Kicking off the year with Glaucoma Awareness Month triggered my interest in potential solutions for this difficult disease. I’m always interested in companies which are focused on innovative devices and products, so was intrigued to take a look into players in the market who could alter the impact of Glaucoma.
Caused by increased pressure in the eye known as intraocular pressure, Glaucoma is a degenerative disease which builds up over many years. It causes damage to the optic nerve of the eyes, which are connected to the brain and enable us to see and remains one of the biggest causes of irreversible blindness in the world. For reasons still only partially understood by medical science, the fluid build-up in the front of the eye increases pressure and eventually causes loss of vision. This often means those suffering are not aware of their diagnosis until far too late.
There are a few treatments available to intercept the effects of Glaucoma, and some companies with innovative approaches to these products. There are different approaches to Glaucoma treatment depending on severity. The ‘gold standard’ in surgical treatment is said to be a Trabeculectomy, it is the most common and has the highest success rate and includes a creating a flap in the Sclera which acts as a trap door to bypass the normal drainage channel and increase outflow.
Other types of Glaucoma surgery include Minimally Invasive Glaucoma Surgery (MIGS), which includes a variety of implants and stents used to reduce IOP, bypassing the trabecular meshwork to allow flow into the Schlemm’s canal. One of the greatest benefits of microinvasive glaucoma surgeries (MIGS) is that they are designed to provide continuous, sustained lowering of pressure, helping reduce the burden of topical medications.
A standout company within the MIGS market is Glaukos ‘iStent inject W’. Intended to reduce intraocular pressure safely and effectively in patients diagnosed with primary open-angle glaucoma, pseudo-exfoliative glaucoma, or pigmentary glaucoma. Delivering two preloaded trabecular micro-bypass stents with a single entry, its design is intended to optimise the benefits of Trabecular Micro-Bypass surgery by improving aqueous outflow through the natural physiological outflow pathway. Benefits of its use include rapid patient recovery and a reduced reliance on medication, as well as preventing the further degeneration of milder forms of Glaucoma.
Another surgical solution is the Aqueous Shunt Implantation, a device used to drain aqueous humour out of the eye, bypassing the normal drainage channel to a small blister called a bleb. This procedure aims to reduce the pressure inside the eye, preserving the current sight level of the patient, but does not promise to restore or improve sight, rather prevent further loss of vision.
I’ve recently taken interest in the New World Medical ‘Ahmed Glaucoma Valve’, an implant designed to prevent excessive drainage. The tapered profile of the Ahmed Glaucoma Valve helps facilitate insertion of the device. Especially innovative due to its ability to immediately reduce and control pressure caused by Glaucoma through its unique flow restrictor, which also reduces the risk of hypotony at low pressures, making it product the world’s leading Glaucoma drainage device
A laser treatment, or trabeculoplasty, is recommended to treat the most common form of the disease, known as open-angle Glaucoma. Companies such as IRIDEX provide office-based laser solutions for retina practices. Its patented Fovea-friendly™ MicroPulse® laser technology has brought laser treatment to the forefront of the market as an option for most common retinal diseases.
The MicroPulse® laser therapy is a tissue-sparing solution for the treatment of retinal diseases and glaucoma. The laser creates a continuous-wave laser beam, chopped into a train of short, repetitive, low energy pulses. These are separated by a brief rest period which allows the tissue to cool between laser pulses.
Another innovator in the laser market I must mention is BELKIN Vision, whose state-of-the-art laser glaucoma procedure can be applied in seconds at the touch of a button. The BELKIN Vision DSLT (Direct SLT) enables the delivery of a single laser beam with a pulse duration of a few nanoseconds, while the eye remains free of contact. With the press of a button the laser beam is delivered to the limbus, behind which the drainage area of the eye – the trabecular meshwork (TM) - is located. In about a second, the laser splits into 120 beams, enhancing intraocular fluid drainage and lowering the intraocular pressure, which is the main risk factor of glaucoma.
This amazing technology uses a camera guided system to enable a precise, non-contact procedure, powered by sophisticated image acquisition and eye tracking algorithms. The advanced image processing algorithm allows real-time corrections through detecting eye movement, to enable fast and effective treatment.
The level of innovation available in laser treatments highlights the ability for glaucoma prevention to become much more widely available to patients, intercepting degeneration of the disease before sight is lost or surgery is crucial.
There are many different types of ophthalmic solution, better known as eye drops, to aid the treatment of glaucoma. Similar to the previous, more severe treatments mentioned, each works in a different way to reduce the amount of fluid build-up in the eye. As a result IOP, and therefore damage to the optic nerve, is reduced.
There are five main categories working in slightly different ways:
Examples of highly administered drops include VYZULTA, from Bauch + Lomb, as well as more complex combinations utilising ROCK Inhibitor formulas, such as Rocklatan and Rhopressa from Aerie Pharmaceuticals. Each aim to increase drainage of fluid from the eye through two different pathways, lowering intraocular pressure for those suffering with open-angle glaucoma (OAG) or ocular hypertension (OHT).
With these being quite a regularly prescribed solution, I was intrigued by EyeD Pharma’s TimoD implant. A combination of the above, this product is only recently tested for human trial. The single intra-ocular implant comes in the shape of a flexible ring and is implanted to assist the delivery of drugs. This method provides an impressive reduction of dose and side effects in comparison to eye drops and uses minimally invasive 15-minute procedure (mimicked or during a cataract surgery).
Despite only being at an early clinical stage (FIH planned Q4 2021), the preclinical phase results show the absence of timolol in blood, meaning there are no systemic side effects. Design and composition have been defined for Phase I, and I look forward to hearing more about this innovative combination approach to treating this life-altering disease.
As we look forward to another year of development, discovery and innovation in the ophthalmic market, I’m really keen to keep tabs on the successes of the products and companies I’ve mentioned. Will patients and practices gravitate towards a more forward-thinking approach with a hope to discover a more effective “cure”? Or will we continue to administer trusted methods, despite their potential inability to make progress in the market?
If you’re interested in discussing any of the points, companies or products mentioned in this article with me in some more detail, I’d love to hear from you. Feel free to drop me a message at firstname.lastname@example.org, or connect with me on LinkedIn, here.
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