AAO review: Novel approaches shaping eye disease treatments in 2022

New routes of therapeutic administration are paving the way for innovative applications.

With the return of some in-person conferences last year, it goes without saying that there is value in the didactic learning that occurs in formal and poster sessions. In addition, attendees benefit from informal experiences with colleagues by being able to discuss ideas or what they are doing in their practices.

Peter J. McDonnell, MD, William Holland Wilmer Professor of Ophthalmology and director of the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, shares highlights following the recent American Academy of Ophthalmology (AAO) 2021 annual meeting in New Orleans, Louisiana. Although not an exhaustive overview of the many novel therapeutics, McDonnell noted some pipeline developments and approvals—and much of the focus of discussion at AAO—that are sure to pique the interest of professionals from across the eye care spectrum and their patients in 2022 and beyond.

Innovation from back to front

“Well, I wasn’t smart enough to become a retina specialist,” McDonnell quipped. “I’m a cornea person but my retina colleagues tell me there’s tremendous interest in the recently approved port delivery system for delivering ranibizumab (Susvimo; Roche/Genentech).

“During this [COVID-19] pandemic, having these [patients] come in every month or 8 weeks to get an intravitreal injection is quite a challenge—for the patients and the doctors and their clinics. The newly FDA-approved delivery system allows the opportunity to dramatically reduce the number of visits and the frequency of injections for these patients,” he explained. With its anticipated availability in the United States in the coming months, McDonnell noted that there is “tremendous eagerness among our retina brothers and sisters to be able to begin to look at incorporating this into their practices and to see for which patients it works well and how well it’s accepted among the patients with [age-related macular degeneration] AMD.”

Another innovation in the retina space, McDonnell noted, is the recently approved

suprachoroidal injection of triamcinolone acetonide (Xipere; Bausch + Lomb/Clearside Biomedical) using microneedles. This is an interesting—and new—technology for retinal disease and for macular edema in the setting of uveitis. But instead of intravitreal injections, these are through the sclera into the suprachoroidal space.

“This is a whole new thing for us,” McDonnell said. “It’ll be interesting to see how this gets adopted. The approval is for macular edema in uveitis patients, but obviously there is the potential for triamcinolone to be helpful for other indications or for this to be a platform for administering other medications through this suprachoroidal route for other disease states. I think this was an exciting topic in New Orleans—one that will be a very exciting topic coming into the new year in our meetings in 2022.”

Turning to cornea/external disease, McDonnell said AAO attendees were also learning more about a newly approved nasal spray for treatment of signs and symptoms of dry eye disease (Tyrvaya; Oyster Point Pharma). “This is the drug that’s been used for years to help reduce the craving for smoking but is now administered intranasally. It improved dry eye in the FDA trials. This will be interesting because it’s such a new route of administration, treating an eye problem with a nasal spray. It’ll be fascinating to see when this launches in the first quarter [of this year] and determine how readily it’s accepted by both doctors and our dry eye patients,” he said.

Presbyopia

Last but not least, the newly approved and launched formulation of pilocarpine (Vuity; Allergan) for the improvement of uncorrected near vision in the presbyopic age group offers a new approach to the gigantic presbyopia market, McDonnell added. “Again, this drug has been around for literally centuries and ophthalmologists of my generation used it routinely in the management of glaucoma when we trained,” he said.

McDonnell also commented on the advent of interesting new treatment applications in eye care. “In each case, it’s not so much a new drug. They’re preexisting drugs but new ways of delivering the drug. Triamcinolone has been around forever and pilocarpine even longer; ranibizumab for a long time. As I mentioned with the nasal spray, the active agent varenicline has been available for quite a while now for smoking cessation.

“It’s about new routes of administration for new ophthalmic indications. It’s exciting to see all these innovations despite the pandemic,” he said.

Peter J. McDonnell, MD

E: pmcdonn1@jhmi.edu

McDonnell serves on the board of directors for Aerie Pharmaceuticals.