EyeWorld India September 2019 Issue

EWAP SEPTEMBER 2019 19 FEATURE A ctivity and innovation in the drug delivery space—whether improving drops or developing external implants or intraocular options—is booming. º/…iÀi >Ài È}˜ˆwV>˜Ì ՘“iÌ needs in drug delivery, and our ability to resolve those needs will result in better patient care,” said Eric Donnenfeld, MD. He calls these areas the “5 Cs” of drug delivery: (1) compliance, (2) corneal problems (dry eye), (3) comfort, (4) cost, and (5) cosmesis (red eyes). “The major unmet need is certainly compliance,” he said. So what are the solutions? Drops One way to improve drop compliance burden is to combine multiple drops and/or use alternative concentrations, said Russel Swan, MD, admitting that the U.S. market lags behind other countries on this front for commercially available options. There are some options, however, available through compounding pharmacies. Vehicles that help medical agents stay on the surface of the eye longer are also coming of age. Dr. Donnenfeld mentioned DuraSite (InSite Vision), which uses a muco-adhesive that ÃÌ>Þà ˆ˜ ̅i Ìi>À w“° /…ˆÃ technology is currently used by AzaSite (azithromycin, Akorn Pharmaceuticals), Besivance LiÈyœÝ>Vˆ˜] >ÕÃV…³ œ“L®] and BromSite (bromfenac, Sun Ophthalmics). Another innovation in drops, Dr. Donnenfeld said, is the use of nanotechnology to increase penetration of medication inside the eye. Products with such technology include Inveltys (loteprednol, Kala Pharmaceuticals) and Lotemax SM (loteprednol, Bausch + Lomb). Inveltys has a mucus- penetrating particle to allow for only twice daily dosage for ˆ˜y>““>̈œ˜ >˜` «>ˆ˜ >vÌiÀ ocular surgery, while Lotemax - >Ãœ vœÀ ˆ˜y>““>̈œ˜ and pain) has a submicron formulation that dissolves quickly into the eye before tear washout. There have been advances in the bottles to deliver the drops properly, but the use of bottles with target systems is not widespread, Dr. Donnenfeld Ã>ˆ`° /i>À i>À ˆÃ “>Žˆ˜} > wÌiÀ that removes preservatives that can be toxic to the ocular surface (namely benzalkonium chloride) from the drop as it exits the bottle, while keeping the solution inside preserved. External implants External inserts have È}˜ˆwV>˜Ì >`Û>˜Ì>}iÃ] À° Donnenfeld said, because they can be applied once and provide sustained release of a medication over a period of time. Dextenza (Ocular Therapeutix), for example, is an FDA-approved bioabsorbable, intracanalicular, hydrogel plug that provides sustained release of a consistent amount of dexamethasone for 1 month after cataract surgery. According to Cynthia Matossian, MD, Dextenza is currently indicated for pain, but Ocular Therapeutix submitted a New Drug Application to the FDA to receive an indication for ˆ˜y>““>̈œ˜ >˜` ˆÌ ˆÃ ܜÀŽˆ˜} on obtaining a J code and pass- through designation as well. Mati Therapeutics is developing a different punctal Innovations in drug delivery by Liz Hillman EyeWorld Senior Staff Writer AT A GLANCE • Innovation in drug delivery is primarily driven by the need to improve patient compliance and reduce adverse side effects from drops. • Combinations, nanotechnology, and other vehicles are improving some drop pitfalls. • External inserts, such as punctal plugs, are offering opportunities for easy insertion and removal and sustained-release medication. • Intraocular options include intracameral injections of antibiotics and compounded medications, sustained-release solutions, and medication- eluting implants. Contact information Donnenfeld: ericdonnenfeld@gmail.com Matossian: cmatossian@matossianeye.com Swan: russell.swan@vancethompsonvision.com Allergan is working on a bimatoprost periocular ring, as seen in the lower right quadrant of this eye. Source: John Sheppard, MD 6JKU CTVKENG QTKIKPCNN[ CRRGCTGF KP VJG /C[ KUUWG QH EyeWorld . It has been UNKIJVN[ OQFKƂGF CPF CRRGCTU JGTG YKVJ RGTOKUUKQP HTQO VJG #5%45 1RJVJCNOKE Services Corp.