Eyeworld

20 | EYEWORLD BONUS ISSUE | FEBRUARY 2025 G UCOMA by Liz Hillman Editorial Co-Director About the physicians Jacob Brubaker, MD Sacramento Eye Consultants Sacramento, California Blake Williamson, MD Williamson Eye Center Baton Rouge, Louisiana patients. "For me, that's a place where Durysta might make a little bit more sense, being not as invasive, not as big inside the eye," he said. If the patient is having cataract surgery, Dr. Williamson said iDose TR makes sense, especial- ly because it seems to have a longer duration per the clinical trials. "Maybe there are nursing home patients where you're concerned with their ability to get to appointments, their ability to follow up, you're not sure when you're going to see them again, and you may want to see them with something longer lasting," he said. In all of his examples, Dr. Williamson said either Durysta or iDose TR would be a fine option, but one or the other may make more sense, depending on your personal algorithm. Jacob Brubaker, MD, said his preferred algorithm overall is SLT followed by the addi- tion of a topical prostaglandin, if needed, to see how it works for the patient. "If the patient has difficulty remembering or tolerating, I will have a low threshold for moving on to iDose TR," he said. "It's designed to last 2–3 years, and while we don't have FDA approval to replace them yet, hopefully in the next 2–3 years we gain that ability to redose. I think that's what Durysta was missing; it was only able to be dosed once on label. … I do think the longevity and the safety of iDose TR is a game changer." A 2023 randomized, double-masked, multicenter, Phase 2 trial evaluating the long- term safety and efficacy of iDose found that the implant was able to maintain IOP lowering and reduce IOP-lowering medication burden for up to 36 months. 1 Laboratory studies of Durysta showed that drug release from the implant was completed by 90 days, and "pharmacokinetics studies" in an animal model showed tissue drug levels were below limits of detection by 4.2 months. 2 The efficacy of the treatment may be longer, however. Teymoorian et al. found in a retro- spective single-site study that the "mean IOP was 16.6 mm Hg at baseline and 13.3 mm Hg at 11–13 months, with the mean number of topical IOP-lowering medications used reduced from 1.4 at baseline to 0.2 at 11–13 months," with a single administration of the bimatoprost implant. 3 Next stop for glaucoma medications: sustained drug delivery W hile ophthalmologists agree that glaucoma drops are not likely to go extinct as part of glaucoma management, recent innovation continues to shift their place in many physicians' glaucoma treatment algo- rithm. One of these disruptive innovations is sustained drug delivery. There are currently two sustained-release drugs for IOP lowering on the market in the U.S., as well as several in the pipeline. Blake Williamson, MD, said the current- ly available and pipeline of sustained-release glaucoma therapies "highlight the number one problem that we face as clinicians [with glauco- ma] … which is compliance." "With our patient population, a lot of times they can be older, have a lot of comorbidities, and a lot of other things going on in their life, and taking daily medications and eye drops can be very laborious. It can be dangerous in some cases. Sometimes I'll see patients who are taking their steroid drop instead of taking their glauco- ma drop. Or patients are poking themselves in the eye, contaminating the dropper. All of those things I see routinely in my patient population," Dr. Williamson said. "At this point, I think the science and the industry side have collaborated to figure out how can we take this out of our patients' hands and get them drugs safely and efficaciously. I think that's why you're seeing drug delivery innovation across all different spectrums and all different anatomical parts of the eye. Retina has been leading the way with that for years and it's been fantastic, and I think we're catching up on the anterior segment side." Current experience Dr. Williamson said he has experience with both commercially available sustained-release glau- coma implants: Durysta (bimatoprost intracam- eral implant, AbbVie) and iDose TR (travoprost intracameral implant, Glaukos). Dr. Williamson said when it comes to patient selection, in some cases it's easy. If the patient has already had a MIGS procedure that stripped the trabecular meshwork, surgeons may not be comfortable anchoring iDose TR, making Durysta a more suitable option. He said Durysta may also be more suited for phakic

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