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    Growing number of devices set to transform glaucoma treatment



    Equinox has a unique approach to glaucoma. Most devices treat glaucoma as a disease of elevated IOP. Equinox treats glaucoma as a disease of two pressures¬≠–intraocular pressure (IOP) and intracranial pressure (ICP). It is the pressure gradient between IOP and ICP at the optic nerve that destroys vision, not simply ocular hypertension.

    “Patients who have glaucoma have a lower ICP than matched controls and those with normotensive glaucoma have even lower ICP,” said John Berdahl, MD, founder and CEO. “Patients with ocular hypertension but no glaucoma had higher, protective ICP. If IOP is higher, the head of the optic nerve bows out (glaucoma). If ICP is higher, the head of the optic nerve bows in (papilledema), which affects about 50% of the astronauts on the International Space Station.”

    Berdahl’s solution is goggles that reduce the exterior pressure on the eye, effectively lowering IOP relative to ICP. The goggles can be worn at night and are compatible with IOP-lowering medications.

    Because the goggles can also increase exterior pressure on the eye, raising IOP, they may be useful to combat papilledema on the International Space Station and during projected space flights to Mars. NASA is supporting research to develop the goggles.


    Glaukos is one of the few device makers focused on glaucoma. It also developed the first MIGS device cleared for the U.S. market, the iStent, which restores physiologic outflow.

    “We are not just iStent,” said Jeff Wells, PharmD, vice president of clinical, regulatory and quality. “Our portfolio consists of three other investigational flow and drug delivery devices.”

    iStent Inject is an injector with two preloaded stents. The two devices are implanted into the Schlemm’s canal a couple of clock hours apart to increase outflow, Wells explained. The 2-year endpoint on the pivotal clinical trial comes up later in 2017 and Glaukos expects to file for premarketing approval by the end of 2017.

    iStent Supra drains into the suprachoroidal space. Enrollment for a 2-year pivotal trial is in the final stages.

    iDose is a travoprost depot that is injected into the sclera to elute drug into the anterior chamber. The device is in phase II with results expected by the end of 2017.


    Fred Gebhart
    The author is a correspondent for Urology Times, a sister publication.

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