Extraordinary—dare I say paradigm-shifting—changes are streaming by us almost daily. New drug delivery systems, treatments for previously untreatable eye conditions, advanced diagnostics and ground-breaking research are making it harder to know the limitations of patient care. This month’s innovations special issue tackles some of the largest eye disease categories, giving you a sneak peek of your future.
It’s been two decades since we’ve had a new glaucoma drug treatment class or mechanism of action, and we have two approved in one month! Vyzulta (latanoprostene bunod 0.024%, Bausch + Lomb), includes a nitric oxide donor to increase aqueous outflow and works directly on the trabecular meshwork (TM). Rhopressa (netarsudil 0.02%, Aerie Pharmaceuticals), also works directly on the TM to increase aqueous outflow while decreasing aqueous production and inhibiting episcleral venous pressure.
It’s still too early to recommend off-label use, given what little we know about rho-kinase effects on human corneal endothelium, but further investigation may also lead to a future treatment for corneal edema in endothelial diseases.
One of the fastest growing diseases in the United States is macular degeneration, in part due to the aging population and unavoidable genetic influences, but unfortunately also perhaps due to our diets and lifestyle. Macular degeneration is already the leading cause of vision loss in Americans 60 years of age and older, and the incidence is expected to double by 2050.1 In addition, advanced AMD (wet and geographic atrophy) are the leading causes of irreversible blindness and visual impairment worldwide.1 Optometry must play a greater role in patient care, including earlier diagnosis (e.g., dark adaptometry), better monitoring (e.g., home-based Amsler testing), better use of technology (e.g., autofluorescence, OCT-angiography, swept-source OCT) and active treatment. This last group may include new anti-VEGF delivery systems, implantable telescopic IOLs or referral to a low vision specialist within our profession.
The CDC expects the number of people with diabetes in the United States, already more than 30 million, to triple by the year 2050.2 As the quarterback for diabetic retinopathy and the physician/specialist communication, optometrists must prepare for this. Advanced digital imaging—from higher resolution and ultra-widefield testing to OCT—in conjunction with a dilated fundus exam, will all be crucial in early diagnosis and treatment.
According to the American Thyroid Association, more than 12% of Americans (more than 20 million people) will develop a thyroid condition during their lifetime—and 60% of those with thyroid disease are not yet diagnosed.3 You would be surprised by how many non-responsive ocular surface conditions turn out to later be associated with thyroid disease. This month’s Optometric Study Center comes from a true expert in the field with both clinical knowledge and personal experience.
Finally, we can’t overstate the growing incidence of myopia in the United States and around the world. Because of changing environmental and lifestyle factors, such as digital device use and less time outdoors, its prevalence will only increase. While the issues surrounding vision with high myopia are cause enough for concern, the ocular disease risks such as glaucoma, myopic degeneration, retinal detachment and myopic cystoid macular edema only make this condition more alarming. All clinicians must be prepared to care for this patient population, and evolving standards of care are geared toward controlling myopia in each and every patient.
Innovation is booming—and essential to our future. Heed what’s written here and use it to help boost your knowledge, your practice and, most importantly, your patients.
1. Rein DB, Wittenborn JS, Zhang X, et al. Forecasting age-related macular degeneration through the year 2050: the potential impact of new treatments. Arch Ophthalmol. 2009;127(4):533-40.