What do you do when there’s an effective treatment for the second leading causes of blindness worldwide, but patients just don’t use it? This was the problem facing the founders of Glaukos, an ophthalmic medical technology and pharmaceutical company, when they founded their company 25 years ago.
Glaucoma, a disease that causes vision loss and blindness by damaging the optic nerve in the back of the eye, presented a significant challenge to doctors. The disease is treatable with prescription eye drops, but patients, for various reasons (discomfort, difficulty of application, inconvenience, the slow-moving nature of the disease) often don’t use the treatment. Research reveals that only 10% of patients use their glaucoma prescription eye drops correctly, and nearly half discontinue medication within six months.
Patients’ abysmal compliance rates with an effective treatment presented an opportunity for Glaukos. Instead of prescribing drops (which patients don’t use), what if there was a more effective way to stop the progression of the disease? This question inspired the founders of Glaukos and launched a decades long partnership with UC Irvine.
Treating the Silent Thief
How glaucoma develops is not completely understood. What is known is that the tissue that regulates the fluid in the eyes, degrades with age. It becomes fibrous and clogs and, like a faulty release valve in a dam, causes the fluid in the eye to back up. This increased pressure in the eye damages the optic nerve. Since the damage progresses slowly, many patients don’t realize their vision is worsening. Nearly half of all glaucoma cases remain undiagnosed, earning it the reputation of the silent thief of sight.
Currently, there’s no cure for glaucoma, but early treatment can prevent damage and preserve vision. Historically, glaucoma has been treated with eye drops. However, as noted earlier, its asymptomatic nature and slow progression, often results in a patient’s being a little “flexible” with following their doctor’s orders. When a patient’s glaucoma continued to progress, they were prescribed more drops, and often more drops after that. If a patient’s glaucoma couldn’t be managed by drops, the next step was an invasive end-stage surgery called a trabeculectomy, where a surgeon makes an incision in the eye for the fluid to escape. Glaukos felt there had to be a better way.
“It’s never a single entity, but an entire ecosystem. UCI has played a great role in building upon the success in ophthalmology and eyecare in the Gavin Herbert Eye Institute. We rely on the thought leaders in the UCI system.”
– Joseph Gilliam, President and Chief Operating Officer, Glaukos
Collaboration Sparks Ingenuity
Since its founding in 1998, Glaukos has built its technology and business from the ground up. They’ve focused on human-centered design, a technique that puts people (e.g., patients who don’t use their eye drops) at the center of the development process. While Glaukos was the driver of the technology, UCI faculty have played an integral part, alongside engineers and industry, in Glaukos’ remarkable journey.
In the beginning, venture capitalist Olav Bergheim reached out to key experts, including former UCI ophthalmology professor Richard Hill, to help develop an alternative to the persistently low compliance rates for glaucoma drops.
Drawing inspiration from cardiac stents, the team sought to create a similar device for the eye. However, they faced a major hurdle: the heart is a much larger organ than the eye. The stent required to bypass the meshwork of tissue in the eye would have to be miniscule.
“Even if you had the idea 30 years ago, you couldn’t have manufactured it. The technology didn’t exist,” says Glaukos president and chief operating officer Joseph Gilliam. “It took Glaukos years to find partners who could manufacture these stents in a way that was reproducible and of high quality.”
Measuring only one millimeter in length, the iStent is one of the smallest implantable medical devices in the world. Its compact size is truly a remarkable feat of engineering and precision manufacturing. It’s so small, it appears like a fleck of pepper when observed by the naked eye.
The iStent works by creating a permanent bypass within the eye to restore the natural flow of fluid, thereby reducing pressure and preserving a patient’s vision. The device is inserted into the eye during a surgical procedure known as Micro-Invasive Glaucoma Surgery (MIGS). Once implanted, the device can’t be seen or felt by the patient. Before the partnership between Glaukos and UCI, MIGS did not exist. Now, an entire industry has developed around it.
Pioneering Innovation
Glaukos’ foray into microscale applications didn’t stop with iStent’s success. The company is currently advancing into phase III of clinical trials for iDose, a revolutionary implant delivering three years’ worth of medication in a single application. This groundbreaking technology presents a significant leap forward in standard glaucoma care and is a testament to Glaukos’ out-of-the-box thinking.
“Think about how many drops need to put in an eye every day for three years versus a single microscopic implant that has enough drug payload to last for the same amount of time. It’s truly incredible,” says Gilliam.
Beyond glaucoma, Glaukos is also making strides with iLution, a topical cream-based solution designed for drug delivery on the eyelids. The drugs being developed for iLution could be used to treat dry eye disease and age-related near-sightedness.
UCI’s “brain trust” of expertise in ophthalmology has been essential to Glaukos’ success. In addition to Dr. Hill’s early involvement, the company continues to rely on thought leaders from UCI, like Dr. Sam Garg, Dr. Marjan Farid, and others at the UCI Gavin Herbert Eye Institute, to contribute their expertise in various aspects of Glaukos’ technology.
With the slogan “We’ll go first,” Glaukos has pushed the boundaries of science and technology to revolutionize ophthalmic care. Their work, with significant help from UCI doctors, solves the tricky problem of patient compliance and has the potential to save millions from going blind.
“We’re trying to go first and pioneer these areas,” says Gilliam. “We find this far more rewarding.”
Discover more at: https://www.glaukos.com/