Reviewed by Sahar Bedrood, MD, PhD
Glaucoma physicians are on the verge of stepping into the future with the development of alternative delivery methods associated with glaucoma medicines underway, according to Sahar Bedrood, MD, PhD, a glaucoma specialist at Advanced Vision Care and an adjunct assistant clinical professor of ophthalmology at the USC Roski Eye Institute in Los Angeles.
This development of alternative delivery methods is a major event considering that it took 100 years for timolol to be developed, she pointed out. This was not so quickly followed by the particular prostaglandins 30 years ago, combination drops, and the most recent rho kinase inhibitors.
Currently, a leap forward occurred with typically the availability of intracameral drug shipping into the anterior chamber and sustained-release products.
In addition , anti-glaucoma drug shipping and delivery also may be possible via other options such as a drug-eluting device anchored into the angle, contact lenses containing glaucoma drugs, this canalicular approach, and port delivery Bedrood reported.
On the market
Intracameral sustained delivery associated with bimatoprost SR (Durysta, Allergan) is now available. The drug, which is on a biodegradable polymer, requires 1 administration into often the anterior chamber and releases drug for up to 15 weeks. Longer efficacy has been reported in a subset of patients. “In these patients, no drug is in the eye, but your efficacy will be thought to be related to remodeling of the exact trabecular meshwork resulting in chronic lowering regarding the IOP, ” Bedrood explained.
Bedrood reported that the 24-month phase 1/2 clinical trial involving bimatoprost SR showed that 1 implant lowered the IOP for up to 1 year in 40% of individuals and at 2 years in 28% connected with patients with a second implant. 1
This particular implant is placed into the particular eye typically during an office procedure. She described that typically the needle is usually inserted within the same manner as when performing a paracentesis, with this exception that will the surgeon aims inferiorly to avoid going behind often the iris or through the pupil (video).
Not yet marketed
Travoprost (iDose TR, Glaukos), a drug implanted in to the angle, is intended to provide continuous drug distribution. The implant was found to become safe and effective for 24 months. The implant can be replaced when the drug is definitely depleted. The particular 36-month analysis showed a mean IOP decrease of 8. 5 mm Hg of fast- and slow-eluting membranes. A phase 3 trial is currently underway.
In the future, the travoprost device will deliver a bigger drug payload and longer duration with effect.
The future also holds promise of an intracameral hydrogel implant for travoprost. This specific implant is intended to release the medication over a 47-month period.
Sustained-release steroids intended for postoperative glaucoma care are also on the horizon. Typically the dexamethasone ophthalmic implant (Dextenza, Ocular Therapeutix) is an intracanalicular insert placed in to the lower lacrimal punctum that is designed to release the steroid over 30 days.
Dexamethasone intraocular suspension is positioned under the iris to provide a long duration about steroid treatment.
Intravitreal injections of glaucoma drugs are not however available, but , she believes, they are usually in the pipeline.
“Port supply of glaucoma drugs seems to end up being an ideal way to deliver drugs in order to glaucoma patients in your long term, ” Bedrood explained. “While there is nothing on the horizon for that at the moment I believe the exact future in glaucoma includes investigation directly into that medicine delivery system” she stated.
Bedrood concluded that the alternative measures are very much a reality.
“They are in the early stages from development plus will be developed over time, ” he came to the conclusion. “We need this with regard to better patient adherence, better 24-hour control of IOP, and to lower the therapeutic costs. ”
Sahar Bedrood, MD, PhD
This article is adapted from Bedrood’s presentation at the American Society of Cataract in addition to Refractive Surgery’s recent annual meeting in Washington DC. She is the speaker consultant for Allergan/Abbvie and Glaukos.
one Craven ER, Walters T, Christie WC, et al., Bimatoprost SR Study Group . 24-Month phase I/II clinical trial of bimatoprost sustained-release pelisse (bimatoprost SR) in glaucoma patients. Drugs 2020; 80: 167-79; doi: 10. 1007/s40265-019-01248-0.