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In March 2020, Durysta (bimatoprost implant 10 mcg, Allergan) was approved as a sustained-release dissolvable implant for open angle glaucoma and ocular hypertension. Patients can only receive one Durysta implant, but it elutes the IOP-lowering agent for 4 months, with IOP reduction up to 2 years. Inder Paul Singh, MD, said in Phase 2 trials that 25% of patients had efficacy out to 2 years and 33% out to 1 year. Even if a patient only gets 6 months' worth of efficacy, Dr. Singh said Durysta can provide a welcome "holiday." It could be a break from ocular surface issues caused by drop toxicity, from the out-of-pocket cost of drops, or even to delay a more invasive procedure. Dr. Singh said he considers patients with open angle glaucoma or ocular hypertension candidates for Durysta when they have compliance issues, when drops have become unsuitable, when they previously had SLT and might need additional IOP lowering, and when patients have Medicare fee for service with access to supplemental insurance since it is covered under Medicare part B. "You're going to get what a typical topical PGA gives you in Durysta," Dr. Singh said, after showcasing ARTEMIS trial data that found Durysta, compared to timolol 0.5%, had a mean IOP reduction of 5–8 mm Hg, about 33% from base- line, over 15 weeks. "Why Durysta has been impactful … from a surgeon perspective is the idea of having 24/7 drug delivery," he said, explaining that he likes having a product consistently released over time directly into the targeted tissues. On the other end of the spectrum is a surgical procedure with wider indications that packs a longer-term IOP-lowering punch. The XEN Gel Stent is indicated for refractory glauco- ma where prior surgery has failed, as well as primary open angle, pseudoexfoliation, or pigmentary glaucomas that are unresponsive on maximum tolerated medical therapy. "We need a procedure that is going to lower the pres- sure when patients are not controlled on maximum medical therapy," said George Tanaka, MD. "When we pick a proce- dure to treat glaucoma, we want something that's safe, we want something that's effective, and we want something that's not going to negatively impact their lifestyle. … For us to intervene earlier with these patients, we need a safer approach, and that's what XEN is. It's a safe procedure that is also effective." Data from the pivotal studies on refractory glaucoma, Dr. Tanaka said, showed a 15.9 mm Hg mean IOP reduction at 12 months, which was reduced from a mean medicated base- line of 25.1 mm Hg. Seventy-six percent of patients achieved a 20% IOP reduction, and there was a 1.7 mean reduction in IOP-lowering medications. Dr. Tanaka said 15 mm Hg is a reasonable goal for many mild to moderate refractory glauco- ma patients, especially if they're on multiple medications. "The best part of the procedure is postop day 1," Dr. Tanaka said, explaining how he used to dread how blurry and uncomfortable the patient would be after trab and tube pro- cedures. "Postop day 1 vision is a line or two down, the pres- sure might be single digits, but the chamber is always deep. Patients might remark, 'That surgery didn't hurt at all. My eye feels great.' It's nice to see that beautiful, low-lying diffuse bleb day 1. My experience has been extremely positive." Editors' note: Dr. Singh spoke about Durysta during an Allergan-sponsored virtual program. Drs. Ashrafzadeh and Tanaka spoke about the XEN Gel Stent during an Allergan-sponsored virtual program. The physicians in this advertorial have financial interests with Allergan. Copyright 2021 ASCRS Ophthalmic Corporation. All rights reserved. The views expressed here do not necessarily reflect those of the staff and leadership of EyeWorld and ASCRS and in no way imply endorsement by EyeWorld and ASCRS. Sponsored by When approaching glaucoma care, Amin Ashrafzadeh, MD, said ophthalmologists have to take a holistic approach. Physicians need to consider how easy it is for patients to place drops in their eyes, their drop tolerance, the state of their ocular surface, how they pay for drops, etc. "We need to take all of these things into consideration and help our patients to maintain their vision," Dr. Ashrafzadeh said. Innovations in drug delivery and surgical options within the last few years can reduce patient dependence on drops and/or help them avoid more invasive glaucoma surgeries. "The best part … is postop day 1" "24/7 drug delivery" New options in medical and surgical glaucoma management improve patient care Sponsored Content

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