Just over a year ago, DURYSTA (bimatoprost intracameral implant) received FDA approval and entered the glaucoma treatment paradigm. The implant offers my patients with glaucoma a treatment option that is more convenient and less invasive than other existing treatments. As a physician, I am pleased that this option helps alleviate some of the burden associated with glaucoma treatments from my patients while also offering more time for me to plan ahead. After administering the implant one to two times per week over the past year, I reflect on how the first sustained release glaucoma therapy has impacted my practice and the way I treat my patients with glaucoma.
Getting Started: Patient Discussions and Clinic Setup
When discussing treatments, my goal is to find the plan that will work best for each individual patient. As physicians, we are always concerned with quality of life for our patients. Applying drops several times a day, even once a day, can be time consuming, frustrating, and even restrictive – no one wants to have to plan their day around their medication schedule. When I speak with a patient who might benefit from DURYSTA, I start by explaining the therapy’s benefits before explaining the procedure. Once patients hear the potential benefits, they tend not to be worried about the administration process. I prefer to administer the implant at the slit lamp rather than the operating room, which helps reassure my patients that DURYSTA administration is a straightforward procedure. The ability to administer DURYSTA in between routine visits and other procedures in the office is also valuable and saves me time as a physician.
Over the past year, I have found an increasing number of patient types that benefit from DURYSTA including people with ocular surface disease, before or after a patient receives Selective Laser Trabeculoplasty (SLT), and patients who have received subconjunctival surgery who need an extra reduction in intraocular pressure (IOP). The elderly, or those who otherwise need assistance from a caregiver with their glaucoma care, are another group of patients that has seen a significant benefit from DURYSTA due to the social distancing restrictions and quarantine protocols. One patient in particular, a woman in her 90s, came in for her follow-up appointment and her eyes were no longer red as they had been from a daily regime of multiple drops. I was pleased to see her quality of life increase along with that of her caregiver who no longer had to administer drops several times per day.
After a patient receives DURYSTA, we don’t have to worry about whether they are administering their drops properly or whether they have filled their most recent prescription. While on DURYSTA, patients may not need to be seen for as many follow-up visits – a welcome reprieve for patients who now only need to come in every four to six months. This is especially true for my patients who live in nursing homes or assisted living facilities, where there were additional barriers to scheduling in-person appointments at the height of the pandemic.
This first year with DURYSTA has been all about finding the right patients for this therapy and finding the environment where I am most comfortable administering the therapy. As a physician, I have come to appreciate the administration process. Once the process has been put in place in the office, there is a certain efficiency that allows you to go all the way from procurement to administration that makes it easy to incorporate the use of the implant into your practice. Administering DURYSTA in my office keeps my patient flow moving on clinic days. The more patients I can see and treat appropriately, the more eyes I have with sustained low IOP, and the more gratification I get from what I do. Of course, in the end, the most important benefits are those experienced by the patient. With DURYSTA I am able to help improve quality of life for many of my patients with glaucoma who experience ocular surface disease, redness, issues with adherence to drop regimens as well as issues related to various comorbidities.
DURYSTA is ophthalmology’s introduction to sustained drug delivery, a new pillar of the glaucoma treatment paradigm that is only expected to grow in the decades to come. The era of sustained drug delivery will likely be marked by fewer follow-ups visits, a lesser role for drops, and providing patients and physicians alike with more time to plan for surgeries and other complex procedures.
Currently, DURYSTA is approved for one administration per eye which offers patients weeks to months of controlled IOP. I am also excited for the potential of sustained release drug delivery to help bring new treatment options to other ophthalmic specialties outside of glaucoma. I don’t know exactly what the future holds, but I am hopeful more and more options like DURYSTA will become available.
Dr. Oluwatosin “Tosin” Smith, MD is a board-certified ophthalmologist at Glaucoma Associates of Texas in Dallas, and has over 26 years of experience in the medical field. She is involved with various aspects of patient care, clinical research and global education.