What’s next in glaucoma treatment?
Over the last 30 years the way glaucoma is treated has drastically evolved and the next 30 years are bound to bring as much change, if not more, said Sahar Bedrood, MD, PhD during a presentation at Hawaiian Eye and Retina 2021.
Pilocarpine was established in 1875 and it took 100 years before timolol was developed. From there, glaucoma has seen prostaglandin in 1997, combo drops from 1998-2014, rho-kinase inhibitors in 2017, and now sustained release and intracameral implants.
“Ultimately, now we’re really on the precipice of discovery and real change in the way that we manage glaucoma and deliver drugs to the patients,” said Dr Bedrood.
Dr Bedrood discussed several drug delivery systems and treatments that, although not on the market yet, are showing promise in clinical trials.
The iDose TR sustained release travoprost implant (Glaukos) is designed for continuous drug delivery with duration of up to 2 years. In a phase 2 trial, the 24-month outcomes showed an average IOP reduction of 29% and 28% from baseline for fast- and slow-release iDose TR arms, respectively, compared to a 30% reduction in the timolol control arm.
An intracameral travoprost implant (OTX-TIC; Ocular Therapeutix) with a target duration of drug delivery of 4-6 months is also currently undergoing clinical evaluation.
Although it is not developed yet, Dr Bedrood said she thinks a port delivery system for glaucoma, similar to the ones used in AMD, would be beneficial. In addition, innovations regarding intravitreal injections of beta blocker, lacriaml plugs, and contact lens/drug eluting rings may have a future in glaucoma treatment.
“There are so many choices and so much innovation on the market and we know that all of this takes the burden off the patient and on to the doctor,” said Dr Bedrood. “We have to think about the shift in your discussions with the patients, with the paradigm shift in how we really treat glaucoma.
Other topics that will need to be addressed as new innovative glaucoma therapies come to market are patient hesitancy in adopting them and overall changes to care time and health care costs.
Bedrood S. Glaucoma drugs and drug delivery. Presented at: Hawaiian Eye and Retina 2021