The focus on medication development for cataract surgery has turned to sustained-release delivery systems.
“Novel drug delivery devices continue to show promise for reducing or ending the need for topical drops in cataract surgery,” Dr. Donnenfeld said.
Dr. Osher agreed. He predicted that conventional topical medications will become obsolete with the advent of delivery systems that overcome the inefficiencies and compliance issues accompanying drops.
Ocular Therapeutix has completed phase III evaluation of a dexamethasone intracanalicular insert (Dextenza), and Mati Therapeutics is entering this space with a drug-eluting plug technology. Icon Bioscience has developed an intracameral sustained-release biodegradable formulation of dexamethasone that delivers the corticosteroid for several weeks. It has completed the phase III pivotal trials and submitted its NDA.
Dr. Packer wondered whether cost would limit adoption of these platforms. He said it will be interesting to see if manufacturers will be able to gain pass-through status for their products that are placed at the time of cataract surgery so that the cost is covered by Medicare.
Dr. Osher said that he was happy to see that adoption of phenylephrine and ketorolac injection 1%/0.3% (Omidria, Omeros) increased dramatically in 2017. He found the delayed uptake of the intracameral product for maintaining pupil size and reducing postoperative ocular pain puzzling, considering its efficacy, safety, pass-through reimbursement status, and the risks of using compounded alternatives. Now, however, he is waiting to see what happens after the pass-through status expires at the end of 2017.
“I and others have written letters asking CMS to grant separate reimbursement for Omidria, and hopefully that will happen,” Dr. Osher said.