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Business & Profession Glaucoma, Cornea/Ocular Surface, Cornea/Ocular Surface, Business and Innovation

It’s All in the Small Print

At a Glance

  • Sean Ianchulev’s company, Eyenovia, is using piezo-printing technology to change the eye-drop delivery process
  • The new piezo-electric delivery system is capable of delivering small doses of 6-8 microlitres – volumes compatible with natural physiology
  • The microdosing system will reduce side effects associated with the eye drop toxicity

Patients dislike glaucoma eye drops; the delivery mode is inconvenient and imprecise – in fact, unlike no other medical field, in ophthalmology we deliver the wrong dose more often than we do the prescribed one – with many studies now demonstrating that only one third to a half of all patients are able to successfully deliver the indicated topical dose to their eye (1). Most of the time they miss the eye altogether or deliver 200-500 percent overdose causing side effects, waste and missed compliance.  Ophthalmic formulations cause a range of unwanted side effects from discoloration to periorbital dermatitis. Hence the famously high non-adherence levels associated with topically-applied glaucoma medication. But given that the standard eye-dropper method dates from before the 20th century, should we really be surprised that it’s problematic? Ianchulev certainly takes this view, and is indignant that the subject isn’t more broadly discussed. “Physicians are using a 150-year-old device to deliver 50 microlitres of drug into a seven microlitre tear film volume – no wonder eye drops are poorly tolerated!” But now Ianchulev’s company, Eyenovia, is bringing 21st century engineering to ocular drug delivery. “By marrying piezo-printing technology with smart drug delivery, we’re completely disrupting the eye-drop technology,” he says. In fact, the implications of the Eyenovia technology go far beyond issues of drug tolerability: some of the off-target effects associated with eye drops are life-threatening, and include cardiotoxicity symptoms, such as arrhythmia and bradycardia. So, by reducing off-target tissue exposure, Ianchulev’s microdosing approach may improve not just patient comfort, but patient safety – good news for patients, physicians and healthcare systems alike.

What’s new about the Eyenovia approach? Discarding the ancient eyedropper, Ianchulev’s team has turned to piezo-electric ink delivery systems – well known for precise delivery of suitable amounts of ink onto paper – by modifying such technology to administer 6–8 µL drug doses that are more compatible with natural physiology; in other words, the volume delivered does not overload the eye with fluid in the same way as an eyedropper. Louis Pasquale, Ianchulev’s clinical collaborator, makes another important point: “Keeping the administration volume to 8 µL or less is important; larger quantities cause a lachrymal reflex that washes much of the dose out of the eye,” he says. “When you think about it, it’s amazing that glaucoma eye drops work at all – much of the administrated dose is washed out by the lachrymal reflex.” Avoiding this wash-out is not only more efficient in terms of drug use, but also more pleasant for the patient.

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