At Hill Vision Services, we are proud to offer two, new, groundbreaking glaucoma medications representing entirely new classes of glaucoma medications. Vyzulta (latanoprostene bunod ophthalmic solution 0.024%) and Rhopressa (netarsudil ophthalmic solution 0.02%) are both promising glaucoma therapies that lower eye pressure by targeting the diseased tissue in glaucoma patients— the trabecular meshwork.
To understand these new medications, let’s first describe how the gold standard of glaucoma medications, prostaglandins, accomplishes reduction of intraocular pressure. If we think of eye pressure and its control as a plumbing system, there is a “faucet” that produces fluid(the aqueous humor)and a drain(actually two drainage systems-the primary, trabecular meshwork and the secondary, uveoscleral outflow path). While some medications “turn off the faucet,” others reduce intraocular pressure by increasing flow through the drain. Prostaglandins work, primarily, by increasing flow through the secondary, uveoscleral path.
While all of these types of medications will result in lowered eye pressure, none of the “older” glaucoma medications targeted the trabecular meshwork, the primary pathway for aqueous humor drainage. Both new medications make this drainage more effective, but they do it by a slightly different mechanism.
What is Vyzulta?
Vyzulta is somewhat of an “updated” prostaglandin analogue with its addition of a nitric oxide component. Nitric oxide helps to dilate blood vessels in the eye which, in turn, increase oxygen supply to the optic nerve as well “relax” the trabecular meshwork, improving drainage of the aqueous humor.
Vyzulta is appropriate as either a first-line treatment option for patients with glaucoma or ocular hypertension, or as an adjunct in patients requiring more than one medication. It is used once daily and has few side effects
Vyzulta might be good for patients who have found success on the prostaglandin, but maybe they’ve lost a bit of its efficacy. Vyzulta may allow additional lowering of eye pressure in order to get back into a safer range.
What is Rhopressa?
Like Vyzulta, Rhopressa is a once-daily eye drop; it is, however, a different class of drug than we’ve ever had before. Rhopressa is a kinase inhibitor, also known as ROCK inhibitor, which helps to lower eye pressure by relaxing the trabecular meshwork and the canal that drains the aqueous humor from the anterior chamber of the eye. This decreases the resistance of drainage in the conventional outflow pathway, thus lowering eye pressure.
Rhopressa might be a good alternative for patients who have tried a prostaglandin analogue and found out that they have an allergy or sensitivity to the medication. Rhopressa also combines well with other types of glaucoma drops.
Is Vyzulta or Rhopressa Covered by Insurance?
Until recently, Rhopressa and Vyzulta had been utilized when regular eye drops were tried without success and many insurance carriers did not cover it. Over time, however, insurance coverage has increased. Please check with your insurance provider.
Talk to Your Doctor to See if These New Glaucoma Medications are Right For You
Once you are diagnosed with glaucoma, you usually require treatment for the rest of your life. Once daily dosing with Vyzulta or Rhopressa is a convenient way to manage your glaucoma routine.
There may be a lot of trial and error in finding the right glaucoma drop for patients. At Hill Vision, we have years of experience in managing glaucoma patients and are sure to make the proper decisions in your care. Contact us now to see if Vyzulta or Rhopressa is right for you!