By Jill Autry, OD, R.Ph.
April 6, 2022
Glaucoma patients are faced with the challenge of potentially losing vision if they do not adhere to demanding at-home treatments. The regimen of remembering to instill eye drops every day, often more than once a day, frequently with multiple side effects, is difficult. This is one of the reasons many patients are not compliant and do not have the more positive outcomes we hope for in our practices. Fortunately, new intraocular implants with medication that lowers intraocular pressure have been developed.
I have been using one of these implants, DURYSTA (bimatoprost intracameral implant), in my own practice, with positive clinical results and positive patient experiences. These patients, who struggled with instilling drops themselves at home and/or tolerating the typical side effects of drop therapy, are grateful for the alternative treatment. The patients have experienced improved or stable intraocular pressure control and decreased side effects due to the decrease or elimination of drops. Many have even referred friends and family to our practice because we offer options over traditional glaucoma therapies.
An Alternative to Eye Drops & Immediate Surgery
In the past, a glaucoma patient in our office, on two different bottles of eye drops, with their glaucoma continuing to progress or their side effects intolerable, was referred for surgery. Now, we have an implant that lowers IOP while taking compliance out of the equation and offering patients an alternative to additional drops or surgical intervention. The implant may enable the patient to delay surgery for a year or longer.
The procedure to place the implant is most often conducted by ophthalmologists, but some states, including Kentucky, Oklahoma, Louisiana, Arkansas and Nebraska, have given optometrists the ability to also do this procedure. The state where I practice, Texas, does not allow for this option, but my cataract and glaucoma partners are all trained to perform the procedure.
Establish a Strong Communication Line with Surgeon
Although I am in an OD-MD practice, the same ophthalmologists you already have relationships with for cataract surgery and glaucoma surgery are likely performing implants. It is important to reach out to those referral sources and discuss the patient profile, stage of glaucoma and current treatment regimen that the surgeon believes makes for a good candidate for this procedure BEFORE you refer the patient. You don’t want to refer a patient, to whom you have already recommended the implant, only to hear from the surgeon that they believe it is not the best treatment option.
To temper the patient’s expectations and allow for unexpected findings during the surgeon’s evaluation, you should let the patient know you think the implant is a good option for them, and that your preliminary conversations with the surgeon have indicated they feel the same way, but there is always a chance the surgeon will come to a different conclusion after their examination.
Educate Patients About Benefits of Implant
In addition to the difficulty of consistently complying with instilling eye drops every day, patients who have been prescribed IOP-lowering drops often experience side effects such as redness, lid-lash darkening and lengthening, dry eye and sometimes the changing of eye color.
Studies have shown DURYSTA to have no impact on lid-lash darkening and lengthening and to only produce eye redness on the day of the procedure. The chronic side effects of IOP-lowering drops are not found with this implant because it is not placed on the ocular surface, but intraocularly.
At this point, DURYSTA has been approved for one-time use only, with additional ongoing studies looking at repeatability. Studies show it is effective for up to 18 months, with ongoing data being collected, so there is a possibility that one implant may be effective in lowering IOP for even longer.
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I tell my patients: “From my examination, and what you’ve told me today, it seems the eye drops I prescribed may not be the best solution for you. The good news is we have a potential alternative. It’s a treatment where the drop essentially goes inside your eye and can possibly provide pressure-lowering benefits for 12-18 months. You won’t have to use as many drops, as this implant will be placed in your eye, and the side effects you are experiencing will be decreased as well. The procedure is quick and essentially pain-free as we will numb your eye at the time of the implantation.
The patient sometimes asks about recovery time, concerned they will have to take time off from work or other responsibilities: “You will be able to do everything you normally would do by the next day, and I will follow your pressure as usual after the procedure.”
Show Patients You’re the Source for Medical Eyecare Expertise
When you can let patients know all of their treatment options for a condition like glaucoma, including the newest and most advanced options, you are demonstrating your medical eyecare expertise. You are affirming your role as part of the patient’s healthcare team when you have established relationships with ophthalmologists you can collaborate with to ensure the patient receives the best possible care.
Even if you can’t do the procedure yourself in your office, the patient will remember that you are the doctor who first educated them about this new treatment option, and will likely return to you for care, telling friends and family about the success they had in your office finding a better way to treat their glaucoma.