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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
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.
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