This roundtable discussion series about sustained-release drug delivery for glaucoma includes Steven R. Sarkisian, Jr., MD, founder and CEO of Oklahoma Eye Surgeons, PLLC, in Oklahoma City, Oklahoma; Jacob Brubaker, MD, from Sacramento Eye Consultants in Sacramento, California; and E. Randy Craven, MD, FACS, Chief of Wilmer Eye Institute, Bethesda Location, Vice Chair for Wilmer Network of Locations, and an associate professor at Johns Hopkins University in Baltimore, Maryland. The first part of this series addresses the challenge of patient compliance with glaucoma drops and the unmet need of a therapy that reduces or removes the burden of drops.

Dr. Sarkisian: I’ve done several visiting professorships this year and noticed a big buzz about the unmet need in glaucoma. And what I don’t think people fully understand is just how radically sustained-release medication is going to change the practice of glaucoma. The first thing we should discuss is compliance. What do you think is the perception among ophthalmologists about patient compliance?

Dr. Brubaker: I think we often lull ourselves into believing that compliance is a problem that other ophthalmologists’ patients have, not our own. The reality is that everybody’s patients are equally noncompliant. We have to wake up to the idea that even if a patient tells us they’re compliant, it doesn’t mean that’s always the complete truth.

Dr. Craven: I think most people do recognize that patients don’t use medicines. When I talk to other ophthalmologists, they seem unsure of whether their patients have been using the medicines the way they should. We are starting to see software that helps alert us to the “less-than-perfect” refill rate. Many ophthalmologists have access to a pharmacy prescription software that interfaces with companies like EPIC. These interfaces review refill and follow-up information to give you data. One such company is Swoop. It amazes me how few people do refill their medicines according to schedule. I believe there’s good understanding by most ophthalmologists that patients are not usually adherent. We might like to convince ourselves, especially when we’re in a hurry, that the patient is using the drops, but I think most of the time we understand that compliance is a big problem.

Dr. Sarkisian: It takes a lot of time to ask the right questions, and that’s difficult. One of the lectures I give is called, “Keeping It Real: Stop living the lie about patient compliance.” When you look at the data, patient compliance is around 50%,¹ and perfect compliance where a group of patients takes their drops at the exact time they’re supposed to in the exact way they’re supposed to is around 10%.² Because a lot of people end up putting in more than one drop, or they miss, even though they’re going through the motions of putting in the eye drops, they’re just not doing it correctly. I think this is partly our failure, and partly just life. It’s like brushing your teeth the week before you go to the dentist. We may not know how many patients are using their glaucoma drops a few days before an appointment, and then their pressure’s great and they get a thumbs up, and when they come back, we wonder why they’re progressing. We, as physicians who have the blessing of teaching others, need to beat this drum and not let patients forget it. There is new technology that’s going to address this. As we know, not everyone with first-line selective laser trabeculoplasty necessarily gets to their target pressure and they need something else. Also, we’d prefer not to have to operate on everybody. The 2 things that are coming around the bend are the iDose sustained-release travoprost by Glaukos and the Bimatoprost SR by Allergan, which are both implanted inside the eye.

Editor’s note: Dr. Sarkisian reports consultancy to, advisory board membership with, speaker’s fees from, and grant support from Alcon; consultancy to, advisory board membership with, and speaker’s fees from Allergan and Bausch + Lomb; consultancy to and advisory board membership with Beaver-Visitec International, Katena Products, New World Medical, Omeros, and Santen; consultancy to, advisory board membership with, equity ownership with, and grant support from Sight Sciences; and consultancy to, advisory board membership with, and grant support from Glaukos. Dr. Brubaker reports consultancy to Glaukos and Allergan. Dr. Craven reports consultancy to and advisory board membership with Aerie Pharmaceuticals, Alcon, Allergan, Aqueous Biomedical, Ivantis, Santen, and W.L. Gore.

References

1. Feehan M, Munger MA, Cooper DK, et al. Adherence to Glaucoma medications over 12 months in two US community pharmacy chains. J Clin Med. 2016;5(9):79.
2. Muir KW, Lee PP. Glaucoma medication adherence. Arch Ophthalmol. 2011;129(2):243-245.