Clinical implications of lowering episcleral venous pressure in the management of glaucoma and the use of Rho kinase inhibitors
- PMID: 40107367
- DOI: 10.1016/j.survophthal.2025.03.003
Clinical implications of lowering episcleral venous pressure in the management of glaucoma and the use of Rho kinase inhibitors
Abstract
There has been limited success in both measuring and modifying episcleral venous pressure (EVP) in clinical practice. Understanding the potential role of EVP in the management of glaucoma for different patients may allow for more individualized treatment approaches. To explore the clinical implications of lowering EVP, an international group of 9 glaucoma experts (the ENGAGE Global Expert Working Group) convened to bridge the gap between the current literature and evidence with clinical opinion and best practices. This review summarizes insights from the group on the effect of current medical therapies on EVP and its potential impact. It also discusses unmet investigational needs to enhance the understanding of EVP, as well as the challenges associated with the measurement and treatment of EVP. Regardless of the relatively modest EVP reductions achieved with current treatments, EVP lowering may have clinical significance in patients with glaucoma, particularly those with low intraocular pressure (IOP). Those who might benefit include patients with elevated EVP; normal-tension glaucoma; undergoing trabecular meshwork bypass surgery, goniotomy, or selective laser trabeculoplasty; or requiring additional IOP lowering to the low teens or with a lower-than-usual target IOP.
Keywords: Aqueous humor outflow; EVP; Episcleral venous pressure; Glaucoma; IOP lowering; Netarsudil; ROCK inhibition; Ripasudil.
Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.
Conflict of interest statement
Declaration of Competing Interest AJS has acted as a paid consultant for Aerie (acquired by Alcon), Allergan, Globe Biomedical, Injectsense, PolyActiva, Qlaris Bio, and Santen, and research support from Aerie, the National Institutes of Health, Nicox Ophthalmics, and Qlaris Bio. MA has received research support from Alcon Japan, Johnson & Johnson, Otsuka Pharmaceuticals, Santen, and Senju Pharmaceutical, and honoraria from Alcon Japan, Crewt Medical Systems, Glaukos, HOYA, IRIDEX, Kowa Pharmaceuticals, Otsuka Pharmaceuticals, Santen, Sato Pharmaceutical, Senju Pharmaceutical, and Wakamoto. APK is supported by the UK Research and Innovation Future Leaders Fellowship, Alcon Research Institute Young Investigator Award, and Lister Institute for Preventive Medicine Award. This research was supported by the NIHR Biomedical Research Centre at Moorfields Eye Hospital and the UCL Institute of Ophthalmology. He has acted as a paid consultant or speaker for AbbVie, Aerie, Allergan, Google Health, Heidelberg Engineering, Novartis, Reichert, Santen, Topcon, and Théa. SCL has acted as a paid consultant or speaker for Aerie, ArcScan, Bausch & Lomb, Dompé, ICare, IRIDEX, and Santen. KM has acted as a paid consultant for AbbVie, Fabrinal, Implandata, iSTAR Medical, New World Medical, Oertli, Santen, and Théa, and has been a speaker for Alcon. AM has received research support from Menicon, Nikon, and SEED, and honoraria from Alcon, Ellex, HOYA, Kowa Pharmaceuticals, Nitto Medic, Novartis, Otsuka Pharmaceuticals, Santen, Senju Pharmaceutical, Topcon, and Viatris Japan.KHP has acted as a paid consultant for Santen, received research grants from AbbVie and Santen, and received honoraria from ArcScan, Novartis, Santen, and Topcon. NP has acted as a paid consultant for AbbVie, Aerie, Alcon, Allergan, Boehringer Ingelheim, iSTAR Medical, Ivantis, Nicox, and Roche, and has been a speaker for AbbVie/Allergan, Alcon, and Santen. He has received instruments from Heidelberg Engineering, Optovue, and Zeiss. RNW has acted as a paid consultant for AbbVie, Aerie, Alcon, Allergan, Amydis, Editas, Equinox, Eyenovia, Iantrek, Implandata, IOPtic, iSTAR Medical, Nicox, Santen, Tenpoint Therapeutics, and Topcon. He receives research instruments from Centervue, Heidelberg Engineering, Meditec-Zeiss, Optovue, Topcon, and Zilia, and has received research grants from the National Institutes of Health, National Institute on Minority Health and Health Disparities, and Research to Prevent Blindness. He has patents licensed to Toromedes and Meditec-Zeiss from UCSD and is a founder of Toromedes.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Medical
Miscellaneous
