Eyeworld

I TECHNOLOGY & INNOVATION N FOCUS 44 | EYEWORLD | MAY 2019 whether it is worthwhile to have patients take multiple trips to the OR to implant devices that deliver medications, considering a possible increased infection risk—and how to handle patients who don't return for follow up if the technology is not biodegradable. Another consideration among the technolo- gy options is a continuous pressure monitoring device that would provide 24-hour IOP mon- itoring. "Their widespread use has not been adopted, although this is an area of interest in the glaucoma community," Dr. Angelilli said. There are also newer therapies for glauco- ma patients to consider, such as the Rho-kinase inhibitor netarsudil (Rhopressa, Aerie Pharma- ceuticals) and the fixed combination of netar- sudil and latanoprost (Roclatan, Aerie Pharma- ceuticals), which was approved by the U.S. FDA earlier this year. Latanoprostene bunod (VYZULTA, Bausch + Lomb) was introduced in 2018, Dr. Cantor added. It's a prostaglandin analog that releases nitric oxide and that may convey vasoactive effects, he said. For in-office IOP measurements, a new device on the horizon called the Correcting Applanation Tonometer Surface (CATS) prism (CATS Tonometer) has a newly designed and engineered tonometer prism tip for Goldmann applanation tonometry, Dr. Radcliffe said. The new tip will help the tonometer limit bias from corneal thickness, curvature, hysteresis, and the tear film. "It's going to be easy for all of us to adopt the CATS prism and patients will benefit quickly," he said. Diagnostic technology One advance within glaucoma diagnostic tech- nology is the ability to better integrate OCT structural data with functional data to help with clinical decision-making, Dr. Cantor said. The use of OCT angiography could help specialists make an earlier glaucoma diagnosis, Dr. Trubnik said. Dr. Radcliffe said that corneal hysteresis may play a greater role in glaucoma diagnos- tic management going forward, specifically to indicate which eyes would do well with therapy such as MIGS and which eyes may require addi- tional therapies. Patient adherence to eye drop use is always a major struggle, so many glaucoma surgeons are excited about newer ways to approach IOP management, including punctal plugs and injec- tions. "Data supporting these newer approaches to therapy will require time before we can best assess which procedures are indicated for which individual patients," said Louis Cantor, MD. Although Dr. Cantor thinks that the majority of glaucoma patients will continue to use topical drops, he also noted that sustained release drug delivery approaches could enhance compliance and reduce the burden of therapy. Punctal plugs and injectable implants that deliver medication to patients could help with the dilemma of patient compliance, Dr. Trub- nik said. "We already have plugs on the market with steroids but not for glaucoma drugs," she said. As one example, Ocular Therapeutix has a travoprost intracanalicular insert that is at the Phase 3 stage (the company also has a travoprost implant at the Phase 1 stage). "If explained the right way, I think a lot of pa- tients would agree to [punctal plugs]," she said. Mati Therapeutics is also developing a punctal plug delivery system for latanoprost and other agents, Dr. Cantor said. However, the bigger concern will be wheth- er Medicare or third-party payers will cover the cost involved with newer drug delivery devices, Dr. Trubnik said. When it comes to implantable drug delivery systems, such as iDose, one concern would be continued from page 43 About the doctors Allison Angelilli, MD Clinical assistant professor of ophthalmology Donald and Barbara Zucker School of Medicine Hofstra University/Northwell Hempstead, New York Louis Cantor, MD Jay C. and Lucile L. Kahn Chair of Glaucoma Research and Education Eugene and Marilyn Glick Eye Institute Indiana University School of Medicine Indianapolis Nathan Radcliffe, MD New York Eye and Ear Infirmary New York Valerie Trubnik, MD Ophthalmic Consultants of Long Island Financial interests Angelilli: None Cantor: Carl Zeiss Meditec, Santen, Allergan, Mati Therapeutics Radcliffe: Aerie Pharmaceuticals, Glaukos Trubnik: None "Data supporting these newer approaches to therapy will require time before we can best assess which procedures are indicated for which individual patients." —Louis Cantor, MD

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