Alternative Drug Delivery Systems for Glaucoma: A Dropless Future?

Currently, there is extensive research and development on “drop-free” or “drop-less” technologies for delivering glaucoma medications to the eye.

When you were last at the eye doctor, were you asked: “When did you put your eyedrops in? This morning? What about last night?” You may have realized that you missed a dose. You are not alone! This happens to many glaucoma patients because it’s hard to get in every dose all the time. In some patients, it is not even a matter of forgetfulness. Mobility problems with the neck, or arthritis in the hands, can make putting in drops physically difficult or even impossible.  Unfortunately, no matter the reason, gaps in timing and dosage of eyedrops can cause your glaucoma to worsen. Medications work only when they are used correctly.

For most people, glaucoma is a chronic and slowly progressive disease and eyedrop medications are used for the long term. Over the years, even small pressure spikes caused by missing drops may eventually cause further damage to your optic nerve.

The good news is that there is extensive research and development on “drop-free” or “drop-less” technologies. These devices would deliver the same medications to your eyes to lower eye pressure and treat glaucoma without having to use drops, or with fewer drops. Reducing glaucoma drops on the eye surface may have the added benefit of reducing symptoms of eye irritation and dryness.

New Dropless Technologies

Various glaucoma drug delivery systems were the topic of a session at the Glaucoma 360 New Horizons Forum in San Francisco (presented by Glaucoma Research Foundation). The medicines in these dropless systems can be delivered to your eye in a variety of ways:

• A dissolvable implant into the front of your eye that contains the medicine bimatoprost (Durysta, Allergan – this implant is being used in clinics today and is FDA-approved for one-time use)
• A microscopic device placed in the natural drain of the eye that releases medicine (iDose, Glaukos)
• An injectable implant placed in the back of the eye, in the vitreous (GB-401, Graybug vision)
• A dissolvable implant made of gel (OTX-ITC, Ocular Therapeutix) or polymer (ENV515, Envisia Therapeutics) that sits in the front of the eye and dispenses the medicine Travoprost.
• A tiny plug that sits in your tear duct that continually releases medicine into the tear film where it can be absorbed into the eye (Evolute, Mati Therapeutics).

These new devices and technologies are still being researched and developed. Much work needs to be done before we know exactly how well these new drug delivery options will perform in the long term. But it is gratifying to know that new and better ways to treat glaucoma are on the way. Hopefully, this kind of alternative drug delivery technology will result in better preservation of vision for many people with glaucoma.

Article by Ronald L. Gross, MD and Lily Kim, MD. Posted on March 21, 2023