Alcon’s acquisition of Belkin Laser and its Eagle DSLT platform ups the company’s ante amidst the rise of interventional glaucoma. We sat down with Sean Clark, president of Global Surgical Franchise at Alcon, to learn more about the move.
If Alcon’s (Geneva, Switzerland) recent major purchase of BELKIN Vision (Yavne, Israel) and their Eagle direct selective laser trabeculoplasty (DSLT) platform is any indication, eye care is firmly in the age of interventional glaucoma.
Alcon completed the acquisition on Monday, July 1 in a deal worth $81 million up front, including $65 million in cash considerations, with an additional $385 million in potential milestone payments. Added to its $475 million acquisition of the United Kingdom-based Ivantis and its Hydrus Microstent in 2021, the Swiss eye care giant’s potential investment into interventional glaucoma has grown to total up to $941 billion if these milestones are met—a strong statement on how the firm sees the future of glaucoma care evolving.
“Glaucoma is a progressive disease that impacts millions of people around the world, with growing volumes of patients diagnosed each year. There remains a huge opportunity to manage these patients with effective interventional therapies,” said Sean Clark, president of Global Surgical Franchise at Alcon.
“With this acquisition and in partnership with our new associates, Alcon will accelerate the expansion of interventional glaucoma practice globally with direct selective laser trabeculoplasty, and we look forward to broadening access to this exciting technology.”
The rise of SLT
Selective laser trabeculoplasty (SLT) is not a new technology. 2024 marks 30 years since the procedure appeared on the scene, and Alcon has waited until now to make a major move. So what’s changed?
Two things, according to Mr. Clark. The first is that SLT has only recently broken into the mainstream for first-line treatment of the disease with the landmark LiGHT trial and its recently-published 6-year results.1
“Global glaucoma treatment guidelines and practice are shifting towards more first-line use of selective laser trabeculoplasty”, he said, pointing to a recent overview of the technology and the latest guidelines from the National Institute for Health Care and Excellence (United Kingdom) and the European Glaucoma Society.2-4
The DSLT difference for surgeons and patients
The second is the technology itself. Alcon sees BELKIN Vision’s Eagle as enough of an evolution of the procedure to warrant a major investment.
“While global glaucoma treatment guidelines and practice are shifting towards more first-line use of SLT, practical challenges have limited it from becoming widely used as a primary therapy,” Mr. Clark said. “DSLT delivers precise treatment in a patient- and physician-friendly experience, helping to overcome these barriers.”
There are myriad features that differentiate this patient and surgeon experience with DSLT from traditional SLT.
The first is that DSLT is contact-free. According to a promotional video by BELKIN Vision, traditional SLT requires patient contact with a lens for over five minutes to perform. Critically, this also requires the expertise of a glaucoma specialist.
By contrast, the BELKIN Vision Eagle requires no contact, using an eye tracking algorithm instead. This means no gonio lens—and no manual tracking, meaning the procedure is more accessible to general ophthalmologists. According to BELKIN Vision, the entire procedure also takes around a second, instead of the minutes standard SLT can require.
The result, according to Mr. Clark, is a much-needed expansion of the procedure into more offices for more patients who can benefit from fewer drops.
“The DSLT experience is patient- and physician-friendly, providing the precision treatment necessary while offering an intuitive, streamlined workflow and non-contact delivery,” he said. “Leveraging Alcon’s footprint as the global leader in eye care will help broaden access to this exciting technology.”
The final piece of the puzzle for Alcon is safety. And according to the pivotal multicentre randomized control GLAUrious trial, this is all done with a similar safety and efficacy profile to well-established SLT procedures.
In the study of 192 patients, the mean unmedicated IOP reduction at six months was 5.46 ± 0.51 mmHg (95%; CI -6.48 to -4.45). Mean medications used by the DSLT cohort at 12 months were reduced by approximately 50%, from 1.19 (1.01) at baseline to 0.63 (0.94). Over half of the patients (61.7%) were medication free, slightly more than the 59.5% for patients who underwent traditional SLT.5
A glimpse into glaucoma’s future
Despite the apparent advantages that the DSLT procedure claims over SLT, however, the fundamental mechanism of action of the procedure remains the same—and along with it, the familiar criticisms of SLT as a whole.
It remains to be seen definitively whether DSLT offers any advantages over SLT in postoperative drops, recovery times, and short-term IOP hikes—or whether it overcomes long-term considerations like limited efficacy in advanced forms of the disease and diminishing returns in frequent flyers.
But SLT has never been presented as a panacea to all forms and stages of glaucoma. And while Alcon has made significant investments into this less drop-intensive, interventional glaucoma future, the firm also has hedges in place.
Alcon has also invested in a pair of next-generation rho-kinase, or ROCK, inhibitor eye drops, RHOPRESSA (netarsudil ophthalmic solution 0.02%) and ROCKLATAN (netarsudil and latanoprost ophthalmic solution 0.02%/0.005%), along with the more conventional SIMBRINZA (brinzolamide and brimonidine tartrate ophthalmic suspension 1%/0.2%) drops.
As for the BELKIN Vision Eagle, Alcon is actively working on expanding its global availability. The device is approved in the EU and UK for SLT procedures, and has received 501(k) designation in the US, though it is not available there yet.
Mr. Clark also unveiled big plans for the distribution and integration of the device, while noting that this process is ongoing. “Ultimately, our plans are to broaden access to the technology. Right now, we are working to integrate the BELKIN Vision team and the device into Alcon. That work doesn’t happen overnight and part of it includes developing commercialization plans,” he said.
“We are also working on integrating DSLT into Alcon’s customer service and technical service systems. As part of this, Alcon is integrating DSLT into its Alcon Vision Suite ecosystem, working to ensure the ability to train and deliver the best-in-class service that our customers have come to expect.”
In the end, time will tell the results of Alcon’s wager on interventional glaucoma. But for now, the firm believes that DSLT has it positioned to ride the wave of interest in this evolving approach.
“We have been extremely encouraged by the excitement around this acquisition, which demonstrates just how powerful the movement to SLT as first-line therapy is,” Mr. Clark said. “We want to harness that energy as we look to expand DSLT access globally, and are looking forward to partnering with our new associates and our customers to make that a reality.”
References
- Gazzard G, Konstantakopoulou E, Garway-Heath D, et al; LiGHT Trial Study Group. Laser in Glaucoma and Ocular Hypertension (LiGHT) Trial: Six-Year Results of Primary Selective Laser Trabeculoplasty versus Eye Drops for the Treatment of Glaucoma and Ocular Hypertension. Ophthalmology. 2023 Feb;130(2):139-151.
- Takusagawa HL, Hoguet A. Selective Laser Trabeculoplasty for the treatment of glaucoma. Ophthalmology. 2024;131(1):37-47.
- European Glaucoma Society Terminology and guidelines for glaucoma, 5th Edition. British Journal of Ophthalmology. June 1, 2021. Accessed June 10, 2024. https://bjo.bmj.com/content/105/Suppl_1/1.long.
- Recommendations: Glaucoma: Diagnosis and management: Guidance. NICE. January 26, 2022. Accessed June 10, 2024. https://www.nice.org.uk/guidance/ng81/chapter/recommendations.
- Belkin M. GLAUrious, a multicentre, randomised, controlled study of direct selective laser trabeculoplasty in open angle glaucoma. Invest Ophthalmol Vis Sci. 2023;64(8): 5393.
