Drs. Radcliffe and Ristvedt discuss treatment of glaucoma with iDose TR
Deborah Ristvedt, DO, of Vance Thompson Vision, and Nathan Radcliffe, MD, of New York Eye Surgery Center, spoke with Ophthalmology 360 at the 2024 AAO Annual Meeting about a panel they took part in, titled “iDose TR: The Gateway to Interventional Glaucoma.”
Deborah Ristvedt, DO:
We are here today to talk about iDose TR, which is our pharmaceutical procedural device that is for ocular hypertension all the way to severe primary open angle glaucoma.
Nathan Radcliffe, MD:
This has been the culmination of a lot of work from Glaukos getting it approved, both as a device, medical device, as well as a pharmaceutical. Lots of work, lots of research went into it. I first found out about it 12 years ago and it’s finally here. It’s an exciting time.
Deborah Ristvedt, DO:
That’s kind of something to celebrate Nate, right? Because it really took Glaukos 15 years in development and $500 million investment to come up with something that is kind of life-changing for our patients. You’ve been on the forefront of interventional glaucoma, and I really look to you as a mentor as well as a friend. But what does interventional glaucoma mean and how is the iDose really fitting into our paradigm?
Nathan Radcliffe, MD:
Yeah, well, it is phenomenal. We have a variety of different interventional glaucoma techniques. I think laser and our primary SLT laser, DSLT is a huge step. But once we’ve got our patient under control and they’re not on drops and they’re happy, they’re not having to run to the pharmacy, they don’t have eye irritation or side effects from drops because the laser worked, we kind of want to keep it that way now, right? We don’t want to go backwards. I mean, we’re always going to use drops as we’ve discussed, but having sustained drug delivery and now something that can last years is just remarkably exciting. It delivers such value to the patient.
Deborah Ristvedt, DO:
Yeah. That’s what we’re really focused on is quality of life and quality of care in glaucoma. Nate, you’ve become a real cool kid now, so I’m so glad that you’re here. But let’s talk about the data. How does iDose stand in regards to data? What are we seeing as far as IOP reduction?
Nathan Radcliffe, MD:
Yeah, so it’s a remarkable level of IOP reduction, and this can be done either as a standalone or with cataract surgery. It’s not a MIGS, it’s a drug; it has a J code pressure reduction. What do you tell your patients?
Deborah Ristvedt, DO:
For a lot of our patients, we’re looking for a 20% to 30% reduction for most of our mild to moderate glaucoma patients. What’s so fascinating to me is now we have a procedural pharmaceutical that we can also combine with MIGS delivery to help with that outflow pathway to get a lot of our patients in that mid-teen range. That’s kind of what we saw with iDose. We saw this beautiful anywhere from 6.5 to 8.5 mm reduction in pressure, which was phenomenal. Then even in cataract surgery an additional 10 mm of mercury, which is so neat. Then what is even more fascinating, and I can’t talk enough about the data, is when you look at a topical prostaglandin versus what iDose TR is doing in the eye, we’re also seeing an extra point, point and a half millimeter in reduction in pressure.
Nathan Radcliffe, MD:
Compared to if they were taking the drop. That’s not even mentioning the fact that the quality of IOP reduction when it’s sustained delivery is a much higher quality than drops, which come on and off every day. To me, when I saw the 40% IOP reduction with cataract surgery, I thought to myself, I do Ahmed valves with cataract surgery and don’t always get 40% IOP reduction. This is really remarkable how dramatic and how simple and safe you can get such a big impact on their disease and one that lasts for a long time. It’s easy to share your confidence with the patient when you’re talking to them. I tell them, “You are so lucky that we have access to this phenomenal technology, and wasn’t here a few years ago. It’s been studied, so we know it’s safe, and I think this is going to be very good for you and for the health of your glaucoma.”
Deborah Ristvedt, DO:
It’s so good. That term, IG or interventional glaucoma, do you think that you as a glaucoma specialist will start doing less invasive procedures over time as we adapt direct SLT, drug delivery, MIGS, going back to maybe a second MIGS?
Nathan Radcliffe, MD:
Yeah. Since the iStent came out in 2012, my goal has always been to do less high-risk incisional, glaucoma surgery. Combination MIGS was something very exciting. Again, same principle, we can use multiple safe things instead of one high-risk thing, and here we have this, and it can be combined with other procedures. It’s not a MIGS. It’s separate, so it is possible to combine it with some other angle procedure or as you were saying, with cataract surgery. Then we build, we got multiple safe things going to sort of hold our patients up and keep them out of trouble, change the trajectory of their disease. The earlier in their career as a glaucoma patient, you change the trajectory, the more benefit they experience over a lifetime. You want to think about this certainly for your early patients, and then of course there’s no time you can’t do it, but this isn’t something you want to put off. I think it benefits them right away.
Deborah Ristvedt, DO:
I think that’s what helped me as a comprehensive surgeon who does cataract, but a lot of MIGS, is to have something in my toolkit that is so effective and I can talk to my patient even after cataract surgery to say, “Hey, this is going to be a standalone procedure. I’m going to make a small incision just like I did for cataract surgery and place a procedural pharmaceutical device that’s going to last for up to 3 years.” Patients are really taking on to this interventional glaucoma concept, and I think that gives me more energy to practice that way too.
Nathan Radcliffe, MD:
It’s a great time to be in practice.
