Optometry ‘can take back treatment’ with sustained release options for glaucoma

J. James Thimons

Robert J. Noecker

ATLANTA – The arc of glaucoma will be impacted by sustained release delivery methods, as compliance is the biggest contributor to progression, according to J. James Thimons, OD, FAAO, at SECO.

“Sustained release is the future; it’s the future in almost every part of medicine,” he said.

The cost of entry on the drug side and on the FDA side is much lower to get a product through versus that of a new drug, Thimons said.

“We are seeing an explosion in these products,” he added.

This is the next great opportunity, as optometrists can take back treatment, he said.

“It’s no longer a patient’s decision, to do what they want, show up when they like and take the drug when they wish,” Thimons said. “Sustained release puts us in a position where we have some sense that we are getting consistent IOP control over time.”

Evolute (Mati Therapeutics Inc.) is a silicone punctal plug that is nonbiodegradable and nonbioerodable and uses a latanoprost core. It has a 98% retention rate, according to 12-week data, Thimons said.

“When you look at the data from these systems external to the eye, you see IOP curves which are usually a couple of points lower than what we see at peak effect,” co-presenter Robert J. Noecker, MD, said.

The interaction with the prostaglandin analogue receptor is important at relatively high dosing, and then it goes away, he said.

“One of the theories is that when there’s always drug present you get nonspecific binding. We know some prostaglandin receptors lower pressure, some raise it,” Noecker said. “I think the binding tends to be less specific.”

It is important to have pulsation to get maximum IOP lowering, he said.

Optometrists need to decide clinically if it is better to have a moderate but always present IOP-lowering versus some peak response if the patient uses the drops, but then not a great response if they do not take them, Noecker added.

Dextenza (Ocular Therapeutix) is an intracanalicular plug that releases dexamethasone for up to 30 days after being placed through the punctum.

The overall retention rate is good, and it is easy to insert, Thimons said.

“Knowing the FDA’s history, I’d think these products would probably be approved on the same day,” Noecker said.

Ocular Therapeutix reports that it is conducting studies for OTX-TP and OTX-TIC in glaucoma.

Bimatoprost SR is an injectable from Allergan with a frequency of two times per year or more. Noecker said the injection can be done in-office with a slit lamp.

With injection there is always the risk of infection, but in terms of utility, it is low risk and safer than surgery, Noecker said.

“From a pure success perspective, this is a home run,” Thimons said. “The question will be if the endothelial cell function stays solid and whether cataract formation is accelerated.”

The iDose (Glaukos Corp.) is a titanium implant with travoprost placed into the trabeculum and Schlemm’s canal.

Glaukos created a capture and retrieval system for the implant. The old implant is removed when placing the new one, Thimons said. As a result, there is never more than one implant in the eye at a time.

Thimons is curious about potential damage to the tissue that might occur.

“Sustained release is the hottest topic in glaucoma right now,” he noted. – by Abigail Sutton and Joan Marie Stiglich, ELS

Disclosures: Noecker reports he is a consultant for Alcon, Aerie, Alimera, Beaver-Visitec, Diopsys, Ethis Communications, Glaukos, InnFocus, Inotek, Iridex, Novartis, Ocular Therapeutix, Omeros, PolyActiva, Santen, Shire, Solx and Sun Pharmaceuticals; is a speaker for Alcon, Allergan, Beaver-Visitec, Diopsys, Imprimis, Iridex, Novartis and Quantel; does research for AqueSys, Glaukos and InnFocus; and has an ownership interest in Ocular Therapeutix, Tula Medical and ISP Surgical. Noecker is a medical monitor on the Ocular Therapeutix study. Thimons reported he is on the advisory board for Allergan, Glaukos and Novartis.