Q&A: New Medications for Glaucoma

Vyzulta® (latanoprostene bunod 0.024% ophthalmic solution) was FDA approved on November 2, 2017. Rhopressa® (netarsudil 0.02% ophthalmic solution) was FDA approved on December 18, 2017.

One drop is instilled every evening into the affected eye(s).

Latanoprostene bunod is a molecule that is broken up after it is placed onto the eye into two active components. One component, latanoprost, is a commonly used medication to lower eye pressure that improves drainage through a pathway known as uveoscleral outflow. Also produced is nitric oxide, a molecule produced normally in the human body that relaxes cells in the drainage angle of the eye, allowing improved drainage through the traditional outflow pathway.

Netarsudil performs a similar function to nitric oxide in relaxing trabecular meshwork cells in the drain of the eye, and there is some overlap in the effect of netarsudil and nitric oxide.

These medications present a new mechanism for improving drainage of fluid out of the eye. They both have shown to lower pressure significantly and compare well to current medications. As they work in a unique way, these medicines may have the potential to further lower eye pressure in patients already using other glaucoma medications.

The most common side effects are typically mild and limited to the eye. Vyzulta has side effects similar to the latanoprost component alone, including redness in and around the eye, eyelash growth, permanent darkening of iris color, and irritation. Rhopressa may cause redness and irritation as well as pigmentation in the cornea, which tends not to affect vision.

Editor’s note: While these new medications may be very effective in some people, they may not work for everyone and, because they are relatively new to the market, they are expensive and may not be covered by insurance. The contents of this article do not constitute medical advice, and treatment should be given under a doctor’s supervision. Please discuss any possible side effects with your doctor.

Article by Mark Werner, MD.
Posted on May 1, 2019; Reviewed on April 7, 2022.