0.002% OMDI eye drops has potential to significantly reduce IOP in Normal Tension Glaucoma

New research found that using 0.002% Omidenepag Isopropyl (OMDI) eye drops in patients with normal tension glaucoma (NTG) having low intraocular pressure has further reduced the intraocular pressure after 6 months of usage. The IOP reduction was significant and stable. The study results were published in the Journal of Glaucoma. 

Lowering intraocular pressure (IOP) is the only proven therapy for glaucoma with the goal of halting or slowing the progression of visual field abnormalities. This is achieved by eye drops, oral medicines, laser treatments, and surgery. Prostaglandin analog eye drops like omidenepag isopropyl is the first-line medication because they have a strong efficacy in lowering IOP. Hence researchers from the Department of Ophthalmology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Korea conducted a study to analyze the efficacy and safety of 0.002% omidenepag Isopropyl (OMDI) eye drops in patients with normal tension glaucoma (NTG). 

Medical records for 62 eyes treated with OMDI for ≥6 months were analyzed. Intraocular pressure (IOP), refraction, keratometry, central corneal thickness (CCT), endothelial cell count, coefficient of variation of endothelial cell area (CV), corneal erosion, and central retinal thickness were compared at baseline and 1, 3, and 6 months. 

Key findings: 

• A significant decrease in IOP from 13.4±3.8 to 11.9±3.0, 11.7±2.9, and 12.2±3.3 mm Hg at each follow-up was seen (P<0.001).
• Though endothelial cell count did not change, CV has transiently increased from 12.6 to 17.0 at 1 month, CCT increased from 531.5 to 538.4 μm, myopia changed from −1.5 to −1.9 D, and keratometry changed from 44.5 to 44.7 D.
• CV, myopia, and keratometry recovered to baseline at 6 months; however, CCT remained high.
• Significant corneal erosion was observed at 6 months.
• There were not many observable central retinal thickness changes.
• There were improvements in prostaglandin-associated skin pigmentation (86.7%), eyelash elongation (40.0%), and deepening of the upper eyelid sulcus and ptosis (~30%) at 3 months after exchange to OMDI. 

Adverse reactions were corneal erosion (27.4%), corneal thickening (21.0%), conjunctival hyperemia (11.3%), photophobia (5.7%), blurred vision (5.7%), anterior chamber cells (4.8%). 

Thus, in NTG patients having low IOP use of OMDI eye drops has elicited significant and stable reductions after 6 months. The researchers also suggested to consider transient myopic and corneal endothelial cell changes, development of corneal thickening, and corneal erosion when using OMDI drops. 

Further reading: Lee, Seung Hyeun MD*; Lee, Won Jun MD*; Kim, Kyoung Woo MD, PhD*; Jeong, Jae Hoon MD, PhD†; Park, In Ki MD, PhD‡; Chun, Yeoun Sook MD, PhD*. Influence of 0.002% Omidenepag Isopropyl on Intraocular Pressure and the Cornea in Normal Tension Glaucoma. Journal of Glaucoma 32(4):p 245-251, April 2023. | DOI: 10.1097/IJG.0000000000002167