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Expert Interview Glaucoma Recent Developments in Glaucoma An Expert Interview with Kin Sheng Lim Guy’s and St Thomas’ Hospitals, London, UK Kin Sheng Lim Mr Kin Sheng Lim qualified from University of Leicester Medical School and undertook his MD research at University College, London. His general ophthalmology training and doctorate research into glaucoma surgery took place in London and Brighton. He also spent a year completing a post-doctoral fellowship at the Mayo Clinic in Rochester, MN, US, supported by a scholarship from the International Glaucoma Association. For over 10 years, Mr Sheng Lim has headed the Glaucoma Service at St Thomas’ Hospital where he is also currently head of research in the ophthalmology department. His clinical interests are in the treatment of glaucoma and high-volume cataract surgery. He supervises a research team of 10 clinical and support staff and is currently conducting 14 clinical trials into the pathogenesis and new treatment options for glaucoma. Keywords Glaucoma, intraocular pressure, IOP, rho kinase inhibitors, minimally invasive glaucoma surgey, MIGS Disclosure: Kin Sheng Lim has consultancy agreements with Alcon, Allergan, Santen and Ivantis, and currently receives research funding from New World Medical, Iridex, Thea, Alcon and EyeTechCare to declare in relation to this article. This is an expert interview and as such, has not undergone the journal’s standard peer review process. G laucoma continues to exert a heavy disability and economic burden and is the most frequent cause of irreversible blindness worldwide. 1 In 2015, 57.5 million people globally were affected by open-angle glaucoma and this is predicted to increase to 65.5 million by 2020. 2 The prevalence of glaucoma increases with age in all populations and generally more men and people of Hispanic and Black race are affected. Effective treatments to lower and maintain intraocular pressure (IOP) and convenient means of continuously monitoring it remain substantial unmet medical needs. In this expert interview Kin Sheng Lim from Guy’s and St Thomas’ Hospitals, London, UK, discusses the new developments to improve this situation and are therefore of great interest to ophthalmologists and to the wider population who are at risk from glaucoma. Acknowledgments: Medical writing assistance was provided by James Gilbart from Touch Medical Media. Authorship: All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship of this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published. Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any non-commercial use, distribution, adaptation and reproduction provided the original author(s) and source are given appropriate credit. Received: 14 December 2017 Published Online: 22 December 2017 Citation: European Ophthalmic Review, 2017;11(2):87–9 Corresponding Author: Kin Sheng Lim, KCL Frost Eye Research Department, St Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH, UK. E: shenglim@gmail.com Support: This expert interview was not supported by any external funding. TOU CH MED ICA L MEDIA Q: What have been the major developments in pharmacotherapy for glaucoma in 2017? One of the most exciting developments in glaucoma pharmacotherapy over the past 12 months has been the progress in the development of rho kinase inhibitors. The mechanism of action of these treatments has not been fully elucidated but it is entirely different to those of existing medications for glaucoma such as prostaglandins and beta-blockers. Rho kinases are serine/ threonine kinases that have multiple functions within various different cell types throughout the body and are key components in regulating cell shape, motility, proliferation and apoptosis. 3–5 Rho kinases achieve these effects by regulating smooth muscle contraction, which results from their interaction with multiple actin cytoskeletal-related targets. Various studies have shown that loss of rho kinase activity is associated with micromechanical relaxation of cells and disassembly of stress fibres and focal adhesion complexes. 6,7 In the eye, rho kinase increases the contractile properties of trabecular meshwork (TM) outflow tissue. Inhibition of rho kinase activity therefore allows increased aqueous outflow via the TM and decreased intraocular pressure. 5 A variety of different rho kinase inhibitors are in development for use in glaucoma of which, ripasudil and netarsudil are at the most advanced stage. 5 In a one-year open-label study (n=354), ripasudil also produced notable reductions in IOP when given as monotherapy, as adjunctive therapy with prostaglandins, beta-blockers or with fixed combination drugs, and was well tolerated. 8 In two phase III studies (n=1,167), treatment with netarsudil 0.2% once daily, produced significant reductions from baseline IOP (p<0.001) and was non-inferior to timolol twice daily. 9 This treatment was well tolerated, with transient conjunctival hyperaemia being the most frequent adverse event. Based on this evidence, the US Food and Drug Administration (FDA) has recently approved Rhopressa ® (netarsudil) for the treatment of glaucoma in the US. 10 87