E. Randy Craven
ROME — Fewer drops are in the future of glaucoma treatment, according to one specialist speaking at the OSN Italy meeting. More laser and new injectable sustained-release devices will alleviate the burden of multiple daily medications, improving compliance and consistency of results.
“In the LiGHT trial, 74% of first-line SLT-treated patients remained drop-free at 36 months, and the target IOP was maintained in 93% of visits. One of the biggest things was that surgery was entirely avoided for these patients, whereas with medications 11 patients underwent a surgical procedure. This is a game changer for us,” E. Randy Craven, MD, said.
The next game changer will be sustained delivery implants, one of which, Bimatoprost SR (Allergan), has shown positive results in clinical trials. Craven, who has been involved in the development of this device since its inception, said that pressure reduction was substantial right after initial dosing. He was surprised to find that 40% of the patients maintained their pressure controlled with one single implant at 1 year and 28% were medication-free and did not require re-treatment at 2 years.
Craven showed one case study in which at 24 months there was no visible evidence of the implant in the angle, yet the IOP was still controlled.
“We went back to the literature trying to figure out why did this happen. Years ago, Robert Weinreb and co-workers found that tissue remodeling that occurs in the ciliary body is different when the drug is contained within the eye as compared to when it is delivered by topical drops, so it seems to allow increased spaces and channels for aqueous that we hadn’t seen before,” Craven said.
The years to come will see selective laser trabeculoplasty become more of a first-line treatment before medications, and injectable devices will likely replace drops, he said. – by Michela Cimberle
Craven ER. Moving towards less drops. What is in store? Presented at: OSN Italy meeting; May 24-25, 2019; Rome.
Disclosure: Craven reports he is a consultant/adviser to Aerie Pharmaceuticals, Alcon Laboratories, Allergan, Aqueous Biomedical, Ivantis, Santen and W Gore.