Cataract and Glaucoma Specialist at Harvard Eye Associates
Before 2010, patients living with glaucoma effectively had only two treatment options to choose from: eye drops or surgery. However, both treatments have their limitations.
Reliance on drops is akin to playing prevent defense late in the fourth quarter with patients gambling that functional vision loss in small increments over a lifetime won’t lead to blindness.
Why? Patient compliance with drops is often extremely low, as I’ve seen firsthand with patients and has been confirmed in studies.1,2 I’ve seen widespread, well-documented eye drop non-compliance caused by dosing errors, cost, and patient adherence issues. Many patients unintentionally drop the ball and struggle to aim, squeeze, dose, or even remember to use their drops correctly. These issues only compound as we age.
The second option for glaucoma patients before 2010 was major eye surgery – usually a trabeculectomy or tube shunts – which carried their own risks, could also fail to lower eye pressure enough to prevent vision loss, and often led to the need for eye drops, anyway.
Over the past decade, the emergence of laser procedures and minimally invasive surgery has been a game-changer for ophthalmologists and patients alike. The entire subspecialty of interventional glaucoma treatments aims to tackle non-compliance and offer our patients a treatment option with immediate, tangible, and positive effects on eye pressure.
I always say that as ophthalmologists, we are 90% eyecare specialist and 10% psychiatrist for our patients. We’ve long needed a middle ground between drops and surgery—a new delivery technology to dispense the medication consistently without the wild card of patient administration and adherence. In 2020, the FDA and industry delivered just such a breakthrough with the historic approval of ocular implants.
DURYSTATM (bimatoprost implant) is the first FDA-approved, dissolvable implant to reduce eye pressure in people with open angle glaucoma or ocular hypertension. As the implant dissolves, it automatically releases medicine over time to lower high eye pressure inside the eye. A single DURYSTA implant reduced eye pressure for 15 weeks in clinical studies and cuts out the need for drops during that time.
I’ve now treated 800 eyes with ocular implants in my ophthalmology practice, and the results have been remarkable. Roughly 75% of my patients, who had two different types of drops before, saw their eye pressure substantially improve when an ocular implant replaced both drops. To me, these results not only demonstrate this innovation’s efficacy, but they also starkly illustrate the seriousness of eyedrop non-compliance.
Side effects can include eye redness, irritation, and light sensitivity, which typically last just a couple of days before resolving. However, eye drops carry the same side effects, which may never resolve for as long as patients are using drops.
As a physician, the most exciting thing about implants is the positive psychological change it has affected in patients with an aversion to eye procedures. When I present ocular implants as an option, I tell my patients they’ll receive small insert of medication that will automatically deliver the same active ingredient as their eye drops and may fully replace their eye drop medications for the treatment duration. Then I explain that the tiny implant is a millimeter in length and point to an informational card I created with an illustration the actual size of the implant. The usual reply is, “I can’t see it.”
With that brief interaction, I’ve helped many procedure-averse patients conquer their fears and open their minds to the merits of going on the offense against glaucoma with an interventional treatment so they can win the fight to keep their sight.
Dr. Savak Teymoorian specializes in cataracts and glaucoma at Harvard Eye Associates, a large, multi-subspeciality ophthalmology practice in South Orange County, California.
References
- Schwartz GF, Quigley HA. Adherence and persistence with glaucoma therapy. Surv Ophthalmol. 2008;53 Suppl1:S57-S68. doi:10.1016/j.survophthal.2008.08.002
- Yeaw J, Benner JS, Walt JG, Sian S, Smith DB. Comparing adherence and persistence across 6 chronic medication classes. J Manag Care Pharm. 2009;15(9):728-740. doi:10.18553/jmcp.2009.15.9.728