EyeWorld Asia-Pacific June 2019 Issue

66 EWAP JUNE 2019 DEVICES physicians want a more permanent monitoring device that could help detect risk of progression, and provide alerts if certain pressure thresholds are crossed, Dr. Sit said. There has been a lot of work on this latter front thanks to advances in extreme miniaturization of electronics in order to produce a biocompatible sensor that needs little calibration, Dr. Moster said. “I think it could be coupled with cataract surgery in the form of a capsular tension ring or perhaps embedded in an implant. It could be used as a standalone device within the sclera or perhaps attached to a shunt or any kind of MIGS device. The sky is the limit as to where this very small, biocompatible device will go. It all depends on the amount of ˆ˜y>““>̈œ˜ ˆÌ “ˆ}…Ì V>ÕÃi]» she said. “The goal is to have it as inert as possible, as small as possible, and to be recharged in a way that there is little need for the patient to pay attention to this. It will need to be easily rechargeable and battery friendly so that just sleeping at the bedside near a wireless charger can enable this to last for 10–20 years.” Some companies making headway on such devices are Implandata Ophthalmic Products (Hannover, Germany) with EyeMate, which is CE marked in Europe, and Qura (Boston) with QSmart. Implandata is currently in clinical trials with a new suprachoroidal `iۈVi] ܈̅̅i wÀÃÌ ÃÕVViÃÃvՏ implantation in human patients occurring in December 2018. This device would be implanted >à «>ÀÌ œv }>ÕVœ“> wÌiÀˆ˜} surgery. QSmart, which is still in development and testing in animal models, is 2.8 mm. When asked how he thought continuous IOP monitoring could change clinical care, Kaweh Mansouri, MD , professor of ophthalmology, University of Colorado, Denver, and Montchoisi Clinic, Lausanne, Switzerland, took it a step back. “Initially, it may not change so much because we need to learn how to interpret that data. We are used to very few data points in glaucoma management when it comes to IOP,” he said. “There will be a period where prospective studies have to be conducted to understand IOP variations, then we will be able to assess continuously and accurately how these IOP variations affect this patient’s glaucoma management.” However, one can imagine uses for such technology, such as assessing the effect of therapy. “Let’s say Mrs. X has a sensor in her eye and the IOP is higher than the doctor would deem safe for her optic nerve,” Dr. Moster said. “They would change the therapy and be able to assess with accurate pressure readings day and night whether the IOP lowering meets the goal that was predetermined by the physician. The same would hold true for surgical procedures.” A secondary effect of continuous IOP monitoring could be a reduction in patient visits because they would no longer need manual tonometry. This could result in not only time saved on the part of the patient and physician but cost savings as well. 2 This could be a double- edged sword, Dr. Moster said. “You want patients to come in to renew their medications, to know you are still quite interested in how they are doing. You can’t do it completely from afar,” she said. Until continuous IOP monitoring devices are easily available and more widespread, Dr. Moster said she doesn’t foresee the pattern of decision making changing among ophthalmologists caring for glaucoma patients. She does, however, expect continuous IOP monitoring devices that could dramatically change this decision-making process to start becoming available within the next 5 years. “People have been talking about continuous IOP monitoring for decades,” Dr. Sit said, “but I think we are on the cusp of having some things that will be clinically useful.” EWAP References 1. Mantzioros N. The history of the meaning of the word glaucoma. www.glaucoma.org.au/media/1281/ history-of-the-word-glaucoma. pdf. Accessed Jan. 24, 2019. 2. Dong J, et al. Potential savings from visit reduction of continuous intraocular pressure monitoring. J Curr Glaucoma Pract. 2018;12:59–63. 6TKIIGTƂUJ KU C EQPVCEV NGPU VJCV KU VJG QPN[ (&# CRRTQXGF YGCTCDNG FGXKEG HQT EQPVKPWCN OQPKVQTKPI DWV KV FQGU PQV FKTGEVN[ OGCUWTG +12 Source: Sensimed