EyeWorld Asia-Pacific September 2019 Issue

EWAP SEPTEMBER 2019 17 FEATURE example, Ocular Therapeutix has a travoprost intracanalicular insert that is at the Phase 3 stage (the company also has a travoprost implant at the Phase 1 stage). “If explained the right way, I think a lot of patients would agree to [punctal plugs],” she said. Mati Therapeutics is also developing a punctal plug delivery system for latanoprost and other agents, Dr. Cantor said. However, the bigger concern will be whether Medicare or third-party payers will cover the cost involved with newer drug delivery devices, Dr. Trubnik said. When it comes to implantable drug delivery systems, such as iDose, one concern would be whether it is worthwhile to have patients take multiple trips to the OR to implant devices that deliver medications, considering a possible increased infection risk— and how to handle patients who don’t return for follow up if the technology is not biodegradable. Another consideration among the technology options is a continuous pressure monitoring device that would provide 24- hour IOP monitoring. “Their widespread use has not been adopted, although this is an area of interest in the glaucoma community,” Dr. Angelilli said. There are also newer therapies for glaucoma patients to consider, such as the Rho-kinase inhibitor netarsudil (Rhopressa, Aerie *…>À“>ViṎV>Ã® >˜` ̅i wÝi` combination of netarsudil and latanoprost (Roclatan, Aerie Pharmaceuticals), which was I t is undeniable that surgical and medical glaucoma management have been revolutionized over the past decade. We are gathering more practical experience with novel instruments and newer concepts of medication, with favorable results—not only in the U.S. but also in other regions of the world where clinical ˆ˜vœÀ“>̈œ˜ yœÕÀˆÃ…ið Since the iStent was approved, trabecular bypass surgery has been another site of attraction. However, ˆÌ VœÕ` ˜œÌ œÛiÀVœ“i ̅i ÀiÃՏÌà œv ÌÀ>LiVՏiV̜“Þ œÀ >à "* œÜiÀˆ˜} ivwV>VÞ Ü>à ÀiÃiÀÛi` vœÀ “ˆ` ̜ “œ`iÀ>Ìi œ«i˜ >˜}i }>ÕVœ“>° ˜ ̅i ƂÈ>‡*>VˆwV Ài}ˆœ˜ ܅iÀi >˜}i VœÃÕÀi }>ÕVœ“> «Ài`œ“ˆ˜>ÌiÃ] their use was received even more skeptically because the extent of PAS would bar the site of implantation; «Àœœ˜}i` ÃޘiV…ˆ> VœÃÕÀi ˆÌÃiv ܜՏ` ˆ“«>ˆÀ ̅i ÌÀ>LiVՏ>À v՘V̈œ˜ œÀ] «iÀ…>«Ã] V>˜> œÕÌyœÜ° œÜiÛiÀ] ÀiVi˜Ì `>Ì> ŜÜi` Vœ“Lˆ˜i` «…>Vœi“ՏÈwV>̈œ˜ ܈̅ˆ-Ìi˜Ì ܜÀŽi` v>ۜÀ>LÞ ˆ˜ >˜}i VœÃÕÀi iÞià >vÌiÀ 1 year follow-up in terms of IOP lowering and medication reduction. 1,2 Of note, those eyes were with open angle after iridotomy or with appositional closure. A single iStent may not be as good as two or three as in many reports; therefore, their cost is yet an issue in many countries. Subconjunctival MIGS such as XEN or InnFocus have easily aroused the interest of many more surgeons, particularly in Asia, since the subconjunctival area is vast and easily manipulated. It may be in part due to Asian eyes having rather stronger tissue response to surgery than Caucasian eyes and glaucoma presentation tends to be rather more advanced. Connecting anterior chamber and subconjunctival space with a microstent which is simply visible postoperatively may more quickly achieve successful IOP lowering, if needed. ," ˆ˜…ˆLˆÌœÀ ̅>Ì “œ`Տ>Ìià ÌÀ>LiVՏ>À “iÅܜÀŽ œÕÌyœÜ…>à Vœ“i ˆ˜Ìœ ̅i “i`ˆV> ÌÀi>̓i˜Ì ëœÌˆ}…Ì° iÈ`ià "* œÜiÀˆ˜} ivwV>VÞ 3 ] Ài«œÀÌà œv ˆ˜VÀi>Ș} Àï˜> Lœœ` yœÜ] «ÀœÌiV̈˜} ˜iÕÀœ˜Ã >}>ˆ˜ÃÌ stress, promoting wound healing as well as treatment of Fuchs’ endothelial dystrophy 4,5 are their potential Li˜iwÌ𠜘Õ˜V̈Û>…Þ«iÀi“ˆ>] ̅i “œÃÌ Vœ˜ViÀ˜ˆ˜} >`ÛiÀÃi iÛi˜Ì] Ü>à V>ˆ“i` ÌÀ>˜Ãˆi˜Ì >˜` “ˆ` 6 . However, the commercial distribution of ROCK inhibitor is still regionally limited. CATS technology for retrieving more accurate IOP is on its way. Portable devices with CATS should be great because quick and correct examination is calling. ۜÛˆ˜} ÌiV…˜œœ}Þ ˆÃ ÃÌi>`ˆÞ ՘`iÀÜ>Þ° ̅i«Ã Õà “>˜>}i }>ÕVœ“> “œÀi Vœ˜w`i˜ÌÞ ܈̅“œÀi options expected. Their progress is believed to be endless, helping us battle the disease that predominantly deprives human sight. References £°…>˜Ã>˜}«iÌV…-] iÌ >° vwV>VÞ œv >Ì>À>VÌ -ÕÀ}iÀÞ ÜˆÌ…/À>LiVՏ>À ˆVÀœLÞ«>Ãà -Ìi˜Ì “«>˜Ì>̈œ˜ ˆ˜ œ“Lˆ˜i`‡ iV…>˜ˆÃ“ Angle Closure Glaucoma Patients. #O , 1RJVJCNOQN 2018 Nov;195:191-198. Ó° iÀ˜ÃÌ>`Ì ] iÌ >° >Ãi -iÀˆià œv œ“Lˆ˜i` ˆ-Ìi˜Ì “«>˜Ì>̈œ˜ >˜` *…>Vœi“ՏÈwV>̈œ˜ ˆ˜ Þià ܈̅*Àˆ“>ÀÞ Ƃ˜}i œÃÕÀi Disease: One-Year Outcomes. Adv Ther. 2019 Apr;36(4):976-986. 3. Khouri AS, et al; Rocket-4 Study Group. Once-Daily Netarsudil Versus Twice-Daily Timolol in Patients with Elevated Intraocular Pressure: The Randomized Phase 3 ROCKET-4 Study. #O , 1RJVJCNOQN 2019 Aug;204:97-104. 4. Honjo M, Tanihara H. Impact of the clinical use of ROCK inhibitor on the pathogenesis and treatment of glaucoma. ,RP , 1RJVJCNOQN 2018 Mar;62(2):109-126. 5. Macsai MS, Shiloach M. Use of Topical Rho Kinase Inhibitors in the Treatment of Fuchs Dystrophy After Descemet Stripping Only. Cornea. 2019 May;38(5):529-534. 6. Sakamoto E, et al. Evaluation of offset of conjunctival hyperemia induced by a Rho-kinase inhibitor; 0.4% Ripasudil ophthalmic solution clinical trial. 5EK 4GR 2019 Mar 6;9(1):3755. 'FKVQTUo PQVG &T 6CPVKUGXK FGENCTGF PQ TGNGXCPV ƂPCPEKCN KPVGTGUVU Visanee Tantisevi, MD Assist Professor, Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand tvisanee@gmail.com ASIA-PACIFIC PERSPECTIVES that the majority of glaucoma patients will continue to use topical drops, he also noted that sustained release drug delivery approaches could enhance compliance and reduce the burden of therapy. Punctal plugs and injectable implants that deliver medication to patients could help with the dilemma of patient compliance, Dr. Trubnik said. “We already have plugs on the market with steroids but not for glaucoma drugs,” she said. As one