Eyeworld

EW GLAUCOMA 138 April 2016 by Matt Young and Gloria Gamat EyeWorld Contributing Writers effectiveness of glaucoma medical treatment," they said. At the 2015 AAO annual meeting, Dr. Brandt and colleagues reported evidence of 6-month IOP reduction using a single dose of a novel topical bimatoprost ocular insert (Helios, ForSight VISION5, Menlo Park, California)—a break- through among studies involving sustained-release bimatoprost. The device, as described by Dr. Brandt, is a non-biodegradable ring loaded with bimatoprost and contains no preservatives. It enables a tapered release of an effective dose of bimatoprost at a predictable rate of approximately 7 mcg per day throughout a 6-month period. "The product, available in sev- eral sizes [diameters ranging from 24 to 29 mm], is easily inserted under the upper lid, and using a scleral depressor or similar instrument, the clinician places it into the inferior cul-de-sac," he said. The phase 2 randomized, double-masked, controlled study compared a 13-mg bimatoprost plus artificial tears (BIM group; n=64) to a placebo insert plus 0.5% For example, in a paper pub- lished in the April 2014 issue of PLoS One, Franca and colleagues 3 report- ed that bimatoprost-loaded inserts provided sustained release of the drug, showing huge potential in the management of glaucoma. "Bimatoprost-loaded inserts lowered IOP for 4 weeks, after one application, while IOP values remained significantly high for the placebo and untreated groups; eye drops were only effective during the daily treatment period," they said. In this particular study, howev- er, a single dose of bimatoprost-load- ed ocular insert was only capable of sustained release of the drug for a period of 1 month. "The sustained release of bimatoprost was proven by phar- macodynamic effects (IOP lowering and neuroprotection) and biodis- tribution studies," said Franca and colleagues. "Our results may reveal a poten- tial application of this new formu- lation in glaucoma management, in order to improve patient compliance by lowering the frequency of admin- istration and to enhance therapeutic concerning the absorption rate of topically administered ocular drugs are just some of the critical factors that have propelled experts to pur- sue more effective ways of getting these drugs to glaucomatous eyes. "Despite highly effective topical treatments, half of our patients stop using their drops by 1 year, and among those who do continue to use their drops, many of them have difficulty using them properly," said James Brandt, MD, professor of ophthalmology and vision science, and director of the glaucoma service, University of California, Davis, at the 2015 American Academy of Ophthalmology (AAO) annual meeting. "To prevent blindness, there is a pressing need for sustained patient behavior independent of delivery of glaucoma medications," Dr. Brandt added. Bimatoprost ocular insert shows potential in IOP control Previously conducted in vitro and in vivo evaluations of bimatoprost- loaded ocular inserts have demon- strated promising results. Study shows new bimatoprost ocular insert provides 6-month IOP reduction A mong glaucoma treat- ments, bimatoprost is known to have one of the most effective hypoten- sive effects along with a safer tolerability profile at a lower concentration (0.01% vs. the previ- ous 0.03% formulation used). Katz and colleagues 1 evaluat- ed the IOP-lowering efficacy and safety of ophthalmic formulations of bimatoprost 0.01% and 0.0125% compared with bimatoprost 0.03%. "Bimatoprost 0.01% was equivalent to bimatoprost 0.03% in lowering IOP throughout 12 months of treatment and demonstrated improved tolerability, including less frequent and severe conjuncti- val hyperemia; bimatoprost 0.01% demonstrated a better benefit-to-risk ratio than bimatoprost 0.0125%," they reported in the April 2010 issue of the American Journal of Ophthalmology. Furthermore, Li and colleagues 2 conducted a comparative effective- ness study of first-line medications for primary open-angle glaucoma (POAG). "Bimatoprost, latanoprost, and travoprost are among the most efficacious drugs, although the within-class differences were small and may not be clinically meaningful," they reported in the January 2016 issue of Ophthalmology. Thus, in selecting an IOP-lower- ing drug for any patient, all factors (i.e., adverse effects, patient pref- erences, and cost) should be well considered, emphasized the investi- gators. Patient compliance issue Despite having established all of the above parameters in IOP-lowering management of glaucoma patients, ophthalmologists continue to be challenged in treating affected pa- tients. The limiting factor has long been attributed to patient behav- iors in topical administration of IOP-lowering pharmacologic agents. Patient non-compliance to treatment coupled with issues Makeover for bimatoprost ocular insert Bimatoprost ocular insert for the upper lid Source: John Sheppard, MD

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