Drug Delivery in Ophthalmology: Challenges and Solutions Impacting Patients and Today’s Therapeutic Landscape

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Laser vision correction concept. Female eye on surgery clinic exam closeup. Treatment for astegmatism and myopia

Photo credit: Depositphotos

By Nancy Lurker, CEO and President of EyePoint Pharma

Across the ophthalmologic landscape, different drug delivery approaches to treating complex diseases of the eye have a direct impact on patient’s ability to comply with their often complicated treatment regimens. The inability to consistently adhere to these complex treatment regimens often results in worsening disease and for the eye, that can be devastating.   As a result, there are now advances being brought to market and product developments underway that aim to directly address some of these eyesight threatening compliance issues that have unfortunately persisted.

Central to drug delivery in ophthalmology is whether the back or front of the eye is being treated. Comparatively longer-release therapies are typically utilized for back-of-the-eye diseases, whereas front-of-the-eye diseases are often treated with an immediate-release, drop formulation. 

Historically, ophthalmic therapies specific to back-of-the-eye conditions – particularly retinal diseases that can have a serious and debilitating impact on vision, to the point of causing blindness – have predominantly been comprised of large biomolecules that offer one-to-two months of drug delivery. This duration – even if lasting up to three months – places a significant burden on the patient population being served. We know from volumes of research and data that, for a variety of reasons, many of these patients continue to suffer from deteriorating eyesight – not necessarily because of efficacy issues, but because of adherence and compliance in getting to a retinal physician’s office frequently for the rest of your life. 

Treatments for the back of the eye are comprised of injections that are inserted directly into the eye to deliver critical medicine to the back of the eye, and while analgesics and other approaches are taken to help reduce pain during the procedure, it nonetheless is not the most pleasant experience for patients. That alone can be a factor in patients feeling apprehensive about the need for relatively frequent injections, and as a result they may eventually avoid or miss their appointments. For others, regular drives to the doctor can be a hinderance – especially if they need to rely on someone else to drive them or take public transportation. And these frequent injections are necessary on an ongoing basis as there is no current cure for these retinal diseases If and when patients miss or stop going to these appointments for such injections and continuity of care is disrupted, they are at a greater risk for disease progression and further diminished eyesight.

Additionally, many existing ophthalmic therapies for retinal diseases are bolus products that inject a large volume of a drug in a single dose that can potentially overwhelm the tissues of the back of the eye. When these delicate tissues are exposed to very high amounts of a drug at once, there can be an increased risk of toxicity, with an up-and-down seesaw effect of drug exposure overtime. Following injection, the retinal fluid can dry up quickly, and then be temporarily and briefly restored with the next injection until the cycle continues –a cycle that can go on indefinitely. 

Unlike injections, eyedrop therapies for front of the eye diseases can typically be self-administered at home. However, while this eliminates the inconvenience and discomfort of an injection at a doctor’s office, other challenges exist that can impact adherence and compliance. While a broad range of patients are living with ocular diseases, those who are older may be more likely to also be coping with dexterity challenges or even memory issues. Both of these factors can result in drops either not being administered properly or frequently enough – to the point that more return visits to the doctor may ultimately be warranted due to problems that arise, such as discomfort from inflammation or even infection.

All of this amounts to a measurable burden on someone already navigating through the challenges of diminished vision – a burden that has been reported by and has an impact on patients, their caregivers and physicians. 

Over time, it has become evident that a change is urgently needed to provide substantially improved approaches to ophthalmologic drug delivery. As a result, companies like EyePoint and others are currently focused on bringing to market options that offer extended drug delivery – targeting delivery that can lasts up to a period of six months from a single injection.

As such, innovations driving changes in the ophthalmologic therapeutic landscape today are shifting treatment paradigms toward greater efficiency and patient adherence and compliance, while continuing to maximize safety and efficacy. This in part is made possible because of extended-release drug delivery options that require less frequent administration, be it at the doctor’s office or at home. With an extended-release formulation and delivery system that can lasts up to six months, there is also more consistent and balanced drug delivery – which can translate into a safer, more optimized therapeutic effect. 

The less often a visit is required to the doctor for an injection, or the fewer eyedrops needed per day or week, the better off the patient. Of course, there are other valid reasons why regular follow-up doctor visits can be warranted and play a crucial role in patient observation and care – but to not have frequent appointments be centered around an eye injection would likely bolster, rather than hinder, attendance.

The improvement of ophthalmologic therapeutics rests in part on the ability to treat diseases at consistent levels over a longer duration with greater convenience to patients – as a result of less frequently-delivered treatment, while maintaining a stable level of vision during that time. Ultimately, our overarching goal is a collective one that unifies those of us in the biotech and pharmaceutical industries, as well as ophthalmology healthcare professionals: to reduce treatment and disease-burden on the patients we serve and improve outcomes that translate into less deterioration of eyesight. It’s exciting to observe the advances being made and efforts underway that are centered on significantly improving the status quo, building on yesterday’s innovations to make those of today and tomorrow even more powerful for patients.