We know that innovation in ophthalmology can save sight: From new devices, drugs and other technologies, advances in this arena serve to improve both safety and patient outcomes. Therefore, it’s always exciting to learn more about these innovations as they make their way down the pipeline on their way to FDA approval. Attendees on Day 3 of the annual meeting of the American Society of Cataract and Refractive Surgery (ASCRS 2022) got to hear about some of the latest technology during the ASCRS General Innovators Session. Below, we highlight one of these innovations…
A New Drug-Delivering Contact Lens
“When you think about contact lens drug delivery, I think it’s important to take a step back as far as eye drops,” said Dr. Joseph Ciolino from Harvard Ophthalmology. “In general, they’re an inefficient drug delivery system — only 1-7% of the medication in a drop gets its way to the eye.”
Clearly, this is a reason to try to improve drug delivery. However, he said that there have been historical challenges in bringing a drug-delivery contact lens to reality, these include achieving sustained delivery and optical clarity, as well as comfort for the patient.
“In the past, much of the focus has been on compliance but one of the things we’re trying to determine is whether we can go beyond that and actually have better outcomes,” explained Dr. Ciolino.
He then described the contact lens drug delivery platform: “We have a very thin drug polymer film situated within the periphery of a standard contact lens.” This provides elevated drug loading, controlled release and consistent loading irrespective of contact lens parameters. Dr. Ciolino discussed how this lens can deliver dexamethasone, latanoprost and moxifloxacin.
“We compared one of our lenses (this is in rabbits) to hourly dexamethasone, placed every hour for 8 hours — we euthanized the animals and looked at the drug levels. And what we found was that over the course of a week, we were able to maintain drug levels in the eye — at levels that were far greater than what you get with drops,” he continued, adding that they then looked at getting better effects.
“We looked at corneal vascularization, uveitis and retinal vascular leakage — you can induce corneal vascularization by placing a suture in the cornea and you can prevent vascularization with dexamethasone drops … and we found that as well with our contact lens,” said Dr. Ciolino. Further, when looking at retinal vascular leakage, they found the lens was just as effective as intravitreal injections of dexamethasone.
In treating glaucoma with the lens, he said they found something surprising: “We had a dose response with our contact lens: With a high-dose contact lens, we had double the pressure reduction than a drop … at the time we published this, we thought we were at the peak of the dose response time, meaning that latanoprost has a bit of a paradoxical effect. If you give more of it, or give it more often, you don’t necessarily get better pressure reduction.”
Regarding the moxifloxacin-eluting contact lens, he shared that this is important “because with fluoroquinolones, it’s not just getting the drug there [to the tissue] but you want to maintain a very high area under the curve that’s well above the MIC and that’s going to show you how effective this is.”
Ophthalmologists will have to wait a bit longer before implementing these drug-eluting contact lenses in patients. The moxifloxacin lens is currently completing pre-clinical studies to support the IND for the treatment of bacterial keratitis. Meanwhile, IRB/IND FDA approvals are underway for the dexamethasone lens (for recurrent cystoid macular edema) and the latanoprost lens (for ocular hypertension).
His final thought on the matter? These drug-delivering contact lenses could result in better outcomes than we’re getting with drops — and getting better outcomes is always a top priority.
Hot Takes from Experts
Following the presentation by Dr. Ciolino, moderator Dr. Edward Holland and panelists Drs. Nicole Fram, Sumitra Khandelwal, Terry Kim and Nathan Radcliffe shared their thoughts on this potential new technology.
Here are some of those comments:
- The panelists are looking forward to having options that are better than topical drops.
- They wondered if drug combinations were available and how acute versus chronic treatments would be approached, like in glaucoma patients who need year-round treatment: Dr. Ciolino shared that they could do drug combinations; and right now, this is more ideal for an acute patient.
In his response, he also shared other instances where this lens could benefit patients: “We’ve also been working on Acanthamoeba keratitis — and talk about an unmet need — I would absolutely love for these patients to be able to put a lens on … and know that they’re getting the medication they need,” said Dr. Ciolino on his future hopes for this technology.
- They asked if patients using these lenses still need to apply drops, and if there’s data on absorption — or if these compete, or act like a reservoir where you get more toxicity.
“Right now, I don’t think it’s going to influence anything more than a bandage contact lens,” answered Dr. Ciolino.
- The panelists also asked about the addition of riboflavin, or other opportunities in patients who use artificial tears.
“Anything you can deliver in a drop, I’m fairly certain you could probably get there with a contact lens,” said Dr. Ciolino.
Editor’s Note: ASCRS 2022 was held on April 22-26, as a physical show in Washington DC, USA. Reporting for this story took place during the event.
