About neovascular glaucoma (NVG)
Neovascular glaucoma (NVG), also known as “hemorrhagic glaucoma”, is caused when the surface of the iris and trabecular meshwork is covered with new fibrovascular membranes, causing adhesions in the surrounding iris and hindering the drainage of aqueous humor. Clinically, patients’ new blood vessels are prone to rupture and hyphema will occur repeatedly. Drug treatment and surgical procedures are usually ineffective. As the incidence of cardiovascular disease and diabetes increases, this type of glaucoma is becoming more and more common.
NVG is usually a secondary form of glaucoma and is one of the most difficult types of glaucoma to treat. The biggest challenge is that it cannot be cured. Clinically, abnormal new blood vessels are likely to be formed when patients have retinopathy caused by hypertension and diabetes, ischemic central retinal vein occlusion, ocular ischemic syndrome caused by carotid artery occlusion, etc. The new vessels can even proliferate to the iris and angles and block the aqueous humor‘s drainage path, causing a sudden increase in intraocular pressure (IOP). In patients with certain pre-existing diseases, IOP will also become very high after cataract surgery due to the proliferation of new blood vessels in the eye induced by surgical procedures.
The changes in IOP in these patients are very dramatic. The IOP could originally be controlled with drugs, but suddenly it rises like an out-of-control wild horse to above 50-60 mmHg. Even if all methods are tried, the IOP cannot be controlled. Patients often feel that their eyes are swollen and painful, their nerves are throbbing, their vision is significantly reduced, and their blood pressure may even rise, causing them to have splitting headaches and general discomfort.
In terms of prevalence, according to Shazly and Latina (2009), NVG accounts for 3.9% of all glaucoma cases.
BRM412：anti-angiogenesis by an eye drop
INDICATION
Neovescular Glaucoma (NVG)
MECHANISM
First anti-angiogenesis eye drop formulation to deliver axitinib into the eyes
ADVANTAGES
- eye drop formulation for easy use
- effectively deliver axitinib to the back of the eye
- minimum side effects
- ODD status and 505b2 reg. path
MARKET
- anti-angiogenesis eye drop can be expanded to the nAMD market
- Global market of USD ~ 8.27 billion in 2023, and projected to be USD ~16.83 billion in 2032
COMPETITION
- anti-VEGF long-acting and slow-release products are in development
- Gene and cell therapy also have significant success in late-stage trials
DEVELOPMENT STAGE
Next NVG Phase 2 is scheduled to be initiated this year
Neovascular glaucoma can be treated with IOP-lowering drugs, laser, or surgery. Due to retinal hypoxia, Panretinal Photocoagulation (PRP) can appropriately reduce the formation of new blood vessels in the anterior chamber and may also avoid the need for more complicated surgeries. Inhibiting the growth of new blood vessels at the back of the eyes is also helpful for controlling glaucoma, but it may need repeated dosing to be effective. In addition, in recent years, the “Ahmed valve” has been proven to be effective in controlling IOP. A thin tube of silicon compound is surgically inserted to drain the aqueous humor to the subconjunctiva outside the eyeball for absorption. The prognosis of neovascular glaucoma is not good, and the visual improvement of the affected eye after surgery is limited. This type of glaucoma has a higher surgical failure rate than other types of glaucoma. The purpose of the surgery is only to reduce IOP and improve symptoms such as headaches and eye discomfort.
Treating the actual cause behind the disease can also help reduce the chance of new blood vessels developing. For example, the internal ring resection of the carotid artery can alleviate the condition of carotid artery obstruction. The use of intravitreal injection of “anti-vascular endothelial growth factor” (anti-VEGF) is currently a new treatment trend. Intravitreal injection of anti-VEGF can inhibit neovascularization in the iris and anterior chamber angle for 3 to 6 weeks.
Anti-VEGF is also currently the most effective treatment for neovascular age-related macular degeneration (nAMD), but the intravitreal injection can only be done by a professional physician. In addition, this administration method usually is low in medication compliance due to the patient’s fear of eyeball injection, and side effects such as eye bleeding, infectious endophthalmitis, retinal detachment, and increased IOP.
Therefore, BRM412 eye drops can be administered in a non-invasive way, which will improve the convenience of use and increase patient compliance. If new eye drops can be successfully developed to treat fundus diseases, they will be able to replace the existing intravitreal injection market on a large scale.
