corneal hysteresis: a new target in glaucoma...
TRANSCRIPT
1 1
Glaucoma pharmacotherapy
Nathan Radcliffe, MD
New York Eye Surgical Center
New York University
April 1, 2016
2
Disclosures
3
Glaucoma
A progressive disease characterized by retinal ganglion
cell and axonal deterioration accompanied by visual
functional loss
Difference Follow-up Baseline
Ritch, Shields, Krupin. The Glaucomas, Vol 1. Mosby, 1989.
4
Medical Therapy History
5
The challenges of medical
therapy: a case
58 year old myopic man with OHTN
Using latanoprost ou qhs, forgets drops “sometimes”
IOP 25 mm Hg OU, CCT 580 ou
6
7
8
Steps to IOP lowering
Prescription written
Prescription presented to pharmacist & dispensed
Medication applied to eye
Medication activates target
9
Prescription fill rates?
Of almost14,000 patients prescribed
glaucoma medications:
Only 10% of patients will endure 1 year
without refill gaps
The medication possession ratio was 0.64.
Difficult topic to study for methodological
reasons
Friedman, D., et al. IOVS. 2007; 48:5052-5057
10
Once they are taking the drops…
Only 39% of attempted eye drop
placements hit the eye1
On average 1.4 drops are delivered per
attempt1
In a typical clinical trial, 16.5% will
experience adverse events and 28.1%
will discontinue therapy2
1. Hennessy, AL, et. al. Am J Ophthal. 2011; 152:982-8.
2. Sherwood, M., et al. Arch Ophthalmol. 2006;124:1230-1238
11
Up to 33% of glaucoma patients touch the bottle to
their eye during eye drop application!
Hennessy, AL, et. al. Am J Ophthal. 2011; 152:982-8.
12
Does it matter?
Poor adherence is associated with visual
field progression1
1. Stewart WC et al. Am J Ophthalmol. 1993;116:176–181.
13
Question:
Is it ideal to use a therapy that we know many patients:
Forget to take
Can not get into their eyes
My answer:
Eye drop therapy has a welcomed place in glaucoma management, but other therapies including laser and sustained delivery may help us avoid the above problems
When we use drops, we should use the ones that are most powerful and best tolerated to avoid the need for additional drops and give our patients the best chance of sucess
14
Selective Laser Trabeculoplasty
The SLT/Med Study group found that SLT laser and
medications performed similarly in a group of patients
randomized to each treatment, with a 6 to 7 mm Hg
reduction in both groups
1. Realini T. Selective laser trabeculoplasty for the management of open-angle glaucoma in St. Lucia. JAMA Ophthalmol.
2013;131(3):321-7.
2. 2. Katz LJ, Steinmann WC, Kabir A, Molineaux J, Wizov SS, Marcellino G; SLT/Med Study Group. Selective laser
trabeculoplasty versus medical therapy as initial treatment of glaucoma: a prospective, randomized trial. J Glaucoma.
2012;21(7):460-8.
15
Trabeculoplasty
Ramulu PY, et al. Ophthalmology. 2007;114:2265-70.
16
Ocular Surgery News 2012
Audience Response Question:
What therapy would you select for yourself if you
developed ocular hypertension or glaucoma?
50% trabeculoplasty, 50% drops
What therapy would you select for your patient as
primary therapy?
90% drops, 10% trabeculoplasty
17
Current treatment paradigm
Initiate with Prostaglandin analog (?SLT)
(~80% acceptance rate)
Single agent Fixed Combination
Surgery
?SLT
?SLT
18
Sustained Release
Allergan
Safety and Efficacy of Bimatoprost Sustained-Release
(SR) in Patients With Open-Angle Glaucoma or Ocular
Hypertension (Phase three trial underway)1
Regarding the Phase II study:2 “All dose strengths of
Bimatoprost SR were comparable with topical
bimatoprost 0.03% in overall IOP reduction through
week 16.”
1. https://clinicaltrials.gov/ct2/show/NCT02250651
2. http://www.allergan.com/news/news/thomson-reuters/positive-phase-i-ii-
interim-data-of-bimatoprost-su
19
Sustained Release
ForSight Vision 5
Bimatoprost sustained release ring (Phase 2)
Other options in the pipeline
20
Sustained Release
Mati Therapeutics
Punctal Plug Drug Delivery System (PPDS)
30
Summary
Glaucoma is a chronic and progressive disease
that requires consistent effective treatment
IOP lowering therapy with medications can be
effective but is limited by compliance, which is a
major problem
Sustained delivery treatments may be part of the
solution
31 31
Thank you!!!