As a renowned glaucoma specialist and cataract surgeon, Nathan Radcliffe, MD, reviews his patient selection process for Durysta (bimatoprost intracameral implant 10mcg, Allergan, An AbbVie Company) and tips for discussing the implant with patients.
Dr. Radcliffe highlighted that for many years, there have been three pillars of glaucoma management: eye drops, laser procedures, and surgical interventions. However, in 2020, the Food and Drug Administration (FDA) approved Durysta, which, in his professional medical opinion, became the fourth pillar of glaucoma therapy in the form of a sustained delivery drug delivery device.
Interventional Mindset is an educational series that gives eye physicians the needed knowledge, edge, and confidence in mastering new technology to grow their practices and provide the highest level of patient care. Our focus is to reduce frustrations associated with adopting new technology by building confidence in your skills to drive transformation.
Browse through our videos on a variety of topics within cataract and refractive surgery, glaucoma, and ocular surface disease to learn practical insights into adopting a variety of new surgical techniques and technology.
Acknowledging the challenges patients face with topical treatments
When mentioning Durysta to patients, he advised surgeons to review with patients why an implant would be recommended instead of a topical eye drop to manage their glaucoma. It could be helpful to acknowledge that there are many limitations to eye drops, some of which patients are likely aware of and others they may not be.
For example, some of the issues he has noticed patients tend to report from using eye drops include: adverse events from the eye drops (i.e., dry eye, redness, discomfort, blurred vision), difficulties with retrieving the medication from the pharmacy and getting refills, high copays, and most often, noncompliance with eye drop instillation.
Additionally, some patients who successfully retrieve the eye drops from the pharmacy likely still struggle with instilling the drops correctly. Dr. Radcliffe stressed that, at best, about 50% of patients put in their drops in the appropriate manner. As such, Dr. Radcliffe often recommends Durysta for patients that he believes might already be struggling with administering topical glaucoma medications.
What do sustained delivery drug delivery devices offer patients?
Further, even if these challenges are addressed, there still remains a challenge in that eye drops taken two to three times a day may not have uniform efficacy throughout the 24-hour period. Consequently, there can be inherent fluctuations in intraocular pressure (IOP) measurements, which could impact glaucomatous progression.
Conversely, a sustained-release approach could eliminate these compliance problems by placing the drug directly where it needs to be in the eye of the patient. He added that this is worth considering for a progressive and irreversible blinding disease such as glaucoma.
Due to the fact that conventional eye drop therapies tend to require patients to be completely in charge of complying with their treatment plan, this approach might make patients more vulnerable to adherence-based issues, which potentially can be avoided with Durysta as a treatment option.
Discussing Durysta with patients
When prescribing Durysta, the surgeon is entirely in charge of the treatment as they administer the injection of the preservative-free intracameral implant. Dr. Radcliffe emphasized that he believes with a progressive condition such as glaucoma, the more treatments can be put in his hands, the probability of a positive treatment outcome can increase depending on the severity of the disease.
Additionally, when discussing Durysta with patients, he asserted that describing his confidence in the efficacy of Durysta (as outlined above) is very valuable to share with patients. Communicating the why to patients is key to ensuring that they understand each step in the treatment plan and can make informed decisions.
Lastly, Dr. Radcliffe added that ophthalmologists can convince patients of the treatment value behind procedures such as laser iridotomies because they, as clinicians, have full buy-in to this being the best treatment for closed angles. As such, when surgeons show patients that they believe in the therapy they are recommending, it’s only natural that patients will eventually understand the value proposition and have confidence in both their surgeon and in the treatment recommendation.
Final thoughts
As compliance and adherence are persistent issues for glaucoma management, Durysta offers ophthalmologists and patients a simplified approach to circumventing the challenges associated with topical ophthalmic medications.
Dr. Radcliffe concluded that, ultimately, having confidence in the efficacy of any treatment being recommended to patients is the bedrock of patient-doctor communication.
Disclaimer: Durysta (bimatoprost intracameral implant) 10mcg from Allergan is a dissolvable preservative-free ocular implant indicated for the reduction of IOP in patients with open-angle glaucoma or ocular hypertension. The medical opinions and views expressed in this article are those of Nathan Radcliffe, MD.
