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Glaucoma pharmaceutical<br />
market expected to generate<br />
$6.1B by 2020<br />
The global glaucoma<br />
pharmaceutical<br />
market is expected<br />
to climb from around<br />
US$4.7 billion ($7.2 billion)<br />
in revenues in <strong>2015</strong> to nearly<br />
US$6.1 billion ($9.3 billion) in<br />
2020 with most of the growth<br />
predicted to come from China,<br />
India, and Latin America.<br />
Although revenues have<br />
decreased in recent years<br />
as generic versions of<br />
prostaglandins have reached<br />
the market in the US, the<br />
overall market is now poised<br />
for growth, according to<br />
international market data<br />
company, Market Scope.<br />
Factors driving these changes<br />
include: aging of world<br />
populations; increasing<br />
urbanisation in emerging<br />
markets and the developing<br />
world; increasing rates of high<br />
myopia; increased access to<br />
care in the developing world,<br />
CONTINUED FROM P20<br />
24 months UCVA fell below baseline and BCVA<br />
returned to baseline. 12 Transepithelial CXL with<br />
ionotophoresis has shown an improvement in<br />
UCVA, BCVA and refractive astigmatism of 0.13<br />
LogMAR (1 line), 0.05 LogMAR (0.5 line), and 0.49D,<br />
respectively at 12 months. 7,9<br />
AS-OCT<br />
As previously mentioned, an apparent demarcation<br />
between treated and untreated corneal stroma<br />
is observable with IVCM, a similar demarcation<br />
line is observable on anterior segment optical<br />
coherence tomography (AS-OCT) (Figure 4). Though<br />
not definitively established, it is believed the<br />
demarcation line indicates how deep the crosslinking<br />
effect has occurred. If this is indeed the<br />
case, it has not yet been determined if there is<br />
an ideal or minimum depth of the demarcation<br />
that would likely result in a successful outcome.<br />
When the Dresden protocol is utilised, the depth<br />
of the demarcation is usually around 300µm. 13<br />
Accelerated CXL modalities reveal a shallower<br />
demarcation. It appears that with increasing<br />
intensity, the demarcation line is shallower and<br />
more variable. With the 18 mW/cm 2 and 30 mW/<br />
cm 2 intensities the average depth of demarcation is<br />
observed at 203µm 2 and 184-201µm, 2,4 respectively.<br />
Similar to accelerated CXL, the demarcation line is<br />
shallower following transepithelial CXL, compared<br />
to the Dresden protocol. In fact 50% of corneas<br />
treated with transepithelial CXL do not display<br />
any demarcation line, even when ionotophoresis<br />
is utilised. 4 Corneas treated with transepithelial<br />
CXL utilising ionotophoresis demonstrates a<br />
demarcation line at 212µm on average, when<br />
present. 4 As previously stated no minimum depth<br />
of demarcation for CXL to be effective has been<br />
revealed thus far hence a possible advantage<br />
of current accelerated and transepithelial CXL<br />
protocols is that they may be employed safely on<br />
corneas
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