Melissa Barnett, OD, of the University of California, Davis Eye Center, Sacramento and Davis, CA, described new strategies, technologies, and classes of drugs to treat chronic diseases such as myopia, Demodex infestation, dysfunction meibomian glands, administration of glaucoma medications, advances in corneal and cataract surgeries, and presbyopia
Every medical breakthrough in history is born out of research, and eye care is at the zenith of research today. Melissa Barnett, OD, of the University of California, Davis Eye Center, Sacramento and Davis, CA, described new strategies, technologies, and classes of drugs to treat chronic diseases such as myopia, Demodex infestation, dysfunction meibomian glands, the administration of drugs for glaucoma, advances in corneal and cataract surgeries, and presbyopia. Here are some important points.
Currently, a record number of cases of myopia are being diagnosed and patients have several treatment options to choose from, including multifocal glasses, multifocal contact lenses, MiSight soft lenses (CooperVision) and Ortho-K lenses (Euclid) .
Atropine drops and atropine derivatives are another tested approach that works in reducing the progression of myopia.
This ectoparasite, the most common in humans, has a prevalence rate of 100% in patients aged 70 and over. The current treatment – 100% concentration tea tree oil – has the fastest kill time compared to all other treatments which include 100% caraway oil, 100% alcohol, 10% povidone iodine and 4% pilocarpine. The most common side effects associated with tea tree oil are burning and stinging. The oil is also associated with the risk of corneal damage.
Topical and oral ivermectin can also be used to treat Desmodex. The topical form combined with daily eyelid scrubs was more effective than eyelid hygiene alone.
Meibomian gland dysfunction
This is associated with most cases of dry eye. Current treatments are meibomian gland obstruction, anti-inflammatories and mechanical devices.
Two drugs, minocycline (Meizuvo, Hovione) showed a positive clinical effect in almost three quarters of patients in clinical trials and perfluorohexyloctane (NOV03, Novaliq) prevented excessive tear evaporation and helped restore the balance of the tear film.
The thrust in the treatment of glaucoma is the development of alternative drug delivery systems to conventional drops.
Microdose latanoprost (Eyenovia) is currently being evaluated in a phase 2 trial. Using the microdose design, substantial reductions in intraocular pressure were observed as with conventional drops; however, the big advantage is that this approach is associated with a 75% reduction in drugs and preservatives, which cause ocular surface toxicity.
Point cap delivery systems deliver both latanoprost (Evolute, Mati Therapeutics) and travoprost (OTX-TP, Ocular Therapeutix) and show promise for glaucoma and ocular hypertension and are minimally invasive.
An intracanalicular insert is bioabsorbable and allows a prolonged release of travoprost without preservative.
Bimatoprost SR (Durysta, Allergan) is an FDA-approved 10-microgram bimatoprost extended-release implant for patients with open-angle glaucoma and ocular hypertension.
The travoprost intraocular implant (iDose, Glaukos) is positioned in the anterior chamber and anchored behind the trabecular meshwork. The 36 month data showed superior IOP lowering ability in higher percentages of patients compared to timolol.
The Travoprost intracameral implant (OTX-TIC, Ocular Therapeutix) is a bioabsorbable sustained-release implant injected into the anterior chamber. It is currently in a prospective phase 1 clinical trial.
Omidenepag Isopropyl (Eybelis, OMDI), is a new topical glaucoma drug that is a selective, non-prostaglandin prostanoid EP2 receptor with the advantage of having no prostaglandin side effects. The drug is currently the subject of the phase 3 AYAME study.
The progress of the cornea
Descemetorhexis without endothelial keratoplasty is a procedure in which Descemet’s membrane is removed but not followed by endothelial grafting to treat Fuch’s dystrophy. Surgical candidates include those with central gutts and a clear peripheral cornea. The procedure is controversial but may result in fewer adverse events compared to Descemet’s membrane endothelial keratoplasty. The recovery time is on average 3 months.
IOTA Cell Therapy (Aurion Biotech) is an injectable corneal endothelial cell therapy that may have the potential to restore sight in some patients.
A new treatment for neurotrophic keratitis, dHGF (deleted form of hepatocyte growth factor) (CSB-001, Claris Biotherapy), is being evaluated. The technology, which is anti-fibrotic, neurotrophic and anti-inflammatory, accelerates the healing of affected corneal tissue.
Advances in cataract care
Advances in cataract care include more sophisticated trifocal intraocular lens (IOL) technology, light-adjustable lens (RxSight), modular IOL systems, small aperture lens designs, and IOLs adapted (Juvene, LensGen; FluidVision PowerVision/Alcon; and Lumina, Akkolens International) .
A few drugs are being developed to treat presbyopia, ie 0.75% phentolamine ophthalmic solution which inhibits the iris dilator muscle; the drug, instilled at night, causes a moderate reduction in the pupil, and pilocarpine at a low dose (0.4%) a daytime drop which acts on the sphincter and the ciliary muscle.
Other new technologies in development include contact lenses for the administration of medications to treat seasonal allergic conjunctivitis (Johnson & Johnson Vision with etafilcon A contact lenses with 0.019 mg ketotifen), latanoprost and prostaglandins for glaucoma (Leo Lens) and dexamethasone for inflammation, and anti-inflammatory and antibiotic agents (OcuMedic).
Scleral lenses are useful for treating persistent epithelial defects, corneal infiltrates, corneal neovascularization, and chemical burns.