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BLOG: Uveitis treatment comes into the modern age
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The treatment of inflammatory ocular disease is becoming more exciting.
In years past, the spectrum of available treatment for uveitis was topical steroids, more frequent topical steroids, subconjunctival steroids and systemic (you guessed it) steroids. The advent of immunomodulatory drugs such as methotrexate and TNF blockers such as Enbrel (etanercept, Amgen) has offered meaningful advances for select diagnoses, but typically these have required the guidance of a rheumatologist or uveitis specialist.
Now, a variety of drug delivery systems are undergoing development that may make it easier for the general ophthalmologist or optometrist to manage this type of chronic disease.
Let’s face it, the only thing worse than a patient having to take topical steroid drops is having to take them chronically. Compliance is just one problem. Another is the uniformity of dosing that comes from suspensions such as Pred Forte (prednisolone acetate ophthalmic suspension, Allergan), which only becomes less consistent with generic formulations. Several studies have shown that the first few drops out of the bottle and the last few drops have vastly differing quantities of steroid, even with proper shaking. Topical dosing may also be more prone toward causing pressure spikes and cataract formation compared with newer options.
Enter modern anti-inflammatory therapy. Implants delivering low but consistent dosing of anti-inflammatories show great promise in early studies for keeping disease under better control. Many of these have been developed for the postoperative cataract population or for patients with macular degeneration because these conditions are so common, but they certainly offer promise for uveitis patients, too. Several companies are working on devices implanted in the posterior segment to deliver drug. Others make a tiny pellet that is delivered into the anterior chamber, safely dissolving over time. Still others take the shape of a dissolving punctal plug that delivers embedded drug and then melts away.
Managing uveitis will always be challenging. It will always benefit from informed guidance from rheumatologists and uveitis specialists, but I am excited about the new technologies that will ease the challenge of drug delivery for both patients and physicians in the coming years.
Disclosure: Hovanesian is a consultant for Ocular Therapeutix, Allergan, Alcon and Bausch + Lomb.