er and more efficient for doctors who don't feel comfortable inserting
some other devices intraoperatively. It can be done post-op, pre-op or
intra-op, because it's external to the eye."
The plug typically stays in for 30 days, delivering a tapered dose of
dexamethasone to treat ocular pain after surgery, and alleviating com-
pliance concerns.
"The idea that patients consistently take their steroids 4 times a day
for a month is just false," says John A. Hovanesian, MD, an assistant
professor at the UCLA Jules Stein Eye Institute who practices at
Harvard Eye Associates in Laguna Hills, Calif. "There's overwhelming
evidence that most patients fail to take drops as directed. Taking the
delivery of medicine out of the hands of the patient is really a step in
the right direction."
And if an unlikely complication occurs? "You have the freedom also
of being able to take it out if, say, someone has a pressure spike for
some strange reason," says Dr. Singh. "The control you have to modu-
late, to change it postoperatively, is very important."
But, as Dr. Hovanesian points out, such a complication may actually
be less likely with an implant. "We think pressure spikes with steroids
happen because of high intermittent dosing, and there is some evi-
dence to support that," he says. "With drugs that release a low but
steady level of steroid, we don't really see pressure spikes."
Dextenza is currently approved for the treatment of surgical pain,
but the company is also looking to have it approved for ocular inflam-
mation. "It's talked about in terms of cataract surgery," says Dr. Singh,
"but it's really meant for any post-operative pain." Ocular Therapeutix
has also submitted an application for transitional pass-through pay-
ment status and an application for a J-code.
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