ROCK and role: the place of Rho-kinase inhibitors in glaucoma care

Moorfields Eye Hospital consultant ophthalmic surgeon, Sana Hamid, outlined the role of Rho-kinase (ROCK) inhibitors in glaucoma care during her 100% Optical presentation (28 February, Excel London).

Explaining how ROCK inhibitors work, Hamid noted that the drug alters the cytoskeleton of Schlemm’s canal – reducing the mechanical tension and stiffness of cells.

She added that this increases aqueous humour outflow and lowers outflow resistance, while a similar effect is seen within the trabecular meshwork.

“Because it works on relaxing smooth muscles, it also relaxes the blood vessels so it has a vasodilatory effect,” Hamid said.

She shared that ROCK inhibitors are the first intraocular pressure (IOP)-lowering medication that has been approved by the US Food and Drug Administration since latanoprost in the 1990s.

Hamid noted that the main side effect observed through clinical trials was conjunctival hyperaemia.

She shared that Roclanda – a combination of latanoprost and the ROCK inhibitor, netarsudil – was launched in the UK in June 2023 following regulatory approval.

It is indicated for use in adult patients with primary open-angle glaucoma or ocular hypertension who are not able to achieve sufficient IOP reduction with latanoprost alone.

Hamid outlined the experience of 94 Moorfields Eye Hospital patients who received Roclanda prescriptions between November 2023 and April 2024.

She noted that 19 patients discontinued Roclanda before or as a result of their first review, while 51 patients discontinued the drug during their follow-up period.

She highlighted that the main reason for discontinuation of Roclanda was due to side effects.

“In the patients who did not discontinue, they did experience an IOP reduction of 14 to 35%,” Hamid shared.

“The majority of the patients in this group were either about to have surgery or needed surgery, but this was used as a last resort. In patients who were not in that situation, we may potentially have seen further benefits,” she observed.