Glaucoma Management: Changing Treatment Algorithms I have the - PowerPoint PPT Presentation

Financial Disclosure Glaucoma Management: Changing Treatment Algorithms • I have the following financial interests or relationships to disclose: • Consultant Andrew G. Iwach, M.D. – AcuMEMS – Alcon Associate Clinical Professor – Bausch & Lomb University of California, San Francisco San Francisco, California Primary POAG Endpoints* Acknowledgments Log Rank P-value <0.001, Hazard Ratio 0.40, 95% CI (0.27, 0.59) 0.15 Observation Medication Flora Lum, M.D. AAO Policy Director, Quality of Care and Knowledge Base Development William L. Rich III, MD, FACS AAO Medical Director of Health Policy Proportion POAG Sue Vicchrilli, COT, OCS AAO Coding Executive 0.10 Cherie L. McNett AAO Director of Health Policy Cathy Cohen AAO Vice President, Governmental Affairs Shan Lin, M.D. AAO Health Policy Committee 0.05 Patient Care Committee, American Glaucoma Society Cynthia Mattox, M.D. AAO Health Policy Committee Emmett Cunningham. Jr., M.D., PhD., MPH Stanford University Faculty. Clarus Ventures 0.00 Industry Members 6 12 18 24 30 36 42 48 54 60 66 72 78 84 *through 8 Nov 2001 Months 1

Treatment vs. Observation Most Patients are Asymptomatic OHT Over 5 Years 1 70 60 50 40 30 20 10 0 Untreated Treated POAG = primary open-angle glaucoma; OHT = ocular hypertension. 1. Kass MA et al. Arch Ophthalmol. 2002;120:701-713. Managing the Odds Diagnostic Studies in Ophthalmology Medicare data, courtesy of Dr. William L. Rich III 2

Glaucoma: Managing the Odds Medical Trends IOP Lowering Medications: Retail Market IOP Lowering Medications: Retail Market Thank you to Rick Halprin at Alcon recent data from IMS Thank you to Rick Halprin at Alcon recent data from IMS 3

The Concept of Persistency Glaucoma & Ectropion Impacting Factors 100 • 74 year old, Exfoliation Syndrome 90 Persistent Patients (%) • Meds: Simbrinza bid 80 70 – Brinzolamide 1.0% 60 – Brimonidine Tartrate 0.2% 50 • Tearing, Lid Crusting, Discharge 40 30 • Lid Redness + Ectropion 20 • Diagnosis: 10 – ? Tear Duct Issue 0 3 mo 6 mo 9 mo 12 mo – ? Drug Reaction Ideal With added side effects After human complacency/denial With economic issues • Need for Surgery?? With complicated dosing Glaucoma & Ectropion Sustained Release Travoprost (OTX-TP) • Intended use: Punctum plug size – Reduction of intraocular pressure in patients with open-angle glaucoma or ocular hypertension • Product design: – Non-invasive punctum plug formulation – Tailored drug release (2-3 months) – Visible for retention monitoring Fluorescent plug observed under blue light – Comfortable and absorbable • Components: – Polyethylene glycol hydrogel – PLA microparticles – Travoprost ophthalmic solution – Fluorescein Vijay Hegde, et al: Drug-Induced Ectropion: What Is Best Practice? 16 Ophthalmology 2007;114:362–366 Ocular Therapeutix, Inc. 4

Sustained Release Travoprost (OTX-TP) Hyperemia n=24 4 Hyperemia Score (0 to 4) 3 Baseline 2 1 0 0 5 10 15 20 25 30 Error Bars = Standard deviation Days 0 = None 1 = Trace 2 = Mild 3 = Moderate 4 = Severe 18 *Data on file at Ocular Therapeutix Surgical Trends 5

Success: Perspectives Surgical Trends: 1994-2014 Surgeon vs. Patient Patient Surgeon Medicare data, courtesy of Dr. William L. Rich III iStents: 2007: 200/month 2014: 4000/month Total: 40,000+ in US so far 6

Surgical Trends: Aqueous Shunts and Cyclophotocoagulation Medicare data, courtesy of Dr. William L. Rich III MicroPulse CP Laser Anterior Uveitis • 72 y.o Vietnamese Male • Pre-Op: Non-Medical Trends – 20/40 – IOP 27 mmHg, Max Meds Affecting Glaucoma Managment • Post-Op Day 1: – IOP = 10, No Meds – Light Perception – Hyphema, Corneal Haze • Meds: Durezol q 1 Hour • Axial Length: 20.8 mm Week 6: Hand Motion Vision 7

Big Data: Impact on Medical Care Newer Health Plans: Impact on Continuity of Care Impact on Glaucoma Management • Older PPO Provider Networks are Only Available with Older Insurance Plans • Older Insurance Plans have been … a) Discontinued b) Significant Increase Premium Increase • Remaining Older Insurance PPO Plans Closed to New Patients • Newer “PPO” Panels are cheaper but have very restricted Provider Panels • e.g. Blue Cross Pathway PPO and Pathway X PPO • Insurance Companies Use Cost and Quality Metrics to Invite Provider to New Plans • Annual Reassessment, Poor/Inconsistent Communication • Disruption of Continuity of Care ACA: Impact on Glaucoma Care Prescribing Patterns http://projects.propublica.org/checkup/providers/search 8

Prescribing Patterns Propublica Partners with Yelp http://projects.propublica.org/checkup/providers/search Corporations: Customer Satisfaction Do you have an opinion? ICD-10 Fundamentals ICD-9 / ICD-10 Comparisons ICD-9 ICD-10 Diagnosis Usage Inpatient and Inpatient and Outpatient Outpatient Number of 3-5 Numeric/ 3-7 Alphanumeric Characters alphanumeric Number of Codes ~17,000 ~141,000 Chapters 17 21 Of the 21 chapters in ICD-10, 10 involve diagnosis pertaining to eyes 9

ICD-10 Fundamentals ICD-10 Fundamentals Glaucoma Center of San Francisco ICD-10 Fundamentals www.GlaucomaSF.com 10

Glaucoma Center of San Francisco January 28 – 30, 2016 San Francisco, CA www.GlaucomaSF.com January 28 January 29 January 30 Annual Gala New Horizons Forum Glaucoma Symposium Celebrate Innovate Educate 11