This article is more than 5 years old. Information may no longer be current.
BLOG: Get AMPED up
Within the last few years, there has been significant innovation in the field of glaucoma care. What is currently available, along with the products working their way through the pipeline, offers hope to ophthalmologists and our patients for better glaucoma care. One area of therapy that is taking form involves new drug delivery systems. A unique category of treatment in this space includes those that provide medication in a sustained-released fashion but located outside of the eye. I refer to this class of medications as “AMPED,” standing for alternative method, pressure-lowering, extraocular depots.
The AMPED category includes treatment options such as ring inserts and punctal plugs. The therapeutic space for these products is the area in the glaucoma spectrum in which patients are not compliant with eye drops and will achieve sufficient IOP reduction from an extraocular product. As providers, we know noncompliance to eye drops is an important issue of which there are a myriad of factors that contribute to it. Therapy options that remove or reduce some of these causes for noncompliance would be very useful.
Two possible AMPED options could include the Bimatoprost Ring (ForSight Vision5) and Evolute punctal plug (Mati Therapeutics), but there are others. The Bimatoprost Ring is a ring much like a rubber band with a central polymer core that provides support and outer silicone-based composite of slow-releasing bimatoprost. It is dispensed via an office procedure in which the ring is placed under the upper and lower eyelids. Initially patients may feel a foreign body sensation, but soon after placement, the ring molds to the contour of the eye and the sensation resolves. The planned follow-up is to have the patient return to the office in 6 months to remove and replace the ring with another one. Recently released phase 2 studies have shown 20% IOP reduction compared with baseline for 6 months with a single ring, bilateral ring retention of more than 90% and a good safety profile.
The Evolute punctal plug is a silicone punctal plug with a drug-eluting core that can include latanoprost or travoprost for glaucoma. Steroids, NSAIDs and allergy therapeutics have also been formulated and tested in the Evolute system. The elution rate is determined by its matrix. It is placed into the punctum similar to a plug used for dry eye treatment. It is placed in the office, and the patient would be asked to return to have the plug removed and replaced. Phase 2 studies over 12 weeks have shown similar rates of IOP reduction, retention and safety as the Bimatoprost Ring.
The advantages of these AMPED options include:
1. The use of a sustained-released delivery system decreases the concern of nonadherence in glaucoma patients.
2. They are easy to see if they are still in place by both the patient and doctor.
3. They can be easily removed from the eye in the occasional scenario of drug intolerance.
New AMPED products in the glaucoma pipeline may soon provide us with other alternatives for patients who have difficulty with eye drop therapy. The hope with these products is that we can more successfully provide products that will allow patients to remain on the less severe end of the glaucoma spectrum. Ultimately this helps in our lifelong journey with our patients to maintain good functional vision throughout their lives.
It’s time to get AMPED up!
Disclosure: Teymoorian reports no relevant financial disclosures.