pharmaceuticals). Rhopressa (Figure 25) is a Rho-kinase inhibitor, which is thought to
enhance the trabecular meshwork egress of aqueous humor. This drug was approved in late 2017
and is now available.
Figure 25. Rhopressa Rho-kinase inhibitor.
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