Eyeworld Supplements

NAVIGATING THE BUSINESS OF GLAUCOMA continued from previous page Dr. Bedrood noted that there are many pros for sus- tained release, including adherence, 24-hour control, and lower cost to the patient. It's a paradigm shift for doctors, but it's procedural in nature, she said, and it saves time in the clinic long term. "I think overall this is a win for us, and I think implementing it into the practice is something we all should think about," she said. Visualization Dr. Singh discussed the heads-up display during surgery, noting that he had neck surgery back in 2018. Physicians can develop neck and back issues as well as headaches if they don't have good posture. Dr. Singh has used the NGENUITY system (Alcon), the Beyeonics One (Beyeon- ics), and has Artevo (Zeiss) in his ASC, hospital, and office surgery suite. There are a lot of opportunities in this space, he said. The other point with visualization is picking an in- traoperative gonio lens that works for you; the lens is so important, and there are many options, he said. The goal is to obtain an en face and perpendicular view. "The proce- dure will be more consistent and efficient if you take your time to obtain that ideal view," he said. If the view changes due to chamber shallowing, especially if you are operating on a phakic patient, don't be afraid to come out and refill the anterior chamber. The most important thing is never compromise on your view, Dr. Singh said, adding that an extra couple minutes of adjusting the scope, head, lens and injecting more viscoelastic can save you. Dr. Singh went on to discuss the FLigHT procedure, femtosecond laser image-guided high-precision trabeculo- tomy (ViaLase). You can place targeted 200- x 500-micron openings to expose the canal where you want, not just na- sally, and target based on what you see using a high quality gonio camera, he said. It also has real-time OCT that verifies the treatment real time. 1. Gazzard G, et al. Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LiGHT): a multicentre randomised controlled trial. Lancet. 2019;393:1505– 1516. 2. Congdon N, et al. Direct selective laser trabeculoplasty in open angle glaucoma study design: a multicentre, randomised, controlled, investigator-masked trial (GLAUrious). Br J Ophthalmol. 2023;107:62–65. Bedrood: saharbedrood@gmail.com Provencher: lorrainemprovencher@gmail.com Radcliffe: drradcliffe@gmail.com Shah: manjool@gmail.com Singh: ipsingh@amazingeye.com Bedrood: AbbVie, Alcon, Elios, Glaukos, Nova Eye Medical, Ocular Therapeutix, Théa Provencher: RadiusXR, Zeiss Radcliffe: AbbVie, Alcon, Bausch + Lomb, Elios, Glaukos, Ocular Therapeutix, RadiusXR, Sight Sciences, Théa, ViaLase, Zeiss References Contact Relevant disclosures Shah: AbbVie, Alcon, Bausch + Lomb, Elios, Glaukos, Nova Eye Medical, ONL Therapeutics Singh: AbbVie, Alcon, Bausch + Lomb, Elios, Glaukos, New World Medical, Sight Sciences, Zeiss Innovations continued with sustained release and drug delivery. Dr. Bedrood said she thinks that sustained release is going to be at the "forefront of what we're going to be using as glaucoma specialists." She mentioned Durysta (bimatoprost intracameral implant, AbbVie) and iDose TR (travoprost intracameral implant, Glaukos). She described drug delivery as an engineered technol- ogy of targeted delivery or controlled release. Intracameral options and implants into the angle have been explored in this space. Other applications with contact lenses, in the subconjunctival space, a port delivery system, and canalicu- lar options are being explored. She discussed ideal patient characteristics for sustained release, which are the same as when using a drop. Charac- teristics include ocular hypertension to advanced glaucoma, open angles with space for implant/delivery, and avoiding any kind of corneal disease. There is so much flexibility in the patient scenario, she said. It's not just for patients who are intolerant to drops. Patients may need a drop vacation, or you may be preparing them prior to SLT or optimizing the ocular surface. Dr. Bedrood discussed Durysta, which is a single ad- ministration implant injected into the anterior chamber. It's made of a biodegradable polymer that is effective for 15 weeks; there is a subset of patients with longer efficacy, and there is the possibility for trabecular meshwork remodeling. She shared 24-month results from the clinical trial, which showed that a single implant lowered IOP for up to 1 year in 40% of patients and up to 2 years in 28% of patients. Another product in this space is iDose TR, which is implanted through the trabecular meshwork into the scleral wall, and the proprietary membrane elutes the travoprost formula. It's a titanium implant with a long duration of drug delivery (36 months). In terms of efficacy, in the Phase 2b trial at 36 months, 69% were well-controlled compared to 45% of timolol alone. At 12 months, 81% of iDose TR pa- tients were off all medications, and iDose TR was explanted at 24 months and found to have 16% of drug remaining.

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