New drug delivery technologies may improve compliance in glaucoma patients
“There’s some good news on the horizon with drug delivery, whether its extra-ocular, intraocular or by implant,” he said.
Interventional technologies and strategies allow for safer IOP-lowering with sustained release drug delivery, he said.
“Getting patients to a lower IOP and keeping them lower is a good place for them to be,” Ahmed said. “We can push back their time of visual disability by intervening earlier and getting them lower, and that will have a greater effect throughout a patient’s lifespan.”
Disease progression can vary in patients, he said. The retinal nerve fiber layer shows damage first in some patients, but in others the ganglion cell complex can be first. “Look at both of them,” Ahmed said.
The rate of progression is unacceptably high, and medication adherence remains a major obstacle in glaucoma treatment, he said. Compliance is a problem.
“People who don’t take their medicine progress in their disease, and it costs more to take care of that patient,” he said. “Although I may be advocating for more expensive devices earlier on in treatment, when you think about the entire cost across the patient’s lifetime in their disease, it makes sense.”
Punctal plugs are being explored, and the Evolute device by Mati Therapeutics is currently undergoing further trials. It elutes drugs for 3 months and addresses adherence in a safe way, but can create ocular surface issues, he said.
The Bimatoprost Ocular Ring Insert (Allergan) is effective at lowering IOP, Ahmed said. “The IOP results were not dramatic compared to timolol, but it can address adherence.”
Allergan’s Bimatoprost SRv is an implant placed in the anterior chamber that absorbs over time. It can deliver drug for 6 months, and multiple injections can be performed.
“It’s not just simply replacing medication for 6 months, it’s much more than that, and I think you’ll really love it. This is really helping us to address disease and adherence,” he said.
Another option, iDose from Glaukos, is an injectable implant that elutes drug potentially for years and is refillable. It may provide long-lasting results and can be interchanged and refilled, he said.
“These are all technologies on the horizon, and the data seems to be quite good,” Ahmed said. – by Abigail Sutton
Ahmed, I. Glaucoma and MIGs. Presented at: SECO; February 20-24, 2019; New Orleans.
Disclosure: Ahmed is a consultant for: Acucela, Aerie, Alcon, Allergan, ArcScan, Bausch + Lomb, Beaver Visitec, Carl Zeiss Meditec, Centervue, ElutiMed, Equinox, ForSight Labs, Glaukos, Gore, Iantech, InjectSense, Iridex, iStar, Ivantis, Johnson & Johnson, KeLoTec, LayerBio, Leica Microsystems, New World Medical, Omega Ophthalmics, PolyActiva, Sanoculis, Santen, Science Based Health, Sight Sciences, Stroma, TrueVision and Vizzario. He receives research support from: Alcon, Allergan, ArcScan, Carl Zeiss Meditec, Glaukos, Iridex, Ivantis, Johnson & Johnson, New World Medical and speakers honorarium from: Carl Zeiss Meditec, Glaukos and Johnson & Johnson.