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Sustained-release glaucoma implants · Glaucoma, Vision & Longevity: Supplements & Science

• 0:00
  SPEAKER_00: Sustained release glaucoma implants.
• 0:02
  SPEAKER_00: Imagine having glaucoma and relying on daily eye drops to protect your vision.
• 0:07
  SPEAKER_00: But every night, whether out of fatigue or busy schedule, you forget or skip them.
• 0:12
  SPEAKER_00: Many patients know this drill missing eye drop doses, administering them poorly, or giving up because the drops sting or irritate.
• 0:20
  SPEAKER_00: Glaucoma often feels like a hidden disease.
• 0:23
  SPEAKER_00: Vision can worsen silently when pressure stays high, so skipping medication can be dangerous.
• 0:29
  SPEAKER_00: Studies show that roughly one in three glaucoma patients admit they do not use their eyedrops consistently.
• 0:35
  SPEAKER_00: Side effects like burning, redness, or dry eyes make matters worse.
• 0:39
  SPEAKER_00: Patients who experience side effects are much more likely to stop or skip treatments.
• 0:45
  SPEAKER_00: In short, relying on daily eye drops is a major problem.
• 0:49
  SPEAKER_00: Many people simply do not take them as prescribed, meaning real-world glaucoma control suffers.
• 0:55
  SPEAKER_00: Ophthalmologists and researchers have long noted these challenges.
• 0:59
  SPEAKER_00: Topical drops can work well if used perfectly, but in reality, poor adherence and side effects are common.
• 1:06
  SPEAKER_00: Recognizing this, scientists have developed sustained release alternatives.
• 1:11
  SPEAKER_00: The idea is to deliver glaucoma medicine inside or near the eye once so it slowly bathes the eye with medication for months, eliminating the need for a patient to remember daily drops.
• 1:22
  SPEAKER_00: These new approaches include small intracameral implants placed inside the eye, drug-eluding devices like medicated spacers or rings, and long-acting prostaglandin delivery systems.
• 1:34
  SPEAKER_00: By continuously releasing medication over time, these technologies promise steadier eye pressure control and far fewer missed doses, potentially reshaping glaucoma care.
• 1:44
  SPEAKER_00: Why eye drops are so hard?
• 1:47
  SPEAKER_00: Glaucoma treatment often starts with eye drop medications that lower intraocular pressure, IOP.
• 1:53
  SPEAKER_00: But using drops correctly isn't easy.
• 1:56
  SPEAKER_00: Many patients struggle with arm or neck stiffness, shaky hands, or poor vision that makes self-instilling drops difficult.
• 2:03
  SPEAKER_00: People sometimes miss the eye entirely or blink the drop out.
• 2:06
  SPEAKER_00: Even simply remembering to take an oftentimes twice-daily dose can be a challenge amid busy lives.
• 2:12
  SPEAKER_00: Surveys and studies confirm this.
• 2:14
  SPEAKER_00: A review found that 30 to 50% of patients with chronic diseases in general do not adhere perfectly to their treatments.
• 2:22
  SPEAKER_00: And in glaucoma specifically, roughly 30% admit missing enough drops to be considered non-adherent.
• 2:29
  SPEAKER_00: Side effects add another hurdle.
• 2:31
  SPEAKER_00: Glaucoma drops often contain preservatives or strong active drugs, which can cause stinging, redness, or eye dryness.
• 2:38
  SPEAKER_00: For example, one study noted that about 38% of patients who had any side effects at all admitted poor use, compared to only 18% of those without side effects.
• 2:50
  SPEAKER_00: Preservatives in drops, like benzylconium chloride, can irritate sensitive eyes, worsening comfort.
• 2:56
  SPEAKER_00: Over time, patients may decide that putting drops in each day is too unpleasant, leading them to skip doses or stop the medication entirely.
• 3:04
  SPEAKER_00: All this adds up to a hidden but serious real-world problem.
• 3:08
  SPEAKER_00: In the controlled setting of a clinical trial, patients may dutifully use every drop and achieve excellent IOP control, but in everyday life, the patient-independent issues, forgetfulness, dexterity, discomfort, often mean glaucoma is undertreated.
• 3:24
  SPEAKER_00: Doctors ring alarm bells.
• 3:26
  SPEAKER_00: Poor adherence is a leading cause of glaucoma progression and vision loss.
• 3:31
  SPEAKER_00: As one glaucoma review put it, conventional drops suffer from poor patient adherence and local side effects, which spurs the search for better delivery systems.
• 3:41
  SPEAKER_00: How sustained release systems work.
• 3:44
  SPEAKER_00: Sustained release glaucoma devices are built to solve these adherence issues.
• 3:48
  SPEAKER_00: Instead of relying on a patient to administer a drug every day, the medication is encapsulated inside an implant or insert.
• 3:56
  SPEAKER_00: These can be placed in or around the eye in a simple procedure, and then they continuously leach small doses of medicine over weeks to months.
• 4:04
  SPEAKER_00: Intracameral implants.
• 4:06
  SPEAKER_00: These are tiny drug-packed rods or reservoirs placed in the anterior chamber, front part of the eye.
• 4:12
  SPEAKER_00: For example, a biodegradable polymer rod can be injected through a needle into the eye.
• 4:17
  SPEAKER_00: Once inside, the polymer slowly breaks down, releasing the drug inside the eye over time.
• 4:23
  SPEAKER_00: Some devices, like the newly FDA-approved IDOS TR, use a tiny titanium reservoir anchored in the eye's drainage angle, dispensing travoprost around the clock.
• 4:34
  SPEAKER_00: Drug-eluding inserts or depots.
• 4:36
  SPEAKER_00: Other ideas include punctal plugs or ocular rings.
• 4:40
  SPEAKER_00: Think of a soft plug placed in the tear duct or a ring in the eyelid that slowly releases prostaglandin analogs.
• 4:46
  SPEAKER_00: These sit in the eye's drainage or surface and diffuse medication gradually.
• 4:51
  SPEAKER_00: Some specialty contact lenses have been tested that soak up a prostaglandin and sit on the eye, giving off drugs slowly over days.
• 4:58
  SPEAKER_00: Biodegradable implants.
• 5:00
  SPEAKER_00: Many approaches use biopolymers, like PLGA or PEA, that safely dissolve in the eye.
• 5:06
  SPEAKER_00: For instance, the Travoprost XR, EN5 and 5 implant, is made of a biodegradable material designed to release Travopross evenly for 6 to 12 months.
• 5:16
  SPEAKER_00: After that period, it has fully dissolved, and if needed, a new one can be injected.
• 5:20
  SPEAKER_00: Other implants may need manual removal or replacement.
• 5:24
  SPEAKER_00: The common theme is set it and forget it.
• 5:27
  SPEAKER_00: A doctor or specialist places the device in the eye during a visit.
• 5:31
  SPEAKER_00: The patient then goes home and in the background, literally behind their eyeball, the medication is continuously supplied day and night, without any effort from the patient.
• 5:41
  SPEAKER_00: It's like having a mini medication pump inside the eye.
• 5:45
  SPEAKER_00: Researchers often describe this as continuous drug delivery, a stark contrast to the ups and downs of dosing with drops.
• 5:52
  SPEAKER_00: Example, Bimatoprost Sustained Release, Dorista.
• 5:56
  SPEAKER_00: One real-world example is Durista, Bimatoprost SR, the first FDA-approved implant, March 2020 for glaucoma treatment.
• 6:05
  SPEAKER_00: This tiny cylindrical implant contains 10 micrograms of bimatoprost, a prostaglandin analog embedded in a solid polymer.
• 6:13
  SPEAKER_00: It is injected with a fine needle into the front of the eye in a quick office procedure.
• 6:18
  SPEAKER_00: Once inside, the polymer slowly dissolves, sending steady bimatoprost to the eye tissues over about four to six months.
• 6:25
  SPEAKER_00: In clinical trials, darista's single injection lowered eye pressure about as well as a daily bimatoprost drop would have.
• 6:32
  SPEAKER_00: But for many patients, it lasted significantly longer.
• 6:36
  SPEAKER_00: Because it is biodegradable, no device removal is needed.
• 6:39
  SPEAKER_00: It simply disappears over time.
• 6:41
  SPEAKER_00: After one derista implant, many patients achieve target IOP for six months or more without any drops.
• 6:48
  SPEAKER_00: However, the FDA label notes a key precaution.
• 6:51
  SPEAKER_00: Derista is currently approved for only one injection per eye, due to some concerns about corneal safety if repeated.
• 6:58
  SPEAKER_00: In a few trial patients, multiple durista implants led to too much stress on the cornea's cells, so repeated use is not allowed at present.
• 7:07
  SPEAKER_00: Example, travopost implant, IDose TR and others.
• 7:11
  SPEAKER_00: Travoprost, a common eyedrop medication, is also being delivered by implants.
• 7:15
  SPEAKER_00: The new IDose TR by Glaucose received FDA approval in December 2023.
• 7:20
  SPEAKER_00: This device is a tiny, non-degradable pill made of titanium with 75 micrograms of travoprost inside.
• 7:28
  SPEAKER_00: A surgeon places it in the drainage angle of the eye, and a thin membrane slowly releases travoprost 24-7 for about three years.
• 7:36
  SPEAKER_00: Once that times up, the implant can be removed or replaced.
• 7:40
  SPEAKER_00: In pivotal trials, a single eye dose implant lowered pressure effectively for years, matching the effect of daily travoprost drops.
• 7:48
  SPEAKER_00: Most people in the trials were able to reduce or stop additional glaucoma drops after the implantation.
• 7:54
  SPEAKER_00: Another travopost implant under study is Travoprost XR, EN55, a biodegradable rod similar in concept to durista but with travoprost.
• 8:04
  SPEAKER_00: Preclinical tests in dogs and early human trials show that a single EN515 injection lowers eye pressure significantly for many months.
• 8:13
  SPEAKER_00: In one trial, by day 25, the implanted eye had a 30% plus drop in IOP, comparable to someone using daily travoprost eye drops.
• 8:23
  SPEAKER_00: Later in that study, most patients on the implant achieve target pressure control for a year or more.
• 8:28
  SPEAKER_00: ENVA15 is still going through clinical testing and awaits FDA approval.
• 8:34
  SPEAKER_00: Other investigational systems research is ongoing on many other sustained release systems.
• 8:39
  SPEAKER_00: For instance, researchers have tested medicated contact lenses that slowly release litanoprost for a week and punctal plugs that release travoprost or latanoprost.
• 8:50
  SPEAKER_00: Some labs are developing long-acting injections like microscopic particles placed under the conjunctiva that dissolve over time.
• 8:58
  SPEAKER_00: These are not yet in mainstream use, but they illustrate the wide interest in drop alternatives.
• 9:04
  SPEAKER_00: Benefits of sustained release implants.
• 9:07
  SPEAKER_00: These new technologies offer several clear advantages over daily drops.
• 9:11
  SPEAKER_00: Steady IOP control.
• 9:13
  SPEAKER_00: Instead of daily peaks and troughs from each drop, the eye is bathed in a constant low-dose stream of medication.
• 9:20
  SPEAKER_00: This can keep pressure very stable.
• 9:22
  SPEAKER_00: Some trials have found that implant patients have more consistent IOPs and less fluctuation than those on drops.
• 9:28
  SPEAKER_00: No missed doses.
• 9:30
  SPEAKER_00: Because the patient doesn't have to apply a drop, there's virtually no chance of forgetting or misusing the medication.
• 9:37
  SPEAKER_00: In a large travoprost implant trial, about 80 to 84% of patients using an implant reduced or eliminated other glaucoma meds by one year, whereas only about 24% of the daily eye drop group did.
• 9:50
  SPEAKER_00: This implies the implant itself was doing most of the work, freeing patients from constant dosing.
• 9:56
  SPEAKER_00: Fewer side effects, potentially.
• 9:58
  SPEAKER_00: With a slow release inside the eye, the drug can often be delivered with fewer preservatives and with less exposure to the front surface tissues.
• 10:07
  SPEAKER_00: For example, darista has no preservatives, which may improve tolerability in some people compared to preservative-containing drops.
• 10:16
  SPEAKER_00: The continuous low dose may also reduce blood levels of the drug, potentially lessening systemic side effects.
• 10:23
  SPEAKER_00: Convenience and compliance.
• 10:25
  SPEAKER_00: Patients report that an in-eye device is often more convenient than multiple daily drops.
• 10:30
  SPEAKER_00: Imagine not needing to wake up or drive around with bottles of eye medicine.
• 10:35
  SPEAKER_00: This is especially helpful for people with busy schedules, memory issues, or physical limitations like arthritis that make drops hard.
• 10:43
  SPEAKER_00: One analysis even noted that despite the higher upfront cost of implants, the adherence advantages might justify it for patients who prioritize relying less on daily drops.
• 10:55
  SPEAKER_00: Improved real-world effectiveness.
• 10:57
  SPEAKER_00: Clinical trials often assume perfect drop use, but real patients are human.
• 11:02
  SPEAKER_00: Sustained release devices largely remove the patient factor.
• 11:06
  SPEAKER_00: In practice, this means more patients may actually get the full benefit of a glaucoma medication.
• 11:12
  SPEAKER_00: Experts suggest these can improve adherence and deliver more predictable effects, potentially reshaping how glaucoma is managed.
• 11:20
  SPEAKER_00: Risks and considerations.
• 11:22
  SPEAKER_00: No treatment is risk-free, and these implants have their own considerations.
• 11:27
  SPEAKER_00: Patients and doctors should weigh the following.
• 11:29
  SPEAKER_00: Procedure-related risks, implantation or removal, requires an intraocular procedure.
• 11:35
  SPEAKER_00: Even though they are designed to be minimally invasive, there is a risk of eye infection, endothermitis, bleeding, or injury with any injection.
• 11:43
  SPEAKER_00: Also, immediately after the procedure, some patients may experience a spike in pressure.
• 11:48
  SPEAKER_00: Eye inflammation.
• 11:50
  SPEAKER_00: Introducing a foreign device can cause inflammation inside the eye, irritus, or uveitis in some cases.
• 11:56
  SPEAKER_00: In trials, a noticeable fraction of implant patients had mild inflammatory signs more often than drop patients.
• 12:04
  SPEAKER_00: This usually resolves with topical steroids, but it's a risk to monitor.
• 12:09
  SPEAKER_00: Corneal safety.
• 12:10
  SPEAKER_00: A major concern has been the health of the corneal endothelium, the cells on the inner cornea.
• 12:15
  SPEAKER_00: In one bimatoprost implant study, patients who received multiple implants in the same eye developed gradual corneal cell loss.
• 12:23
  SPEAKER_00: That is why Darista is limited to one administration per eye, and why long-term corneal safety is being carefully studied.
• 12:31
  SPEAKER_00: Newer devices are designed to sit away from the cornea, and early data, for example with Idose TR over three years, suggest endothelial cell counts remain stable, but long-term follow-up is needed.
• 12:44
  SPEAKER_00: Side effects.
• 12:45
  SPEAKER_00: Because these are still prostaglandin analogs, they can carry similar side effects as drops, only delivered continuously.
• 12:51
  SPEAKER_00: For example, conjunctival redness, hyperemia, or changes in eyelash growth might still occur.
• 12:58
  SPEAKER_00: Some patients might get persistent high eye pressure if the dose is too strong.
• 13:02
  SPEAKER_00: Examples from studies show the most common side effects over 2% of patients are increased IOP and mild eye irritation.
• 13:10
  SPEAKER_00: Cost?
• 13:11
  SPEAKER_00: Current versions of these implants can be expensive.
• 13:14
  SPEAKER_00: For instance, one report noted the eye dose device's list price is about$13,950 per implant, whereas a vial of a month's drops might cost around$64.
• 13:25
  SPEAKER_00: Deresta's wholesale price is lower, around$1,950 per implant, but compare this to roughly$64 for a bottle of drops, even generic ones.
• 13:35
  SPEAKER_00: Insurance coverage varies and long-term cost effectiveness is under study.
• 13:40
  SPEAKER_00: Patients should check whether their plan covers these new devices and consider the financial trade-off.
• 13:46
  SPEAKER_00: Repeat treatments.
• 13:47
  SPEAKER_00: Durista currently can only be used once in each eye.
• 13:51
  SPEAKER_00: Other systems like IDOS TR can be replaced after their course.
• 13:55
  SPEAKER_00: It's designed to last three years, but this involves another minor procedure.
• 13:59
  SPEAKER_00: Ongoing treatments, every 6 to 12 months for a biodegradable rod or every few years for a refillable implant.
• 14:07
  SPEAKER_00: Means patients must return to the clinic periodically.
• 14:10
  SPEAKER_00: In summary, while sustained release implants greatly reduce the daily burden on patients, they do require an upfront procedure and carry a different risk profile.
• 14:20
  SPEAKER_00: Ongoing studies and real-world use will continue to clarify their safety and cost implications.
• 14:26
  SPEAKER_00: Who might benefit most?
• 14:28
  SPEAKER_00: Not every glaucoma patient will jump to implant therapy immediately, but certain groups stand to gain the most.
• 14:35
  SPEAKER_00: Patients with poor adherence.
• 14:37
  SPEAKER_00: Anyone who has trouble taking drops regularly, for example, due to forgetfulness, busy routine, or difficulty handling bottles, is a prime candidate.
• 14:46
  SPEAKER_00: Elderly or disabled patients, people with tremors, arthritis, or vision impairment often struggle with drops.
• 14:53
  SPEAKER_00: A one-time implant can be far easier on this group.
• 14:56
  SPEAKER_00: Those with ocular surface disease.
• 14:59
  SPEAKER_00: Patients who developed chronic redness, dry eye, or irritation from drops, especially those with preservatives, might prefer an implant to avoid these issues.
• 15:09
  SPEAKER_00: Patients on multiple medications.
• 15:11
  SPEAKER_00: Many glaucoma sufferers use two or three different drops.
• 15:14
  SPEAKER_00: Instead of juggling multiple bottles, an implant that covers 6 to 12 months of therapy could simplify management and improve overall control.
• 15:23
  SPEAKER_00: Busy professionals and travelers.
• 15:25
  SPEAKER_00: Someone who flies often or can't be tied to a strict daily routine may appreciate getting the medicine in them in one visit.
• 15:33
  SPEAKER_00: Advanced or progressing glaucoma.
• 15:36
  SPEAKER_00: Patients who continue to progress despite drops might consider an implant or depot as an adjunct, ensuring more consistent pressure reduction.
• 15:44
  SPEAKER_00: People wary of surgery, some implants can be placed in an office setting with a needle, which may appeal to those at risk for more invasive glaucoma surgeries.
• 15:54
  SPEAKER_00: In fact, implants like derista and IDOS are often considered interventional therapies that sit between drops and full incisional surgery.
• 16:03
  SPEAKER_00: In clinician reviews, experts note that already approved devices like B Mataprost SR, DERIESTA, and IDOS are being used in practice, and more are in trials.
• 16:14
  SPEAKER_00: Selecting the right patient involves balancing glaucoma severity, adherence history, side effect profile, and willingness to undergo an in-office procedure.
• 16:23
  SPEAKER_00: Ophthalmologists will typically discuss these trade-offs with eligible patients.
• 16:27
  SPEAKER_00: Could this become standard care?
• 16:30
  SPEAKER_00: It's still early days for sustained release glaucoma treatments, but momentum is building.
• 16:36
  SPEAKER_00: Regulatory approvals and positive trial results suggest these implants very well could become an integral part of future glaucoma care.
• 16:44
  SPEAKER_00: Think of other chronic diseases.
• 16:46
  SPEAKER_00: For example, diabetics now have insulin pumps.
• 16:49
  SPEAKER_00: Psychiatry has even experimented with long-acting injectable antipsychotics.
• 16:54
  SPEAKER_00: Glaucoma may see a similar shift if these dropless solutions prove safe, effective, and economically viable.
• 17:01
  SPEAKER_00: Long term, it's possible that devices like these will be offered routinely to patients early on, especially those predicted to struggle with drops.
• 17:10
  SPEAKER_00: Some experts imagine a time when a patient newly diagnosed with glaucoma could have a brief procedure and then not worry about daily drops for a year or more.
• 17:19
  SPEAKER_00: Clinical practice guidelines may evolve.
• 17:22
  SPEAKER_00: We already see some call for incorporating device-based therapies for suitable patients.
• 17:27
  SPEAKER_00: However, standard adoption will depend on accumulating evidence, comparative studies, e.g., drops versus implants in various patient groups, and real-world data on outcomes and cost.
• 17:39
  SPEAKER_00: Safety remains paramount.
• 17:41
  SPEAKER_00: The glass half-full perspective is that these devices improve adherence and deliver more predictable effects, potentially reshaping treatment paradigms.
• 17:51
  SPEAKER_00: The cautious side notes that we must watch corneal health and long-term vision results closely.
• 17:56
  SPEAKER_00: If ongoing studies show clear benefits in preventing vision loss, beyond just lowering IOP numbers, insurers might endorse wider use.
• 18:05
  SPEAKER_00: At the very least, sustained release implants are adding exciting tools to the glaucoma toolbox.
• 18:11
  SPEAKER_00: For patients frustrated with drops, they offer hope, a future where managing glaucoma could be as simple as a quarterly or annual office visit instead of a nightly routine of squeezing bottles.
• 18:24
  SPEAKER_00: Conclusion.
• 18:25
  SPEAKER_00: Daily glaucoma drops are effective only when patients actually use them, but real-world adherence is frustratingly low.
• 18:32
  SPEAKER_00: Sustained release implants and drug-eluding devices have emerged to bridge this gap.
• 18:37
  SPEAKER_00: By steadily delivering prostaglandin medications inside the eye for months at a time, these innovations can keep eye pressure stable without daily patient effort.
• 18:46
  SPEAKER_00: Early examples, like Allergan's Durista, bimataprost implant, and Glaucos' IDOSTR, Travoprost implant, have shown they can match the pressure lowering of drops while reducing the need for patient compliance.
• 19:01
  SPEAKER_00: The potential benefits are clear: fewer missed doses, less worry about side effects, and more consistent pressure control.
• 19:09
  SPEAKER_00: But they also come with trade-offs, implantation procedures, possible inflammation, and costs.
• 19:15
  SPEAKER_00: Most devices in use or in trials are still one-time or limited use, so ongoing research is determining how best to reuse or refill them.
• 19:24
  SPEAKER_00: For now, these implants are excellent options for patients who struggle with drops, the elderly, busy professionals, or anyone with ocular surface issues.
• 19:33
  SPEAKER_00: As more data comes in, eye doctors anticipate that sustained release treatments will increasingly complement or even partly replace daily drops.
• 19:42
  SPEAKER_00: The goal is a future where everyone with glaucoma gets the reliable therapy they need, whether by drops or devices, to protect their vision.
• 19:51
  SPEAKER_00: For many patients, sustained release implants could be the drop free path to better glaucoma control.
• 19:57
  SPEAKER_00: All links to sources are available in the text version of this article.
• 20:01
  SPEAKER_00: You can find the full article at visualfieldtest.com.
• 20:04
  SPEAKER_00: Thanks for listening.
• 20:05
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