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OCULAR

THERAPEUTICS

EYE ON NEW DISCOVERIES

This publication has been supported by Alcon Research, Ltd.

OCULAR

THERAPEUTICS

EYE ON NEW

DISCOVERIES

Edited by

THOMAS YORIO,

Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, Texas, USA

ABBOT F. CLARK

Alcon Research Ltd, Fort Worth, Texas, USA

MARTIN B. WAX

Alcon Research Ltd, Fort Worth, Texas, USA

AMSTERDAM • BOSTON • HEIDELBERG • LONDON • NEW YORK • OXFORD PARIS • SAN DIEGO • SAN FRANCISCO • SINGAPORE • SYDNEY • TOKYO

Academic Press is an imprint of Elsevier

360 Park Avenue South, New York, NY 10010-1710 84 Theobald’s Road, London WC1X 8RR, UK

30 Corporate Drive, Suite 400, Burlington, MA 01803, USA 525 B Street, Suite 1900, San Diego, California 92101-4495, USA

First edition 2008

No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means electronic, mechanical, photocopying, recording or otherwise without the prior written permission of the publisher

Permissions may be sought directly from Elsevier’s Science & Technology Rights Department in Oxford, UK: phone (+44) (0) 1865 843830; fax (+44) (0) 1865 853333; email: permissions@elsevier.com. Alternatively you can submit your request online by visiting the Elsevier web site at http://elsevier. com/locate/permissions, and selecting Obtaining permission to use Elsevier material

Notice

No responsibility is assumed by the publisher for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions or ideas contained in the material herein. Because of rapid advances in the medical sciences, in particular, independent veriﬁcation of diagnoses and drug dosages should be made

British Library Cataloguing in Publication Data

A catalogue record for this book is available from the British Library

Library of Congress Cataloging in Publication Data

A catalog record for this book is available from the Library of Congress

ISBN: 978-0-12-370585-3

For information on all Academic Press publications visit our web site at books.elsevier.com

Typeset by Charontec Ltd (A Macmillan Company), Chennai, India

www.charontec.com

Printed and bound in Slovenia

Contents

Contributors xi

Preface xv

SECTION I. GENERAL PRINCIPLES AND THERAPEUTIC TARGETS

1. The Eye as a Drug Target				3
Thomas Yorio, Abbot F. Clark and Martin B. Wax
2. Drug Delivery Systems in Ophthalmic Applications							7
Alan L. Weiner
I.	Introduction		7
II.	Mechanics of Delivery Systems and Their Administration							13
III.	Delivery Systems for Ocular Disease					16
IV.	Conclusions		29
V.	References		30
3. IOP as a Target – Inﬂow and Outﬂow Pathways							45
Iok-Hou Pang and Abbot F. Clark
I.	Glaucoma: IOP as a Risk Factor				46
II.	Basic Mechanisms of Aqueous Hydrodynamics						46
III.	Overview of Currently Available Glaucoma Medications							48
IV.	Prostaglandin Analogs (PGAs)				49
V.	β-Blockers		49
VI.	α2-Agonists		50
VII.	Topical Carbonic Anhydrase Inhibitors					50
VIII.	Cholinergics		50
IX.	Epinephrine and Analogs			50
X.	Recent Development in Future Ocular Hypotensive Medications								51
XI.	Cytoskeleton Acting Agents				51
XII.	Protein Kinase Inhibitors			53
XIII.	Statins	54
XIV.	Serotonergic Agonists			55
XV.	Activators of Extracellular Matrix Hydrolysis						56
XVI.	Compounds that Increase Cyclic GMP					57
XVII.	Cannabinoids		59

CONTENTS

XVIII.	Identiﬁcation of New Therapeutic Targets Based on Understanding
	Disease Pathogenesis		60
XIX.	Conclusions	62
XX.	References	62
4. The Ciliary Body: A Potential Multifaceted Functional Neuroendocrine Unit					69
Thomas Yorio, Ganesh Prasanna and Miguel Coca-Prados
I.	Introduction	69
II.	Ciliary Epithelial Peptides and Aqueous Flow			72

III.New Frontiers of Ciliary Body Research: Retinal Progenitor Cells and

		Ocular Stem Cells		79
IV.		Acknowledgments		80
V.		References	80
5.	Growth Factors and Neurotrophic Factors as Targets				87
Robert J. Wordinger and Abbot F. Clark
I.		Growth Factors		87
II.		Expression and Function of Growth Factors in Ocular Tissues				94

III.References 109

SECTION II. VISUAL PATHWAY

6. New Therapies for Dry Eye Disease				119
Gary N. Foulks
I.	Introduction	119
II.	Historical Perspective		119
III.	Enhanced Tear Stabilizers and Ocular Surface Protectants				120
IV.	Anti-Inﬂammatory Medications			122
V.	Conclusion	129
VI.	References	129

7. Refractive Surgery – Corneal Opacity (Haze) after Surface Ablation				133
Steven E. Wilson and Fabricio W. Medeiros
I.	Clinical Disease		133
II.	Clinical Objectives		134
III.	Basic Mechanisms		134
IV.	Current Therapy		138
V.	Future Therapy		139
VI.	Summary	139
VII.	Acknowledgments		140
VIII.	References	140

8. Progress in Preventing Age-Related Cataract				143
David C. Beebe and Ying-Bo Shui
I.	Introduction	143
II.	Age-Related Cataract: At Least Three Different Diseases				145
III.	Causality and Cataracts		147

				CONTENTS			vii
IV.	Investigating Cataracts			147
V.	The Inﬂuence of the Intraocular Environment on Cataract Formation						150
VI.	Risk Factors for Age-Related Cataracts				151
VII.	Final Thoughts		160
VIII.	References	160
9. Myopia Pharmacology: Etiologic Clues, Therapeutic Potential						167
Richard A. Stone
I.	Introduction		167
II.	Clinical Myopia		168

III.Why Myopia? 169

IV.	Basic Research Approaches to Studying Myopia Pathogenesis					171
V.	Pharmacology as an Approach to Myopia Pathogenesis				175
VI.	Pharmacology of Myopia		176
VII.	Eyes with Non-Restricted Vision			186
VIII.	Concluding Thoughts		186
IX.	Acknowledgments	188

X.References 188

SECTION III. INFLAMMATION, IMMUNE SYSTEM AND ANTI-INFECTIVES

10. Immune System and the Eye			199
Jerry Y. Niederkorn and M. Reza Dana
I.	Basic Principles of Regional Immunity in the Eye and Ocular Immune Privilege				199
II.	Immune-Mediated Ocular Diseases			204
III.	References	233

11. Ocular Allergy: Clinical, Therapeutic and Drug Discovery Considerations				239
John M. Yanni and Neal P. Barney
I.	Introduction	239
II.	Allergic Conjunctivitis – Seasonal/Perennial		240
III.	Conjunctivitis	249
IV.	References	265

12. Ocular Inﬂammation in Anterior Segment				275
Shlomit Schaal and Henry Kaplan
I.	Clinical Disease – Anterior Uveitis (Iritis, Iridocyclitis)					275
II.	Clinical Objectives		279
III.	Basic Mechanisms		281
IV.	Current Therapy		290
V.	Future Therapy – Targeting Basic Mechanisms				292
VI.	References	296


13. Posterior Segment Uveitis		301
Russell N. Van Gelder
I.	The Classiﬁcation of Uveitis		301
II.	Types of Posterior Segment Uveitis			302

viii					CONTENTS
III.	Aspects of the Posterior Segment Uveitis Work-Up							305
IV.	Treatment of Posterior Segment Uveitic Disease							305
V.	Future Directions in Treatment of Posterior Uveitic Disease								313
VI.	Summary	313
VII.	Eye on New Discoveries			314
VIII.	References and Further Reading				314
14. New Anti-Infectives for Ophthalmology							317
Barry A. Schlech
I.	Introduction	318
II.	The Ocular Assault		318
III.	The Enemy	318
IV.	Avoiding Ocular Infections				318
V.	Evolution of Anti-Infective Agents					320
VI.	Pharmaceutical Research			321
VII.	Ocular Anti-Infective Research				322
VIII.	The Scourge of Antibiotic Resistance						322
IX.	The Attack Strategies – Antimicrobial Targets							323
X.	Ophthalmic Usage		324
XI.	Anti-Bacterial Agents for Ophthalmology						325
XII.	Novel Approaches		327
XIII.	Anti-Fungal Agents for Ophthalmology						328
XIV.	Anti-Viral Agents for Ophthalmology						328
XV.	Summary	328
XVI.	Acknowledgments		329
XVII.	References	329
SECTION IV. CLINICAL THERAPEUTICS
15. Tissue Repair and Regeneration					333
Peng Tee Khaw, Stelios Georgoulas, Annegret H. Dahlmann, Kamiar Mireskandari,
Maryse Bailly, Julie Daniels, Astrid Limb and Stephen Brocchini
I.	Introduction	333
II.	Basic Healing and Scarring Processes					334
III.	Modulating the Different Stages of Wound Healing and Scarring									334
IV.	The Future: From Repair to Regeneration						357
V.	Summary	358
VI.	Acknowledgments		358
VII.	References	358
16. Therapeutic Drugs for Anterior Segment Ocular Surgery									367
Malik Y. Kahook and Joel S. Schuman
I.	Introduction	367
II.	New Developments in Anterior Segment Anti-Inﬂammatory Medications										368
III.	New Developments in Anterior Segment Antibiotic Medications									369
IV.	New Developments in Treating Dry Eye Syndrome							370
V.	New Developments in Topical Ocular Medication Delivery Systems									370

					CONTENTS					ix
VI.	New Developments in Anterior Segment Surgical Adhesives									372
VII.	New Advancements in Anti-Angiogenic Medications							373
VIII.	The Future	374
IX.	References	374
17. Therapeutic Agents for Posterior Segment Vitrectomy Surgery										377
Lucian V. Del Priore, Henry J. Kaplan and Tongalp H. Tezel
I.	Introduction	377
II.	Normal Vitreous Anatomy and Composition						378
III.	Importance of Posterior Vitreous Detachment						379
IV.	Speciﬁc Agents for Posterior Segment Vitreous Removal								381
V.	Summary	389
VI.	References	389
18. Progress and Prospects in Ocular Gene Therapy							393
Xuyang Liu, Carol A. Rasmussen, Jean Bennett, Curtis R. Brandt, B’Ann T. Gabelt and
Paul L. Kaufman
I.	Introduction	394
II.	Gene Delivery Methods			394
III.	Gene Therapeutic Strategies/Concepts in the Eye						400
IV.	Constraints and Challenges				409
V.	Summary	412
VI.	References	412
SECTION V. RETINAL DISEASES AND NEUROPATHIES
19. Neuroprotection in Glaucoma					423
Joseph Caprioli and Natik Piri
I.	Introduction	423
II.	Neurotrophic Factors Promote RGC Survival						424
III.	RGC Protection from Glutamate Induced Excitotoxicity								425
IV.	Protection from Free Radicals and Nitric Oxide Neurotoxicity									428
V.	Anti-Apoptotic Therapy				429
VI.	RGC Protection with HSP70				432
VII.	Immune Response and Neuroprotection					435
VIII.	Conclusion	436
IX.	References	436
20. Degenerative Retinopathies				443
Gerald J. Chader
I.	Introduction	443
II.	Clinical Disease		443
III.	Clinical Objectives		444
IV.	Basic Mechanisms		445
V.	Current Therapy		447

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