Published in Glaucoma
Managing Glaucoma in the Year 2030
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In this session from Eyes on Glaucoma 2022, Sahar Bedrood, MD, PhD, examines the changing landscape of glaucoma management, including drug delivery, remote monitoring, and the role of artificial intelligence.
Have you wondered about what taking care of glaucoma will look like in the next decade? By the year 2030, estimations show that over 100 million people could be reported having a glaucoma diagnosis, with a severe increase of over 47% residing within Asia and Africa alone.
The cost of the care for glaucoma is not a light subject; as if the cost of healthcare in the United States isn’t a sensitive enough subject. As of this year, the cost for topical drops range from $70-$1,500 for a single bottle. Brand-names run around $1,100, and generics $300 or less.
Studies show that, between the medication, visits, surgeries, glaucoma patients were found to have an additional financial claim of $2,900 annually when it came to their personal healthcare cost—this is simply for the prevention and care of the glaucoma they did nothing to cause. If you translate that by the number of patients, that’s $12 million in care estimated to be spent worldwide on glaucoma care alone.
Imagine what it would feel like to try treating a million patients with just eye drops—pretty difficult to adhere to as a physician, not to mention keeping up with the inventory.
Having decades of knowledge should mean that we as an industry have the opportunity to thrive and grow. The world needs more eyecare specialists, better education for patients, and physicians on monitoring glaucoma and the development of new treatment types and modalities.
In 2014, colleges and fellowships were focusing mainly on trabeculectomy corrections. They slowly introduced the onset of mixed development, where eye stents and combination drops came in. It was something new, exciting, and refreshing. Now, that is the go-to, with various different styles which have developed over the last 8 years, and focusing more on MIGS (micro-invasive glaucoma surgery).
Over the last century and a half, we’ve seen an enormous growth in formulas and treatments for glaucoma. By the year 2030, the industry expects to see an increase of remote IOP monitoring and testing, with a considerable amount of sustained releases and delivery, chosen over the typical drop-use. With science and technology at this day and age, different platforms and formulas will continue to develop and release—some already underway.
‘Drug delivery’, by definition, is an engineered technology of a targeted delivery with a controlled release. The method in which the medicine is delivered, as we all know, can provide a little more control on the effectiveness & length of the treatment. Will it be directed into the anterior chamber, or into a docking device to be released over time? Will the treatments utilizing contacts stick? Will something new be designed?
The current most popular treatment for glaucoma is a single-dose of bimatoprost administered intracamerally, and is the first sustained-release formula to obtain FDA Approval. During one trial, a single treatment lasted about 15 weeks for most of the patients, but 20% of them retained it for nearly 2 years.
Rho kinase inhibitors have proven to be the most effective when it comes to reducing pressure. Professionals surveyed don’t seem to prefer them, being the most time-consuming and difficult to insert. iDose is developing many other solutions. Coming soon on the market is iDose-TR and iDose-TREX, hoping to simplify glaucoma management.
The team at iDose has been working on development and clinical trials for these new rho kinase sustained-release titanium implants of 1.8mm by 0.5mm, designed for continuous delivery of the travoprost formula through the membrane, with up to a 2 year duration. Instead of being implanted into the AC, it’s docked into the meshwork and left in to allow for continuous drug delivery. This route seems to have the longest-lasting results, but only time will tell, as clinical trials for Phase 3 are still underway.
When the results were compared between the iDose FE (fast-eluting) versus the iDose SR (sustained-release) formulas, it was found that the FE lasted a month or so less than the SR version.
When you think about general glaucoma treatment now, it’s a simplified process: see the patient, put the drops in, and see them again in a couple of months. Looking into the future, we are looking at a much higher percentage of patients opting for port delivery, similar to the Anti-VEGF delivery model. The new port deliveries are expected to last 6 months, as opposed to the monthly Anti-VEGF treatment. Experts are optimistic that a 6-month dose could be attained through either the AC or vitreous, via glaucoma drops.
It all starts from the first visit. The more we become educated, the more we can create a positive progression in the way we guide our patients. As time goes on, patients are increasingly willing to self-administer eye drops. With this, not only will the cost be lower for the patient, but all parties involved will have more of an all-day control on the dosage. With in-office visits, it’s nearly impossible to avoid the IOP spike after a few hours and monitor the results thereafter.
Of course, many of us don’t have much time left in our schedules, and quickly administering drops may be easier on-the-spot, but taking a bit longer to talk to one patient at an appointment will save chair time in the long run, increasing your appointments, growing your practice even further.
Companies are releasing new technology-based remote monitoring devices, such as IOP, contact lens monitoring, and artificial intelligence (AI) & field testing (HVF).
The current monitoring device on the market is iCare Home Monitoring, which is the first FDA-Approved home-monitoring system with 24-hour data collection. The data is collected, and then transmitted onto a portal for the physician to review.
Next to come on the market are two different types of contact lens monitoring. The first is Trigger Fish by Sensimed, which monitors the changes to the volume of the eye, as well as surface changes. The other is much earlier in its release stages: a wireless theranostic CL with a sensor detecting IOP functions, thusly releasing the drug as needed. Due to the many levels of testing required, this is where we will need AI to step in.
Artificial Intelligence has created a device that measures the IOP of an eye. The measuring duration lasts 3 minutes, then able to be automatically be downloaded and viewed by a physician. At this time, only physicians can obtain this device, but some would call it beneficial to have it in the hands of patients.
The years have already advanced glaucoma studies significantly, and will only continue to grow. With all of the models, diagnoses, and purely by nature, we all work in different ways.
Fortunately, that is a key factor when it comes to the growth of glaucoma research, as we are continuing to learn from our colleagues. We continue to expand our awareness as well as our teaching. In 2022 alone, two MIGS devices were released. If that is the standard, our field is in pretty good shape for the future.