First-line treatment for glaucoma is typically pharmacologic and aimed at lowering intraocular pressure, which is the only modifiable risk factor to date. However, successful treatment with traditional topical glaucoma medications may be limited by their well-known barriers of adverse effects and poor patient adherence to drop instillation. Tune in to hear Dr. Qi Cui and Dr. Davinder Grover discuss the novel pharmacological therapies and minimally invasive glaucoma surgery procedures that can lower treatment burden and increase compliance.
Lessening Glaucoma Treatment Burden: Sustained-Release Therapies (Part 2)
Lessening Glaucoma Treatment Burden: Sustained-Release Therapies (Part 2)
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Hi, this is CME on ReachMD, and I’m Dr. Davinder Grover. We’re going to talk today about the iDose implant – the iDose TR. Now this is an intraocular implant in the late stages of development that’s providing kind of continuous drug delivery for patients with glaucoma. And let’s look at this clinical data and its potential uses.
So as you know, the iDose TR is currently under FDA review. It’s an implantable device that slowly elutes travoprost, and it’s held into the angle in the Schlemm’s canal through the trabecular meshwork with a specific implant. And it’s truly designed to help improve compliance and adherence and really minimize the side effects of topical therapy.
There were 2 pivotal trials, that are not yet published, that were showing noninferiority to timolol twice a day. Now the mean IOP [intraocular pressure] reduction – the mean diurnal IOP reduction – was somewhere in between 6-8 mmHg, depending on the time of day. These studies had about 1,150 subjects that were randomized to both of the phase 3 trials, and the mean washed-out IOP at baseline was 24 mmHg. 81% of these study eyes had primary open-angle glaucoma, where 19% had ocular hypertension. 67% of the randomized subjects were on at least 1 antiglaucoma medication, whereas 23% of these study eyes were on 2 or more. Now at 12 months when you look at the phase 2B and the phase 3 trial, there’s somewhere between 92% and 93% of patients were well controlled on the same or fewer medications. And at 24 months, 72% of eyes were controlled on the same or fewer medications compared to baseline. At 36 months, 69% were controlled, and interestingly, at 12 months, 81% of eyes were free of all glaucoma drops.
Now at 1 year for the phase 3 and at 3 years for the phase 2B, there were really no safety concerns. There was no periorbitopathy that we typically see with prostaglandins, no significant endothelial cell loss, no change in iris color. Now, this platform can be implanted and exchanged, and there was a subset of patients that had that performed without any safety concerns or endothelial cell health concerns. Now the majority of this study was done in the operating room, but the company did have a small group of patients that had this performed in the minor procedure room in the office without, again, any safety concerns. I don’t think that’s the major goal, but that is something – it’s an option to be had.
So the take-home point, really, is that the iDose is a potential revolution in interventional glaucoma, and the results on safety and efficacy are very promising, and this is really just the beginning of the sustained-release technology revolution and evolution of this technology. And I think the future is going to be very bright for this technology, and we’re going to continue to see more and more innovations in this space.
Thank you again for tuning in. I’m Davinder Grover, and this has been CME on ReachMD.
You have been listening to CME on ReachMD. This activity is provided in partnership with the National Eye Institute of the National Institutes of Health, of the U.S. Department of Health and Human Services along with Prova Education, and is part of our MinuteCME curriculum.
To receive your free CME credit, or to download this activity, go to ReachMD.com/Prova. Thank you for listening.
In accordance with the ACCME Standards for Integrity and Independence, Global Learning Collaborative (GLC) requires that individuals in a position to control the content of an educational activity disclose all relevant financial relationships with any ineligible company. GLC mitigates all conflicts of interest to ensure independence, objectivity, balance, and scientific rigor in all its educational programs.
Qi Cui, MD, PhD
Assistant Professor of Ophthalmology
University of Pennsylvania
No relevant relationships reported.
Davinder S. Grover, MD, MPH
Glaucoma Specialist, Ophthalmologist
Glaucoma Associates of Texas
Fort Worth, TX
Advisory Board: CATS Tonometer, iSTAR Medical, Sanoculis, Versant Health
Consulting fees: Allergan, New World Medical, Nova Eye Medical, Olleyes, Reichert, Sanoculis
Research: Allergan, New World Medical
- Stephen Chavez has nothing to disclose.
- Cindy Davidson has nothing to disclose.
- Elizabeth Lurwick had nothing to disclose.
- Andrea Mathis has nothing to disclose.
- Colleen Resnick has nothing to disclose.
- Robert Schneider has nothing to disclose.
- Stephanie Wenick, MPhil, has nothing to disclose.
After participating in this educational activity, participants should be better able to:
- Describe topical therapies and sustained-release formulations of antiglaucoma medications that may improve patient adherence
- Recognize minimally invasive glaucoma surgery (MIGS) uses and indications
- Evaluate clinical data of recently approved topical therapies, sustained-release formulations of antiglaucoma medications, and MIGS for patients with early- to moderate-stage glaucoma
- Implement strategies to individualize therapy for patients with early- to moderate-stage glaucoma
This activity is designed to meet the educational needs of ophthalmologists and optometrists.
In support of improving patient care, Global Learning Collaborative (GLC) is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the healthcare team.
Global Learning Collaborative (GLC) designates this enduring activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Global Learning Collaborative (GLC) designates this activity for 1 nursing contact hour. Nurses should claim only the credit commensurate with the extent of their participation in the activity.
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This activity is supported by independent educational grants from AbbVie, Inc and Alcon.
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