Mapping the Future of Glaucoma, edited by Robert N. Weinreb
IGR 10-2 September, 2008
Different outcomes linked to IOP
Keypoints
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- There is broad enthusiasm amongst glaucoma specialists for better drug delivery systems
and alternative dosing options with a reduced dosing frequency.
- A wider choice of treatment modalities and options is important, allowing clinicians to
individualize treatment decisions based on disease severity, symptomatic visual field loss,
progression risk, disease velocity, patient compliance, life expectancy and age.
- Topical weekly administration, sustained drug release, or annual intravitreal drug delivery
may all prove to be appropriate future treatment modalities that could improve treatment
compliance and persistency, and thereby enhance likely vision outcome.
- Effective weekly topical medication is generally considered the immediate next step in efforts
to reduce dosing frequency and improve convenience and medication compliance.
- Efficacy evaluations have yet to determine whether sustained delivery of commonly
prescribed glaucoma medications will achieve equivalent or better pressure lowering
effects compared with topical daily use and intermittent ‘pulse’ effects on IOP.
- Treatment response to drugs delivered via an invasive surgical implant may not be
easily predicted and this may limit the application of such technology in glaucoma
management.
- Robust evidence demonstrating superior efficacy over current glaucoma treatments may
be needed to support the possible adoption of intermittent intravitreal procedures, not
least given the potential for serious but rare procedure-related complication risks.
- Any new therapeutic option offering improved compliance with prescribed treatment,
assuming equal efficacy to daily pressure lowering therapy, would be likely reduce the
burden of glaucoma blindness and vision loss due to disease progression.
- Implanted slow-release polymer technology has potential for general use in routine
clinical practice in glaucoma management. Advanced polymer-based drug delivery
systems offer a novel approach to sustained drug delivery, providing broad applicability
and formulation versatility.
- The availability of long-acting medications or an intravitreal treatment alternative will not
necessarily eliminate the need for additional adjunctive treatment.
- The optimal delivery route for pressure-lowering glaucoma medications is unknown.
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