Efficacy of Netarsudil in Open and Closed Angle Glaucomas Within the Vietnamese Population: A Single-Center, Retrospective Study

Purpose: To compare the intraocular pressure (IOP)–lowering efficacy and safety of netarsudil, a Rho-associated kinase (ROCK) inhibitor, among eyes with open-angle glaucoma (OAG), combined-mechanism glaucoma (CMG), and angle-closure glaucoma (ACG) in a predominantly Vietnamese population. Patients and Methods: A retrospective chart review was performed of eyes diagnosed with OAG, CMG, or ACG and treated with netarsudil (Rhopressa or Rocklatan) between 2018 and 2024 at a single glaucoma specialty clinic in San Jose, California. Baseline demographics, IOP, visual acuity, and cup-to-disc ratio were collected. The primary outcome was mean IOP reduction at 6 months. Secondary outcomes included discontinuation due to adverse effects and uncontrolled IOP requiring additional therapy or surgery. IOP values were adjusted using an estimated value for medication changes following ROCK inhibitor initiation. Mixed-effects linear regression and parametric survival models were used, adjusting for baseline covariates and IOP. Results: A total of 235 eyes were included: 116 with OAG, 66 with CMG, and 53 with ACG. The mean patient age was 74.9 ± 9.4 years, with 90% identifying as Vietnamese. Mean IOP reduction at 6 months was similar across groups (OAG: 4.2 ± 3.9 mmHg; CMG: 3.4 ± 4.1 mmHg; ACG: 4.3 ± 5.0 mmHg; p> 0.05). After adjustment for baseline IOP and covariates, no statistically significant differences were found. Discontinuation due to adverse effects occurred in 16% of OAG, 14% of CMG, and 8% of ACG eyes (p> 0.05), with conjunctival hyperemia most common. Rates of uncontrolled IOP were also similar among groups (p> 0.05). Conclusion: Netarsudil and its combination therapies demonstrated no significant difference in IOP reduction and tolerability across OAG, CMG, and ACG. These findings support its use as an adjunctive therapy regardless of angle configuration and highlight the need for prospective studies in Asian populations. Keywords: ROCK inhibitor, intraocular pressure, open-angle glaucoma, angle-closure glaucoma, combined-mechanism glaucoma