Ninety-three percent of patients do not correctly apply eye drops they were prescribed after cataract surgery, which means introducing new drug routes.
New systems for delivering antibiotic and anti-inflammatory drugs hold promise for cataract surgery, said Francis S. Mah, MD. Patients will benefit from not having to administer eye drops, explained Dr. Mah, director of cornea and external disease, Scripps Clinic, La Jolla, CA.
“One of the drivers for this is to improve compliance to improve efficacy and reduce problems with the medication,” he said.
Applying eye drops requires more knowledge and manual dexterity than most patients can muster. One recent study (J Cataract Refract Surg. 2014;40:1857–1861) showed that 93% of patients do not correctly apply eye drops they were prescribed after cataract surgery, even when carefully educated, Dr. Mah said.
“And that’s when they were in a study and educated in the proper methods,” he said. “Our patients are probably getting much less education.”
New devices might improve efficacy and reduce toxicity as well, he said. “If we’re talking about drops in general something like less than 1% of the drop gets to the site of the target,” he said.
Some of the eye drop drains through the lacrimal system, he said, and the cornea and epithelium also keep the drops from penetrating into the eye. Pharmaceutical companies are also interested in developing drug-delivery systems that are unique so they can patent them, fending off competition from generic versions of their drugs, Dr. Mah said.
The devices may become even more important for glaucoma and retina diseases because the targets are inside the eye, he said. For prevention of miosis and pain in cataract surgery, the FDA has approved some new drug delivery devices and others are in the pipeline.
One approved drug is phenylephrine/ketorolac injection 1%/0.3% (Omidria, Omeros Corp.) One 4-ml single-use vial is added to a 500-ml container of irrigation solution. Preservative and bi-sulfite-free, the drug product is considered safe and well tolerated.
Adverse reactions were similar to those of placebo in clinical trials. It increased pupil diameter by at least 2.5 mm in 27% in one phase III trial and 28% in another while reducing pain. Patients taking phenylephrine/ketorolac used fewer analgesics.
In a retrospective study of real-world outcomes by Drs. Donnenfeld and Rosenberg, phenylephrine/ketorolac caused fewer complications, less papillary dilating device dependence, improved best-corrected visual acuity on day one in select age groups, and decreased procedure times compared with intracameral epinephrine alone. Some physicians are also administering compounded antibiotics, steroids, and non-steroidal anti-inflammatory drugs (NSAIDs) in the anterior chamber or through intravitreal or transzonular injection.
Francis S. Mah, MD
E: [email protected]
This article was adapted from Dr. Mahs’ presentation at the 2017 meeting of the American Academy of Ophthalmology. Dr. Mah disclosed fi nancial relationships to Abbott Medical Optics, Alcon Laboratories, Allergan, Bausch + Lomb,CoDa Therapeutics, ForSight Labs,Novabay Pharmaceuticals,Ocular Therapeutix, Ocular Science, Omeros, PolyActiva, Shire, and TearLab.