Navigating Glaucoma Treatment: From Drops to iDose!

Thomas Nettleton

 

Glaucoma stands as one of an eye doctor’s most formidable adversaries with the potential of silently eroding vision until it’s too late. Understanding this chronic, progressive optic neuropathy is critical, especially considering its impact as the leading cause of irreversible blindness worldwide. With approximately 76 million individuals affected globally, and projections indicating a potential surge to 111 million by 2040, it’s crucial to understand both traditional and cutting-edge treatment modalities.

Understanding Glaucoma: The Silent Thief of Sight

Glaucoma, characterized by optic nerve damage often associated with elevated intraocular pressure (IOP), predominantly affects individuals over 40, with around 3% of this demographic worldwide impacted. Although glaucoma is a complex disease with many variables contributing to optic nerve damage, current treatment continues to revolve primarily around lowering IOP.

Traditional Treatment: Eye Drops and Beyond

Eye drops have long been the first-line in glaucoma management, with various classes available to address elevated IOP. Prostaglandin analogues (PGAs), beta-blockers, carbonic anhydrase inhibitors (CAIs), alpha-2 adrenergic agonists, and combination drops offer diverse mechanisms to lower intraocular pressure and preserve vision.

Innovative Solutions: A Glimpse into the Future

While traditional eye drops remain important, recent advancements have expanded the treatment landscape. Newer drops like Rocklatan™ and Vyzulta™ offer novel mechanisms to lower intraocular pressure effectively. Additionally, rho-kinase inhibitors such as Rhopressa™ provide promising alternatives with comparable efficacy to PGAs.

However, the biggest challenge with drops remains patient adherence. Despite their efficacy, drops only work if consistently used—a hurdle prompting exploration into alternative solutions and too many patients out there are either unable to afford the drops or bothered by the hassle of having to remember to put them in every day.

The Emergence of MIGS (Minimally Invasive Glaucoma Surgeries)

MIGS represent a paradigm shift in glaucoma management, offering minimally invasive procedures with rapid recovery and proven efficacy. These procedures, characterized by their minimal disruption to normal anatomy and physiology, provide a safer and more sustainable approach to lowering intraocular pressure than eye drops alone or more invasive surgeries.

Sustained Release Options: Expanding Horizons

Sustained release options like iDose TR implants provide a promising avenue for long-term glaucoma management. These implants ensure consistent drug delivery, circumventing issues of patient adherence associated with eye drops. With demonstrated efficacy and minimal side effects, sustained release options offer another valuable option in the battle against glaucoma.

Looking Ahead: Bridging Innovation with Patient Care

As we navigate the complexities of Glaucoma treatment, it’s imperative to adopt a comprehensive approach tailored to individual patient needs. From traditional drops to innovative solutions like MIGS and sustained release options, the future of Glaucoma management is bright with possibilities.

Empowering Patients with Knowledge: Glaukos Clinical Study Information

For healthcare providers looking to empower their patients with the latest advancements in Glaucoma treatment, the ongoing Glaukos clinical study offers a unique option with proven results. The objective of this study is to evaluate the IOP-lowering efficacy of administering an iDose TR in conjunction with the placement of iStent infinite compared with the placement of iStent infinite alone. This means that your patient will receive glaucoma treatment regardless of which arm of study the patient is enrolled in and both treatments are already FDA approved.

Inclusion Criteria:

• Diagnosis of open angle glaucoma (including pseudoexfoliation or pigmentary or ocular hypertension)
• On either 0, 1, or 2 topical medications at the time of screening.
• IOP on medications less than 33mmHg.
• Able to safely undergo a medication washout in the study eye. (no severe cases)
• Trabecular meshwork visible to a grade of 3 or 4 on gonioscopy.
• Endothelial cells WNL with specular microscopy.
• Best-corrected visual acuity (BCVA) of 20/80 or better.
• Unmedicated mean diurnal IOP in the study eye taken at 8 am, 10 am, 4 pm must be between 23mmHg and 36mmHg following washout period.
• If on a PGA, the IOP must be >3mmHg higher after washout than on gtts.

By participating in this study, patients have the opportunity to contribute to advancements in glaucoma treatment while benefiting from newer therapies tailored to their individual needs. It’s through collaborative efforts between doctors and patients that we can pave the way towards a brighter future for glaucoma treatment.

If enrolled, your patient will receive treatment in one eye, leaving their other eye to be managed as directed by you. Your patient will also receive financial compensation for their time.

At Parkhurst NuVision, our approach encompasses a personalized treatment plan, incorporating the latest advancements while prioritizing patient well-being. With a focus on early intervention, we strive to empower individuals in their journey towards optimal eye health and we endeavor to partner with you as you deliver cutting-edge treatment options to your patient base.