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Subspecialties Glaucoma, Business and Innovation

Evolving Design, Advancing Predictability

sponsored by Glaukos

Patient compliance is a hot topic in every ophthalmic subspecialty – not least glaucoma, where complex dosing regimens, adverse side effects, and difficulty instilling drops have led to non-adherence rates as high as 90 percent (1). With 25 percent of patients failing to refill their second prescription (2), physicians are left with the difficult task of preserving what sight is left before further deterioration takes place. Unfortunately, adherence is not the only issue associated with drops. Excessive use of topical medications has also been found to cause ocular surface disease and impede healing, increasing the already substantial treatment burden for patients (3) – but there is hope. Glaukos, the revolutionary glaucoma company, has found a way to alleviate the treatment burden… by requiring no patient intervention at all.

Enter the iDose®: a unique intraocular drug delivery system that offers a viable alternative to traditional topical drop medications. Expected in 2022 in the USA, the iDose consists of a titanium intraocular implant filled with a proprietary, ultrapotent Travoprost formulation. A scleral anchor is designed to serve the function of holding the device in place.

With a miniature profile – a mere 1.8 mm by 0.5 mm – the iDose is inserted through a tiny clear corneal incision, enabling direct implantation into the anterior chamber, where it begins the process of sustained drug elution.

Impressive – but it is not the only new product in Glaukos’ arsenal. The company has extended its range of revolutionary iStent technologies to include the iStent inject W® – precisionengineered for increased predictability. Like its predecessors, it comprises a unique handheld injector designed to implant two heparincoated titanium stents via a single incision. A wide flange at the base of the device is designed to facilitate seamless implantation by providing observable positioning, while molded-in grip texture and matte finish on the injector provides optimum comfort and control. The iStent inject W is designed to provide targeted stent placement, allowing physicians to bypass the trabecular meshwork – the source of 75 percent of resistance (4) – and improve aqueous outflow through the conventional pathway. Built on proven Glaukos trabecular micro-bypass technology iStent inject W is designed to provide a significant reduction in intraocular pressure, as well as potential to minimize patient dependence on topical medications (5).

The success of the iStent series is backed by more than 10 years of clinical data and more than 500,000 implantations to date.

As with all iStent technologies, the iStent inject W can be used during cataract surgery or as a stand-alone procedure – often requiring no additional follow-up beyond that of a usual cataract procedure. It is already being hailed as a safe and efficacious option for mild-tomoderate glaucoma patients, but for anyone familiar with iStent technology, this will come as no surprise. The success of the iStent series has been reported in more than 125 published peer-reviewed studies, backed by more than 10 years of clinical data and more than 500,000 implantations to date. Its appeal is due, in part, to its affordability.

By intervening at the same time as cataract surgery, iStent inject W may delay the need for alternative surgeries, reduce the number of follow-up appointments (6) and potentially reduce medication costs (7), making it easier for physicians to meet the current – and future – needs of their patient population, affordably. Both the iDose and iStent inject W will join Glaukos’ portfolio of cutting-edge micro-scale therapies. With treatments to address the full range of glaucoma disease states – from ocular hypertension to advanced glaucoma – Glaukos continues to build a comprehensive and proprietary portfolio of micro-scale surgical and pharmaceutical glaucoma therapies.

For more information, visit glaukos.com.

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  1. Glaukos, “Implementing iStent inject in your NHS service”, 5 (2019).
  2. Hopkins Medicine, “Wilmer Glaucoma Center of Excellence”. Available at: https://bit.ly/2PKNvKi. Accessed November 1, 2019.
  3. Z Anwar et al., “Glaucoma therapy and ocular surface disease: current literature and recommendations”, Curr Opin Ophthalmol, 24, 136 (2013). PMID: 23542350.
  4. R Rosenquist et al., “Outflow resistance of enucleated human eyes at two different perfusion pressures and different extents of trabeculectomy”, Curr Eye Res, 8, 1233-1240 (1989). PMID: 2627793.
  5. AF Resende et al., “iStent® trabecular microbypass stent: an update”, J Ophthalmol (2016). PMID: 27413541.
  6. RAP Guedes et al., “Intermediate Results of iStent or iStent inject implantation combined with cataract surgery in a real-world setting: a longitudinal retrospective study”, Ophthalmol Ther, 8, 87 (2019). PMID: 30721523.
  7. K Ngan et al., “A cost minimisation analysis comparing iStent accompanying cataract surgery and selective laser trabeculoplasty versus topical glaucoma medications in a public healthcare setting in New Zealand”, Graefes Arch Clin Exp Ophthalmol, 256, 2181 (2018). PMID: 30132278.

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