ONLINE EXCLUSIVE

Glaucoma
June 2024

by Liz Hillman
Editorial Co-Director

Drop compliance—due to complicated topical regimens, cost, and/or negative side effect profile—is a perennial problem when it comes to topical glaucoma medical therapy.

Constance Okeke, MD, said that one simple change has helped her glaucoma patients from a compliance standpoint, and recently published research is supporting its efficacy as well.

This change is switching out the typical top on the medication for the Nanodropper Adaptor (Nanodropper). Dr. Okeke described this as a screw-on cap that delivers a smaller drop of the medication—10–12 μL vs. 35–75 μL. A small pilot study she conducted found this smaller drop seems to be associated with a decreased topical drop side effect profile.

Dr. Okeke said her study included four patients who had previously been on Rocklatan (netarsudil and latanoprost ophthalmic solution, 0.02%/0.005%, Alcon) or Rhopressa (netarsudil ophthalmic solution 0.02%, Alcon). The patients had discontinued use of the medication due to the side effect profile, namely redness (hyperemia) and irritation/dryness. The patients were put back on one of these drops with the Nanodropper top and documented how they did with the medication over a weeklong period.

Dr. Okeke said after a week, three out of the four patients were able to go back on the medications and remain on the regimen due to decreased negative side effects. The one patient who didn’t seemed to have some ongoing allergies that were not drug related.

“At least 75% of the patients having less redness and less irritation using the Nanodropper with the drug was enough indication for me to say, ‘I’m going to try using this,’” she said. Dr. Okeke explained that she wanted to include Rocklatan and Rhopressa as therapies for some patients for various reasons but found that many of her patients were hindered by the side effects. “I was looking for a solution to try to still utilize these great drugs but not have all of the issues with the side effects for the patient. The Nanodropper became a great way for me to routinely use these medicines.” Dr. Okeke said that she had not done a study looking at the IOP effects of using the Nanodropper with the topical drops but since more of her patient population has been using it, she hasn’t seen any correlation with it impacting drop efficacy.

Evaluation of patients afterward and their ability to be on the drops and their pressure to still be controlled and at target indicates the Nanodropper isn’t affecting the IOP-lowering effect of the active ingredients, she said. “The same way as with any drop, we can tell its efficacy because it’s lowered the eye pressure; it’s maintained from visit to visit, and the diagnostic testing supports stability.”

A prospective, non-inferiority study published in Ophthalmology in March 2024 evaluated if 12.5 μL timolol maleate, 0.5%, delivered via Nanodropper Adaptor was non-inferior in IOP lowering compared to typical 28 μL drops at 1, 2, 5, and 8 hours after administration. The study found that the microdrop was as effective as the higher volume drop at three of the four timepoints. The authors saw the timolol had less of an effect on resting heart rate and blood pressure in the Nanodropper group as well.

Going forward, Dr. Okeke said she’d like to see companies incorporating the concept of the Nanodropper Adaptor into their actual bottle design. She said this would require investment and FDA trials to assess efficacy, but it’s something she thinks could be rewarding.

Dr. Okeke said she originally was advising patients on how they could get the Nanodropper Adaptor from the company’s website, but she has since seen a higher adoption rate after she brought it into her office for sale, similar to how she has vitamins, masks, etc., available onsite for patient convenience.

“That’s how I got over the hurdle of getting effective drugs it into the hands of my patients more often and consistently,” Dr. Okeke said.

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About the physician

Constance Okeke, MD
Assistant Professor of Ophthalmology
Eastern Virginia Medical School
Virginia Eye Consultants
Norfolk, Virginia

Relevant disclosures

Okeke: Alcon, Nanodropper

Contact

Okeke: iglaucoma@gmail.com