A Brave New World in Glaucoma

American Academy of Ophthalmology 2013

Jonathan S. Myers, MD; George L. Spaeth, MD; Sonya B. Shah, MD; Victor Cvintal, MD


December 06, 2013

Editorial Collaboration

Medscape &

In This Article

Drug Delivery Innovations

Dr. Myers: Earlier, Dr. Shah, you mentioned some work that you have seen on drug-delivery devices. Can you tell us more about that?

Dr. Shah: Sure. One of the scientific posters that stood out to me at the conference was a study on travoprost impregnated in a punctal plug.[5] So many of our glaucoma patients must take a drop every single day or multiple drops every day. This can have a huge impact on their quality of life, their daily routine, and it's very difficult for most people to adhere to.

There is thought now that you can have a punctal plug placed in the punctal system that would deliver the drug for a certain period of time, and perhaps this would take away the issues with medication adherence.

Of course, we have to think about the way punctal plugs work. They only work if they are in the puncta, and they can easily fall out. The patient might not know if the plug came out, falsely believing that he or she is still being treated. We would have to see them regularly to make sure that these plugs are in place. These are good advances, and perhaps in the future, we will see such things as contact lenses that can elute drugs.

Dr. Spaeth: Do you know who developed that? A retina surgeon. It is important for us to remember that all of us can think outside of the box and make good contributions, not just in glaucoma. It's exciting that a retina person developed the punctal plug.

Dr. Cvintal: Talking about thinking outside the box, there was an outstanding presentation in the Innovation Summit. They are now producing a peptide to deliver drugs straight to the mitochondria. Imagine what this could do. The whole drug-delivery system will be so good and so quick.

Dr. Myers: It is certainly a much more sophisticated and complex approach than anything we have seen with simple eye drops.