Biography: Hovanesian is on faculty at the UCLA Jules Stein Eye Institute and in private practice at Harvard Eye Associates in Laguna Hills, California.
Disclosures: Hovanesian says he is a consultant or investor in a number of companies involved in new forms of drug delivery.
Putting eye drops in a young child’s eye is difficult. Putting eye drops in your own young child’s eye is impossible.
Your own child summons every shred of guilt within you, presses every emotional button (that he has installed, by the way) and squirms in every anatomically impossible way to keep you from fulfilling your parental duty. So how are parents supposed to give their children daily atropine drops to prevent progressive myopia? How much trauma is really necessary?
John A. Hovanesian
Adults, you’re not much better at drops; a study showed that 93% of you fail to take glaucoma medication. And that’s why some new alternatives to traditional drops could change the future of eye care. Here are three approaches that I find interesting.
1. No water. Topical perfluorocarbon drops from a German company, Novaliq, now partnered with Bausch + Lomb, will likely soon enter the US market as a treatment for meibomian gland dysfunction. This organic vehicle has enormous potential for delivering difficult-to-formulate drugs like cyclosporine for dry eye and others that were not available for topical use because they do not dissolve in water. Due to the surface tension characteristics of these solvents, they form drops approximately one-fifth the size of water-based formulations, and they spread like a thin oil over the ocular surface, enhancing absorption. They are preservative-free and very shelf-stable. Waterless formulations like this are clearly part of the future of topical therapy.
2. No bottle. Eyenovia’s Optejet and Kedalion’s AcuStream are palm-sized devices designed to deliver very small doses of topical medication to the eye, including atropine. Since less drug is delivered, toxicity must be reduced without sacrificing local potency. For people who have issues with arthritis in their hands or difficulty bending over, or for my son who became a restless wolverine when I approached him with drops, it might be a lot easier.
3. No drop. Some of us are familiar with drugs like Dextenza (dexamethasone ophthalmic insert, Ocular Therapeutix), Dexycu (dexamethasone 9% intraocular suspension, EyePoint Pharmaceuticals), Durysta (bimatoprost implant, Allergan), and Ozurdex (dexamethasone 0 intravitreal implant, 7 mg, Allergan), which are already FDA-approved drug depots injected or implanted to deliver several weeks of treatment. Many follow-up technologies are in the lab or in the FDA pipeline to treat every part of the eye with every type of disease. Investors, pay close attention to this space because the collective drug market that will be replaced by these products is in the tens of billions of dollars.
According to author Dave Barry, the secret to success in child-rearing is to lower your standards. While treating my son, could I really retain some self-respect with one of these new advancements in drug delivery? Probably not, but eye medications might just go from “impossible” to “negotiable.” Now if only they could work to get him to eat vegetables.