EyeWorld Asia-Pacific September 2019 Issue

FEATURE 20 EWAP SEPTEMBER 2019 plug for drug delivery. Dr. ivi` Ã>` Ì ÕÃÌ wÃi` Phase 2 trials, of which he was the primary author/investigator, for a nonsteroidal medication for 3 months. But, Dr. Donnenfeld added, almost any medication could be used here. “I think that the best application for this type of punctal plug is dry eye. Not only do you get the advantage of the punctal plug, which helps dry eye, but you also get the advantage of sustained release agents,” Dr. Donnenfeld said, noting its value for glaucoma and cataract surgery as well. Another insert is a bimatoprost periocular ring (Allergan), which is under investigation to provide at least 4 months of glaucoma therapy. Finally, Dr. Donnenfeld mentioned the Topical Ophthalmic Drug Delivery Device (TODDD), an under the eyelid device being developed by Vista -ViÌwV] VÕÀÀiÌÞ vVÕÃi` sustained timolol delivery. Intraocular options We are now in an era where there is a means of reducing compliance issues by delivering drugs right to the target tissue, À° >ÌÃÃ> Ã>`] Ã«iVwV>Þ noting the FDA approval and vwV> ViÀV> ÀÕÌ of Dexycu (dexamethasone, EyePoint Pharmaceuticals). Dexycu has a J code and pass- through status. This injection, Dr. Matossian said, eliminates the most burdensome and confusing post-cataract surgery drops—the steroid—which has to be used several times a day and tapered over several weeks. Dexycu mimics this titration over time, she said. À° ivi`] wÀÃÌ >ÕÌÀ on the clinical trials for Dexycu, said studies showed it was identical in reducing cell and y>Ài V«>Ài` Ì *Ài` ÀÌi (prednisolone, Allergan), and "* Ü>Ã Ì > Ã}wV>Ì ÃÃÕi° “It looks to have safety and ivwV>VÞ >` i>ÌiÃ Ìi `À« burden,” he said. Plus, there will be no cost to the patient, no cost to the surgery center, and no cost to the doctor. “I think this will be widely appreciated Dr. Donnenfeld injects Dexycu after cataract surgery. Source: Eric Donnenfeld, MD I n 2003, the World Health Organization issued a report stating that in developed countries, only 50% of patients suffering from chronic disease were adherent to their prescribed medications. 1 The report concluded that increasing the effectiveness of adherence interventions may have a far greater impact on population health than any «ÀÛiiÌ Ã«iVwV i`V> ÌÀi>ÌiÌ° /i ÌÞ«i v ÌiÀÛiÌ could be subdivided loosely into medical, surgical or economical. In this feature article by Donnenfeld, approaches currently under clinical evaluation reviews some of the medical innovations taking place today. Dr. Eric Donnenfeld states the important “5 Cs” of drug delivery. I would include two other Cs to his list: (6) consistency, (7) cost-effectiveness. Consistency: Having a consistent release of drug 24/7 will provide a far greater and predictable drug performance than relying on patients to administer medications at the prescribed times of the day. This is especially challenging for glaucoma patients using more than one bottle of eyedrops to medically control their intraocular pressure. Therefore, having a reliable method that guarantees consistent drug delivery will provide great reassurance to patients and doctors alike. Cost-effectiveness: As with all new advanced innovative treatments that promise a better way of managing patients, they come at a price. With the explosion of health care costs and people living longer, governments, insurance companies, and hospitals are more cost-conscious than ever. Therefore, the cost-effectiveness and improvement in quality of life years that new treatments can offer over current standards of care will need to be weighed carefully and will determine which new delivery systems will be readily adopted. As such, all relevant parties need to work together to address this important and relevant matter. Despite these challenges highlighted, the future is exciting in medical management. The exponential rise in the different types of drug delivery systems being evaluated today is a testimony to the strong desire for the ophthalmic community to offer patients something other than the current eyedrops. Not all patients need ÃÕÀ}iÀÞ° i`V> ÌÀi>ÌiÌ Ã > `>Ì wÀÃÌi >««À>ViÃ«iV>Þ in glaucoma. In fact, even after surgery, some patients still require eyedrops to treat their condition. Medical treatment with eyedrops has not changed for over 150 years, but I believe we are going to see a breakthrough and a rise in new drug delivery systems on offer to patients in the very near future. Reference 1. Sabaté E. “Adherence to long-term therapies: evidence for action.” World Health Organization; 2003. 'FKVQTUo PQVG &T 9QPI KU EQ HQWPFGT QH 2GTGITKPG 1RJVJCNOKE 2VG .VF Tina Wong, MBBS, FRCS(Ed), FRCOphth, FAMS, PhD (Lond) Professor, Singapore National Eye Centre 11 Third Hospital Avenue, Singapore 168751 tina.wong.t.l@singhealth.com.sg ASIA-PACIFIC PERSPECTIVES continued on page 24