My first day at SUNY was the coldest day recorded that winter. I was given a tour of the 12-floor building, which is divided into different specialty clinics. The building itself is situated next to the eminent Bryant Park and New York Public Library, making the views from the university extraordinary.
During my visit to SUNY, I was given the freedom to choose which specialty clinics and cases I wanted to observe. I chose to spend the majority of my time with Dr Richard Madonna and Dr Laura Dull in the glaucoma clinic.
In New Zealand, we are privileged to have a publicly funded health system with subsidised medication. In the United States, this is not the case. Because of this, prescribing glaucoma drops and other medications can be highly influenced by what is covered under the patient’s health insurance. The lack of subsidised medication and an organisation like Pharmac, means there is an abundance of prescription medication in the United States.
During my visit, I learnt about two newly FDA-approved eye drops for primary open angle glaucoma, Rhopressa and Vyzulta. Both have a dual acting mechanism designed to directly target the trabecular meshwork. Vyzulta is formulated to release nitric oxide, which relaxes the trabecular meshwork to increase aqueous flow. There has also been the suggestion that nitric oxide can increase ocular perfusion pressure. While Rhopressa is a rho-kinase inhibitor. Rho-kinase enzymes regulate cell shape and movement. The inhibition of these enzymes initiates the relaxation of the trabecular meshwork and, consecutively, Schlemm's canal, and is thought to promote retinal ganglion cells survival.
I was also impressed by the advanced technology that was available at SUNY. While I was there, I was introduced to SITA-faster and the ocular response analyser. The ocular response analyser is a non-contact tonometer, which can measure the flexibility of the cornea (corneal hysteresis). This value defines the ability of the cornea to absorb and release energy and was found to be lower in patients with any classification of glaucoma, making it a measurable risk factor.
