Eye care therapies on the move: What’s in the pipeline

Every medical breakthrough in history was born through research, and eyecare is at the zenith of research today. Melissa Barnett, OD, from the University of California, Davis Eye Center, Sacramento and Davis, CA, described new strategies, technologies, and drug classes to treat chronic conditions that include myopia, Demodex infestation, meibomian gland dysfunction, glaucoma drug delivery, advancements in corneal and cataract surgeries, and presbyopia. Here are some of the highlights.

Myopia

Currently, a record-breaking number of myopia cases are being diagnosed, and patients have several different treatment options to choose from that include spectacle multifocals, contact lens multifocals, MiSight soft lenses (CooperVision), and Ortho-K lenses (Euclid).

Atropine drops and atropine derivatives are another approach being tested that work by reducing the progression of myopia.

Demodex

This ectoparasite, the most common one in humans, has a prevalence rate of 100% in patients 70 years and older. The current treatment—tea tree oil at a concentration of 100%—has the most rapid kill time compared to all other treatments that 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 also is associated with the risk of corneal damage.

Topical and oral ivermectin also can be used to treat Demodex. The topical form in conjunction with daily eyelid scrubs was more effective than lid hygiene alone.

Meibomian gland dysfunction

This is associated with most cases of dry eye. The 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 clinical trial patients and perfluorohexyloctane (NOV03, Novaliq) prevented excessive tear evaporation and helps restore tear film balance.

Glaucoma

The push in glaucoma therapy is the development of alternative drug delivery systems to conventional drops.

Microdose latanoprost (Eyenovia) is currently under evaluation in a phase 2 trial. Using the microdose design, substantial intraocular pressure reductions 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 toxicity of the ocular surface.

Punctal plug delivery systems deliver both latanoprost (Evolute, Mati Therapeutics)and travoprost (OTX-TP, Ocular Therapeutix) and are promising for glaucoma and ocular hypertension and are minimally invasive.

An intracanalicular insert is bioresorbable and provides sustained-release of preservative-free travoprost.

Bimatoprost SR (Durysta, Allergan) is an FDA-approved 10-microgram bimatoprost sustained-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 capability in higher percentages of patients compared with timolol.

Travoprost intracameral implant (OTX-TIC, Ocular Therapeutix) is a bioresorbable sustained-release implant injected into the anterior chamber.It currently is in a phase 1 prospective clinical trial.

Omidenepag Isopropyl (Eybelis, OMDI), is a new topical glaucoma medication that is a selective, non-prostaglandin, prostanoid EP2 receptor, that has the advantage of no prostaglandin side effects. The drug is currently in the phase 3 AYAME Study.

Advances in cornea

Descemetorhexis without endothelial keratoplasty is a procedure in which Descemet’s membrane is removed but not followed by endothelial transplantation to treat Fuch’s dystrophy. Surgical candidates include those with central guttae and a clear peripheral cornea. The procedure is controversial but may cause fewer adverse events compared with Descemet membrane endothelial keratoplasty. The recovery time is a mean of 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 an anti-fibrotic, neurotrophic, and anti-inflammatory, accelerates healing of the affected corneal tissue.

Advances in cataract care

Cataract care advancements include more sophisticated intraocular lens (IOL) trifocal technology, a Light Adjustable lens (RxSight), modular IOL systems, small aperture lens designs, and accommodating IOLs (Juvene, LensGen; FluidVision PowerVision/Alcon; and Lumina, Akkolens International).

Presbyopia

A couple of drugs are being developed to address presbyopia, i.e., phentolamine ophthalmic solution 0.75% that inhibits the iris dilator muscle; the drug, instilled at night, results in moderate pupil reduction, and low-dose pilocarpine (0.4%) a daytime drop that works on the sphincter and ciliary muscle.

Other novel technologies under development include contact lenses for drug delivery 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.