MAY 2019

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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I TECHNOLOGY & INNOVATION N FOCUS 46 | EYEWORLD | MAY 2019 Contact information Donnenfeld: ericdonnenfeld@gmail.com Matossian: cmatossian@matossianeye.com Swan: russell.swan@vance thompsonvision.com by Liz Hillman EyeWorld Senior Staff Writer A ctivity and innovation in the drug delivery space—whether improv- ing drops or developing external implants or intraocular options—is booming. "There are significant unmet 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 compli- ance," he said. So what are the solutions? Drops One way to improve drop compliance bur- den is to combine multiple drops and/or use alternative concentrations, said Russel Swan, MD, admitting that the U.S. market lags behind other coun- tries on this front for commercially avail- able options. There are some options, however, available through compound- ing 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 stays in the tear film. This technology is currently used by AzaSite (azithromycin, Akorn Pharmaceuticals), Besivance (besifloxacin, Baus- ch + Lomb), 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 + Innovations in drug delivery Lomb). Inveltys has a mucus-penetrating parti- cle to allow for only twice daily dosage for in- flammation and pain after ocular surgery, while Lotemax SM (also for inflammation 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 bot- tles with target systems is not widespread, Dr. Donnenfeld said. TearClear is making a filter that removes preservatives that can be toxic to the ocular surface (namely benzalkonium chlo- ride) from the drop as it exits the bottle, while keeping the solution inside preserved. External implants External inserts have significant advantages, Dr. Donnenfeld said, because they can be applied once and provide sustained release of a medi- cation over a period of time. Dextenza (Ocular Therapeutix), for ex- ample, is an FDA-ap- proved bioabsorb- able, intracanalicular, hydrogel plug that provides sustained re- lease of a consistent amount of dexameth- asone for 1 month after cataract surgery. According to Cyn- thia Matossian, MD, Dextenza is currently indicated for pain, but Ocular Therapeu- tix submitted a New Drug Application to the FDA to receive an indication for inflamma- tion and it is working on obtaining a J code and pass-through designation as well. Mati Therapeutics is developing a different punctal plug for drug delivery. Dr. Donnenfeld said it just finished 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. 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, nanotechnol- ogy, 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. "Drops as we know them will cease to exist over the next couple of years as new drug delivery systems change the way we deliver medications." —Eric Donnenfeld, MD

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