Research on Treatments for Glaucoma Shifting to Focus on Drug Delivery, Extended Duration

Jonathan Eisengart, MD, an ophthalmologist at Cleveland Clinic, discussed how treatment for glaucoma has shifted to both extended duration treatment and drug delivery, though there are a few obstacles in the way of widespread use.

This transcript has been lightly edited for clarity.

Transcript

Are any changes to treatment for glaucoma in the pipeline?

You know, for all the early innovation we've had, we're still stuck with kind of the same hammer, which is [to] try to lower eye pressure. There was a while back [that] there was a lot of research in what we call neuroprotection, which is trying to find ways to protect the optic nerve from degeneration, from glaucoma degeneration that didn't involve lowering pressure. But so far, nothing has really panned out in that area. So this, this whole advent of minimally invasive glaucoma surgery, has been really, really important for us, and enormously helpful. And I would say that we've seen, most of that innovation was really, really active I want to say, between like 5 and 10 years ago, and we're still seeing new instruments and techniques come out but at a slower rate than they were.

One of the areas that a lot of people are looking at now is extended duration glaucoma medications. So let's say a small implant that you put into the eye that releases glaucoma medication over a long period. So the advantage of these are people who get sort of irritation from putting in eye drops, or maybe older folks with arthritis who have physically arthritis or strokes or something, physical trouble getting the eye drops in. It would be nice to be able to go to your doctor once a year, or once every 2 years, and have a sustained release implant put in. And there's a few of these on the market. You know, in my mind at the moment, they're just limited by extremely high cost. There's actually a couple that release a medicine called travoprost, which is available as an eye drop. There's 1 that is FDA approved for 3 months, and unfortunately, it's currently limited, at least FDA approval, it's only limited for a single treatment. There's another one that's supposed to last, I think I want to say almost 2 years, but that one is extraordinarily expensive, in the 10s of 1000s of dollars. And so here at Cleveland Clinic, we're still kind of evaluating those and deciding if that's a good sort of cost benefit, because the medication that they're currently releasing is generic and pretty low cost if you administer it as an eye drop, so it's many, many, many times more expensive as a sustained release. But I would say that's where a lot of work is going now, is drug delivery, so trying to find ways to make our medications have fewer side effects and more convenient for patients. So I'm still hopeful that things will come around in that space.

And to be clear, there are some topical medications, you know, just glaucoma drops, that can cost 2, 3, [or] 4 dollars a drop, and they can cost people hundreds of dollars out of pocket a month. And there's a big variety. There's some older, still very, very effective glaucoma medications that are just a few dollars a month with, you know, with many insurance plans. So it's definitely a barrier. Cost and availability of these newer medications are still a barrier, as they are in probably most fields of medicine these days.