SECO

SECO

March 06, 2020
4 min read
Save

New technologies change glaucoma treatment paradigm

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.

ATLANTA – Noncontact selective laser trabeculoplasty, a drug-eluting contact lens and a sustained release therapeutic under development may expedite glaucoma management and increase compliance, according to a panel of experts here at the OIS@SECO meeting.

The first human trial was just completed for the Belkin Laser Direct SLT, a noncontact, automated, rapid selective laser trabeculoplasty (SLT), according to Larry Baitch, OD, PhD, CEO of Medical Vision Technologies, here at the meeting.

“It’s like doing SLT,” panelist Robert Noecker, MD, MBA, said, “but it gets you away from the problem of putting the lens on the eyes. Some patients have issues with that. It makes it a more standard treatment. It’s the next step up with newer technology.”

“The LiGHT study [Gazzard et al.] has shifted thoughts on initial SLT for glaucoma,” moderator James Thimons, OD, FAAO, said.

“The study has definitely changed the way we educate patients,” panelist Justin Schweitzer, OD, FAAO, said, “especially newly diagnosed patients. We offer them drops, or I’ll say we also have the option of laser, especially in a younger patient. No matter what we do, it’s not going to last forever. It’s a bridge to the next step.

“Seventy-eight percent of patients reached target pressure on SLT and zero medications in LiGHT,” he continued. “At least have a conversation about it.”

Panelist Mitch Ibach, OD, FAAO, calls SLT “interventional glaucoma.”

“In our practice, we’re underutilizing SLT, considering the data that was so impactful from the LiGHT study,” he said. “Secondary glaucoma interventions were less in the SLT group, as well as cost.”

Presenter Chris Adams, co-founder and CEO of Diopter Corp., said the Diopter contact lens, which is impregnated with a glaucoma therapeutic, completed phase 1 trials.

Thimons asked the panelists if they saw sustained release systems “changing the nature of the interface between the doctor and patient.”

“Patient compliance is a huge issue in glaucoma,” Ibach said. “So if we can put the medication on the eye or take it out of the bottle, it’s a huge win. I think about how many patients are already wearing a contact lens.”

He noted that this technology would be a challenge for elderly patients, however.

“I’m excited about this drug delivery,” Schweitzer added. “We know our patients aren’t compliant. A contact lens is in optometry’s wheelhouse. One thing that will be very important for optometrists and ophthalmologists is that we educate our patients on these things because patients have different attitudes about different types of drug delivery devices. The way we word it when we discuss it with patients will be crucial.”

PAGE BREAK

“I always think of customization,” Noecker said. “Eye drops won’t go away. Patients who are diagnosed early and are on one drop once a day do fine with that. If we have more than one drop or failures, that’s where we need these things. It’s a nice bridge before surgery. “

Noecker said his practice often uses bandage contact lenses in older patients.

“A daughter or son could change it out once a week or they can come back to the office and have a tech do it,” he said.

Mitra Sehi, OD, PhD, MBA, director of anterior segment ophthalmology for Allergan, presented information on clinical trials for bimatoprost sustained release (SR), which is administered through a clear cornea with an intracameral procedure.

Before anti-VEGFs, “it was crazy talk, putting a needle in the eye, but now it’s just another day,” Noecker said. “It will start with glaucoma specialists, but then there will be a trickle down.”

Schweitzer said he sees this technology as a component of a three-part offering: topical glaucoma medication, SLT or a device placed inside the eye.

“The data tells the story,” he said. “[Bimatoprost SR is] as good as one drop of prostaglandin.”

Thimons asked the panel to also discuss minimally invasive glaucoma surgery (MIGS).

With multiple options available, Noecker said, “Now we’re figuring out how to customize MIGS for the patient. We have canal-based procedures to open the canal, we can just dilate the canal, we have stents, we’re in the suprachoroidal space now we’re back out and we have transscleral devices.”

“We don’t want to do procedures that will put the eye at more risk than what the glaucoma is going to put the eye at risk for,” Schweitzer noted. “MIGS is middle ground. It bridges the gap between drops or SLT and filtration surgeries.”

Ibach said he and his colleagues are creating a goggle to decouple ocular pressure from atmospheric pressure.

“With the goggle, we can dial in pressure,” he said. “Analogous to a CPAP, patients will wear it at night. It’s the brainchild of John Berdahl, MD.” by Nancy Hemphill, ELS, FAAO

References:

Gazzard G, et al. Lancet. 2019;doi.org/10.1016/S0140-6736(18)32213-X.

Thimons JJ, et al. The coming era for advancements in glaucoma therapies. Presented at: OIS@SECO, Atlanta, Ga., March 4, 2020.

Disclosures: Ibach reports he is a consultant or speaker for Aerie, Allergan, Glaukos, Sight Sciences and Ocular Therapeutix and is an investor in Equinox. Noecker reports he has been a paid consultant to Aerie, Alcon, Allergan, BVI, Bausch + Lomb, Diopsys, Inotek, Iridex, Katena, Mobius, Ocular Therapeutix, Optos, Quantel and SOLX; he has served on the speakers bureau for Alcon, Allergan, BVI, Diopsys, Iridex, Katena, Mobius, Ocular Therapeutix, Optos and Quantel; and he has received research support from Aquesys, Glaukos, InnFocus, Iridex, Lumenis and Ocular Therapeutix. Schweitzer reports he is a consultant for Allergan, Equinox, Glaukos and Sight Sciences. Thimons reports he is a speaker for Aerie, Alcon, Allergan, Bausch + Lomb, Diopsys, Glaukos, Innfocus, PRN, Reichert, Shire, TearLab and Carl Zeiss Meditec.