The Evolving Glaucoma Therapy Paradigm: Moving Toward Sustained Drug Delivery in Glaucoma Management (Archived CME Monograph)
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The traditional approach to glaucoma management begins with topical medications and progresses, as needed, to laser therapy and ultimately incisional surgery. This approach reflects the Hippocratic philosophy of minimizing harm by applying the least invasive options first, yet it necessarily relies on the patient to accept and adhere to the responsibility for daily self-dosing (often multiple times per day). Adherence to glaucoma therapy is well known to be suboptimal for numerous reasons, including forgetfulness, difficulty instilling drops, and difficulty with the medication schedule. Suboptimal adherence is associated with worse visual field defects, highlighting an important public health issue. Toward a solution to this problem, several implantable devices that release analogues of the same medications found in topical glaucoma therapies are under investigation. The desired results of this educational activity are for learners to improve their knowledge and competence regarding the potential role of sustained drug delivery systems in improving visual outcomes for patients with glaucoma who are challenged to adhere to topical therapy.
This educational activity is intended for ophthalmologists caring for patients with glaucoma.
Upon completion of this activity, participants will be better able to:
- Discuss the limitations of the current topical glaucoma treatment paradigm
- Describe the pharmacodynamics of topical and sustained delivery of glaucoma therapy
- Compare the relative efficacy and safety of novel drug delivery systems with topical formulations of glaucoma medications
- Identify patients who would be most likely to benefit from sustained delivery of glaucoma therapy
Robert N. Weinreb, MD (Chair)
Distinguished Professor and Chair, Ophthalmology
Distinguished Professor, Bioengineering
Director, Shiley Eye Institute
Director, Hamilton Glaucoma Center
Morris Gleich, MD, Chair of Glaucoma
University of California, San Diego
La Jolla, California
Ike K. Ahmed, MD, FRCSC
University of Utah
Salt Lake City, Utah
Director, Glaucoma and Advanced Anterior Segment Surgery (GAASS) Fellowship
Research Director, Kensington Eye Institute
University of Toronto
E. Randy Craven, MD
Wilmer Eye Institute - Bethesda
Associate Professor of Ophthalmology
Johns Hopkins University School of Medicine
Disclosure Policy Statement
It is the policy of New York Eye and Ear Infirmary of Mount Sinai that the faculty and anyone in a position to control activity content disclose any real or apparent conflicts of interest relating to the topics of the educational activity in which they are participating. They are also required to disclose discussions of unlabeled/unapproved uses of drugs or devices during their presentations. New York Eye and Ear Infirmary of Mount Sinai is committed to providing its learners with quality CME activities and related materials that promote improvements in healthcare and not the proprietary interests of a commercial interest and, thus, has established policies and procedures in place that identify and resolve all conflicts of interest prior to the execution or release of its educational activities. Full disclosure of faculty/planners and their commercial relationships, if any, follows.
Ike K. Ahmed, MD, had a financial agreement or affiliation during the past year with the following commercial interests in the form of Consultant/Advisory Board: Aequus BioPharma, Inc; Aerie Pharmaceuticals, Inc; Akorn, Inc; Alcon; Allergan; ArcScan, Inc; Bausch & Lomb Incorporated; Beaver-Visitec International; Beyeonics Surgical Ltd; Camras Vision, Inc; Carl Zeiss Meditec, Inc; CorNeat Vision Ltd; Ellex; ELT Sight, Inc; ElutiMed; Equinox; Genentech, Inc; Glaukos Corporation; Injectsense, Inc; IRIDEX Corporation; iSTAR; Ivantis Inc; Johnson & Johnson Vision Care, Inc; Kelotec Inc; LayerBio, Inc; Leica Microsystems; MicroOptx; MicroSurgical Technology; New World Medical, Inc; Ocular Instruments; Ocular Therapeutix, Inc; Omega Ophthalmics; Polyactiva Pty Ltd; Sanoculis Ltd; Santen Inc; ScienceBased Health; Sight Sciences; Strõma Medical Corporation; Vialase, Inc; Vizzario; and W. L. Gore & Associates, Inc; Contracted Research: Aerie Pharmaceuticals, Inc; Alcon; Allergan; Camras Vision, Inc; Glaukos Corporation; Ivantis Inc; Johnson & Johnson Vision Care, Inc; New World Medical, Inc; and Santen Inc; Honoraria from promotional, advertising or non-CME services received directly from commercial interests or their Agents (eg, Speakers Bureaus): Alcon; Allergan; Carl Zeiss Meditec, Inc; Johnson & Johnson Vision Care, Inc; MicroSurgical Technology; and Mundipharma International.
E. Randy Craven, MD, had a financial agreement or affiliation during the past year with the following commercial interests in the form of Consultant/Advisory Board: Aerie Pharmaceuticals, Inc; Alcon; Allergan; Ivantis Inc; Santen Inc; and W. L. Gore & Associates, Inc; Contracted Research: Haag-Streit Group.
Robert N. Weinreb, MD, had a financial agreement or affiliation during the past year with the following commercial interests in the form of Receipt of Intellectual Rights/Patent Holder: Carl Zeiss Meditec, Inc; and Toromedes, Inc; Consultant/Advisory Board: Aerie Pharmaceuticals, Inc; Allergan; Bausch & Lomb Incorporated; Eyenovia, Inc; and Novartis Pharmaceuticals Corporation; Contracted Research: Bausch & Lomb Incorporated; Ownership Interest (Stock options, or other holdings, excluding diversified mutual funds): Eyenovia, Inc; Toromedes, Inc; and Unity Biosciences.
New York Eye and Ear Infirmary of Mount Sinai Peer Review Disclosure
Kateki Vinod, MD, has no relevant commercial relationships to disclose.
Editorial Support Disclosures
Erika Langsfeld, PhD; Cynthia Tornallyay, RD, MBA, CHCP; Barbara Aubel; and Michelle Ong have no relevant commercial relationships to disclose.
The contributing physicians listed above have attested to the following:
- that the relationships/affiliations noted will not bias or otherwise influence their involvement in this activity;
- that practice recommendations given relevant to the companies with whom they have relationships/affiliations will be supported by the best available evidence or, absent evidence, will be consistent with generally accepted medical practice; and
- that all reasonable clinical alternatives will be discussed when making practice recommendations.
The New York Eye and Ear Infirmary of Mount Sinai is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. This educational activity was developed and implemented in collaboration with MedEdicus LLC.
AMA Credit Designation Statement
The New York Eye and Ear Infirmary of Mount Sinai designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
This continuing medical education activity is supported through an unrestricted educational grant from Allergan.
This CME activity includes discussion of unlabeled and/or investigative uses of drugs. Please refer to the official prescribing information for each drug discussed in this activity for FDA-approved dosing, indications, and warnings.
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The views and opinions expressed in this educational activity are those of the faculty and do not necessarily represent the views of New York Eye and Ear Infirmary of Mount Sinai, MedEdicus LLC, Allergan, EyeNet, or the American Academy of Ophthalmology.
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