EyeWorld Asia-Pacific March 2020 Issue

PHARMACEUTICALS 54 EWAP MARCH 2020 (Graybug Vision). This involves microparticles that can deliver the drug over several weeks to several months via a subconjunctival injection, Dr. Bacharach noted. What to expect Efficacy with all of these surface systems can be somewhat limited. “To date, external devices, such as plugs and rings, have not achieved prostaglandin-like efficacy, with most achieving timolol-like efficacy or exhibiting efficacy slightly worse than timolol over months of therapy,” Dr. Kahook said. Meanwhile, Dr. Bacharach noted that there was an approximately 20% reduction in IOP for both the Mati plug and the bimatoprost ring. When putting in one of these devices, there has to be a comfort level for all types of practitioners, Dr. Bacharach stressed. “I think that, in general, we might see optometric doctors gravitate more to the external, non-surgical delivery devices like plugs and rings and you might see a comprehensive ophthalmologist use everything, both external and internal,” Dr. Bacharach said, adding that tertiary-care specialists would probably use more efficacious platforms that have more associated risks such as intracameral delivery devices. For many patients who need mild-to-moderate reductions of IOP, these eGAPs may give patients enough of a decrease, he noted, adding that this may be a way to overcome some of the challenges of adherence, peak and trough effects of drops, and acquisition costs of the medicine. “It’s a potentially safe treatment option that will give you reasonable efficacy,” Dr. Bacharach said. Going forward, Dr. Bacharach believes that there will be winners and losers with all of this kind of nascent technology. “But I think that pushing the envelope here is where we’re headed,” he said. Early on, practitioners may opt for an external delivery system and then later decide to move more internally, he noted. Likewise, Dr. Kahook also believes that all safe and effective options are needed. “In a perfect world, we would have an external device that is 100% retained and free of adverse events, with the ability to deliver drugs over at least 6 months, while being totally independent from patient interactions,” he said. “We are not there today, but future devices might get us closer to my wish list.” EWAP Editors’ note: Dr. Bacharach is medical director, founding partner, North Bay Eye Associates, co-director, Glaucoma Services, California Pacific Medical Center, San Francisco, and has relevant financial interests with Allergan, Ocular Therapeutix, Glaukos, Equinox, and New World Medical. Dr. Kahook is the Slater Family Endowed Chair in Ophthalmology, professor of ophthalmology, Vice Chair for Translational Research, Director, Glaucoma Service, UCHealth Sue Anschutz Rodgers Eye Center, Aurora, Colorado, and has relevant financial interests with Alcon, Aurea Medical, Equinox, Fluent Ophthalmics, Ivantis, New World Medical, Johnson & Johnson Vision, ShapeTech, and SpyGlass Ophthalmics. Over 15 years of Ophthalmic Education A News Magazine of the APACRS Keeping readers at the forefront of international trends in Cataract and Refractive Surgery Digital editions are now available! Asia-Paci c • China • India • Korea ASIA-PACIFIC eyeworldap.apacrs.org APACRS Secretariat Singapore c/o Singapore National Eye Centre, 11 Third Hospital Avenue, #06-20, Singapore 168751 Email: apacrs@apacrs.org Tel: (65) 6322 7468 Fax: (65)6327 8630