Updated Eye Drops on the Horizon

A new drug delivery system might solve many of your topical medication woes. 
By Rebecca Hepp, Senior Associate Editor

Topical drops have always been a blessing and a curse for eye care providers. While they provide some form of treatment for patients, they come with a host of problems as well. 

“The current use of topical drops for the treatment of ocular disease is certainly an issue,” says Jill Autry, OD, a partner at the Eye Center of Texas ophthalmology center. “There are concerns regarding compliance, convenience, concentration and toxicity—not to mention the poor pharmacokinetic profiles.” 

Researchers have developed a possible solution to some of these age-old problems. Engineers at McMasters University in Ontario, Canada, created microscopic packets designed to sit in the base of the tear film and dissolve gradually—causing a slow release of medication. The researchers believe the new drops could make it possible for patients with conditions such as dry eye and glaucoma to receive the same amount of therapeutic effect from using drops once a week instead of daily.

“Using micelle polymers (miniature dissolvable drug packets), scientists are able to increase contact time and decrease drug concentration while still being easy on the ocular surface,” says Dr. Autry. “This could potentially enable medications to be delivered less frequently and with less systemic and ocular side effects than we have ever known.”

The team’s mucoadhesive drug delivery system, recently described in the journal Biomacromolecules, is comprised of phenylboronic-acid-based polymeric micelles that show low in vitro cytotoxicity against human corneal epithelial cells and undetectable acute in vivo ocular irritation in rats. 

“My concerns are how this technology would be patented,” Dr. Autry says. “Would all companies have access to this delivery system for medications or would it be proprietary and only used in the newest, branded products? I am also concerned about how the delivery system would be affected by ocular conditions such as epiphora, dry eye, corneal scarring, artificial tear use, other drop use, etc., which can alter how the micelles are activated or retained.”

The researchers are in the final stages of investigating the safety and effectiveness of the new technology, hopefully answering many of these concerns. They aim to have it on the market in the near future.

Prosperi-Porta G, Kedzior S, Muirhead B, Sheardown H. Phenylboronic-Acid-Based Polymeric Micelles for Mucoadhesive Anterior Segment Ocular Drug Delivery. Biomacromolecules. 2016;17(4):1449.


CE: The Winning Act at VEW in Vegas 

By Jane Cole, Contributing Editor

Education held the spotlight at the recent Vision Expo West (VEW), held from Sept. 14-17 in Las Vegas. This year’s annual meeting boasted the second all-time highest CE attendance in Expo’s history, with preliminary numbers coming in at 4,542, according to International Vision Expo. Total attendance figures for the entire conference were not available at press time, but will be released in a few weeks, International Vision Expo said.

Top-notch Learning
In total, VEW 2016 offered more than 320 hours of education, with clinical sessions covering everything from ocular disease diagnosis and treatment, contact lenses and therapeutics to the very latest in imaging. 


The Global Contact Lens Forum—and this “State of the Contact Lens Industry in 2016” course in particular—was a hit at this year’s Vision Expo West.

“Our comprehensive and inclusive education programming, combined with our extensive exhibits, came together to offer a high value, impactful experience in Las Vegas,” said Ben Gaddie, OD, co-chair of the Vision Expo conference advisory board. “Vision Expo provides a unique and innovative approach to all aspects of clinical care education including refractive care, contact lenses, anterior segment disease, specialty dry eye management, glaucoma and retinal disease. It’s why more eye care professionals choose International Vision Expo for their education than any other conference.” 

New Perspectives
VEW served up several new courses this year, including a scleral lens track with five hours of CE credit. Scleral lenses provide new opportunities and challenges for practices, and this track featured presentations by Melissa Barnett, OD, Stephanie Woo, OD, and Barry Eiden, OD, on subjects such as fitting, lens design, patient selection, specialized testing and problem solving for both full and mini-sclerals.

Another new track, “CAB Chairman Top Picks,” provided up to 21 hours of CE credit. Some of the highlights from this track included: 

  • The Best and the Worst Ocular Emergencies and Urgencies, presented by Vincent Young, MD, and Marc Myers, OD
  • Neuro For the Rest of Us, by William Marcolini, OD
  • What Do You Do If?... Diagnosis and Treatment of Anterior Segment Disease You Meet Every Day! by Dr. Eiden and Andrew Morgenstern, OD
  • Cloak and Dagger Retinal Clues to Systemic Disease, presented by Steven Ferrucci, OD

During the new “Lightening Rounds” five key opinion leaders offered their different perspectives in a speed-dating type of setting. Topics included glaucoma and anterior segment diseases.

“We recognize that doctors and staff are taking time away from the office to attend Vision Expo, which is why we offer a comprehensive didactic curriculum that is rich in ocular disease and contact lens courses as well as elevated business education sessions catered to bringing back actionable solutions that can be immediately implemented,” said Mark Dunbar, OD, co-chair of the Vision Expo conference advisory board. “Our continuing education is increasingly focused on the practical elements of providing vision care while running a successful business, or those wishing to open a practice.” 

In the Hall
In addition to CE, the conference had 183,000 square feet of exhibit space in the Medical & Scientific Pavilion. The hall showcased the latest ophthalmic technologies and innovations, including 178 companies—24 of which were first-time exhibitors this year.

Mark your calendar for more CE in Sin City next year, as VEW will be back in Las Vegas from Sept. 13-16, 2017. For more information about VEW 2017, go to west.visionexpo.com.

Internal Astigmatism Exposed

Internal astigmatism does not compensate for changes in the structure of the eye, according to new research. Investigators looked at 14 years of measurements and refractive error evaluations on 367 myopic patients and compared the data with one-time measurements of 204 non-myopic individuals. 

Optometrists typically consider internal astigmatism a constant, yet the researchers found evidence suggesting otherwise. Internal astigmatism was greater in non-myopes who proved better able to compensate for corneal astigmatism, and internal astigmatism remained stable over time, not changing as the shape of the eye changed. 

“This work finds that internal astigmatism varies by refractive error, ethnicity and the magnitude of corneal astigmatism,” says Ruth E. Manny, OD, PhD, of University of Houston College of Optometry, and lead author of the study. “Therefore, internal astigmatism should not be thought of as a constant.” 

“Predicting patients who have high internal astigmatism could be important when considering sending a patient for refractive surgery or cataract surgery since neglecting this component of the refraction could produce unwanted outcomes,” Dr. Manny says. 

“Using new technologies may provide a better understanding of the sources of internal astigmatism,” Dr. Manny says. “Direct measurement of internal astigmatism may also allow us to understand what is responsible for the differences in internal astigmatism by refractive error, ethnicity and corneal astigmatism.”

Manny RE, Deng L, Gwiazda J, et al. Internal astigmatism in myopes and non-myopes. Optom Vis Sci. 2016;93(9):1079.


Pediatric Eye Care Linked to Affluence, Study Shows 

Children from less affluent homes are considerably less likely to obtain eye care services, according to a recent study published in Health Affairs.1 This results in approximately 12,800 missed strabismus diagnoses and 5,400 missed amblyopia diagnoses, researchers say.1 

The 10-year study divided subjects into groups based on household income.1 The findings show that children from the highest earning households (more than $500,000) had 19% more visits to eye care professionals (ECPs) than those from the middle-income group (between $150,000 and $250,000).1 Children from the lowest earning households (less that $25,000), however, had 16% fewer visits to ECPs than children from the middle-income group.1

“Most children aren’t asked or required to get a full dilated eye exam until they fail a screening either with their school nurse or pediatrician,” says Luis Trujillo, OD, who specializes in pediatric and binocular vision at The Eye Institute in Philadelphia. “Children of underserved populations may not have access to a pediatrician 

(depending on insurance status) and, at least here in the Philadelphia area, I have found that nurses are asked to cover more than one school within the district. This can delay when a child gets screened, to say nothing of when they will actually get an exam.”

“More attention should be directed to overcoming economic barriers that keep children from obtaining necessary eye care services,” the report concludes.1 

There are ways optometrists can help level the playing field, according to Dr. Trujillo, who suggests contributing to programs, such as Infant-See, which allows patients within a certain age range access to an exam at any participating provider’s office. Another option is to reach out to your local school district. “As an assistant professor and practicing pediatric optometrist at Salus University, I have been given the opportunity and privilege over the last three years to go into the schools in the Norristown school district and give full eye exams to students who have failed their nurse’s screening. These students do not have health insurance or access to eye care, period. Along with the exam, these students get two pairs of glasses, and the entire program is funded through donations from the community,” says Dr. Trujillo.

Government funded programs, such as Head Start, also allow ODs to provide screenings to preschool-aged children. 

Dr. Trujillo also recommends doctors lobby lawmakers to push for mandatory eye exams for all children. 

1. Stein J, Andrews C, Musch D, et al. Sight-threatening ocular diseases remain underdiagnosed among children of less affluent families. Health Affairs. 2016;35(8):1359-66.

 

In the News

Researchers have identified the first cellular model of exfoliation glaucoma, which could lead to improved treatment. Investigators grew cells using tissue samples from trabulectomy procedures and compared them with other cells without exfoliation glaucoma. The cells were much larger than normal and contained an abundance of disorganized vesicles—leading to the discovery of a defect in the autophagy system. 

Want A, Gillespie SR, Wang Z, et al. Autophagy and mitochondrial dysfunction in tenon fibroblasts from exfoliation glaucoma patients. PLOS One. July 8, 2016. [Epub].

New research on the effectiveness of Humira (adalimumab, AbbVie) for noninfectious uveitis suggests it is an effective, nonsteroid alternative for eye inflammation. The study included 217 adults with active, noninfectious intermediate or posterior uveitis, or panuveitis. The researchers found that median time to treatment failure was 24 weeks in the Humira group and 13 weeks in a placebo group. Treatment failure was based on the assessment of new inflammatory lesions, best-corrected visual acuity, anterior chamber cell grade and vitreous haze grade.

Jaffe GJ, Dick AD, Brézin AP, et al. Adalimumab in patients with active noninfectious uveitis. N Engl J Med. 2016;375(10):932. 

Johnson & Johnson recently announced an agreement to acquire Abbott Medical Optics for $4.325 billion, which includes ophthalmic products in cataract surgery, laser refractive surgery and consumer eye health. The acquisition will allow Johnson & Johnson to enter the cataract surgery market, the company said in a release. The transaction is expected to close in early 2017.