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PRECIS Brand glaucoma medication prices vastly increased in the United States over the past 7 years, despite a reduction in eye-care providers' tendency to prescribe brand medications over generics. PURPOSE Determine the changes in prices of brand and generic glaucoma medications and to identify changes in eye-care providers prescribing patterns since 2013. MATERIALS AND METHODS The National Average Drug Acquisition Cost (NADAC) database (2013-2019) was used analyze per-unit drug price. Medicare Part D prescriber profile was used to identify eye-care providers prescribing patterns between 2013 and 2017. RESULTS Brand-name medication prices increased by 59% between 2013 and 2019, while generic medications decreased by 22%. Brand-name drugs were 13 to 162 times more expensive than their generic counterparts. Eye-care Providers prescribed 25% less brand name medications in 2017 compared with 2013. CONCLUSION Brand glaucoma medication prices vastly increased in the United States over the past 7 years, despite a reduction in eye-care providers' tendency to prescribe brand medications over generics. A change in government policy, allowing Medicare medication prices negotiations, could greatly reduce health expenditure on glaucoma treatment.

PRECIS Intermediate term results suggest that ab-interno Minimally Invasive Micro Sclerostomy (MIMS) stent less subconjunctival filtration procedure is a promising treatment option for patients with open angle glaucoma. PURPOSE Minimally Invasive Micro Sclerostomy (MIMS) is a novel ab-interno, stent-less, subconjunctival filtration procedure. This study set to investigate the safety, performance and efficacy of MIMS in open angle glaucoma patients. METHODS Prospective, open-label, single arm clinical trial with intra-subject comparisons. Study participants were adults with open angle glaucoma who were candidates for a filtration procedure. Patients were operated by a single surgeon (A.A) in Chennai, India. Following mitomycin C pretreatment, Ab-interno MIMS procedure was performed alone or combined with Phacoemulsification surgery. Procedure-related complications and adverse events were assessed. Primary outcomes: patients (%) achieving an IOP≥5▒mmHg and ≤18▒mmHg, and an IOP reduction of >20% as compared to baseline, with or without hypotensive medications, with no need for recurrent surgery. RESULTS 21 Phacoemulsification-MIMS and 10 standalone MIMS procedures were performed. Mean age was 63.94±6.33 years. Mean duration of MIMS was 1:58±0:25 (min:sec). Scleral tunnels were achieved in all cases. No device malfunctions, intra-operative complications, or serious adverse events were reported. Five (16.12%) patients presented with iris clogging 1-24 weeks following procedure. Two were treated with laser and 3 required trabeculectomy. Mean IOP change from baseline at 24 weeks was 47.4% (31.2 to 16.4▒mmHg, P

Brand glaucoma medication prices vastly increased in the United States over the past 7 years, despite a reduction in eye-care providers' tendency to prescribe brand medications over generics.Determine the changes in prices of brand and generic glaucoma medications and to identify changes in eye-care providers prescribing patterns since 2013.The National Average Drug Acquisition Cost (NADAC) database (2013-2019) was used analyze per-unit drug price. Medicare Part D prescriber profile was used to identify eye-care providers prescribing patterns between 2013 and 2017.Brand-name medication prices increased by 59% between 2013 and 2019, while generic medications decreased by 22%. Brand-name drugs were 13 to 162 times more expensive than their generic counterparts. Eye-care Providers prescribed 25% less brand name medications in 2017 compared with 2013.Brand glaucoma medication prices vastly increased in the United States over the past 7 years, despite a reduction in eye-care providers' tendency to prescribe brand medications over generics. A change in government policy, allowing Medicare medication prices negotiations, could greatly reduce health expenditure on glaucoma treatment.

PRECIS We present a novel stentless filtration system used to create a permanent sclerocorneal drainage channel that reduces intraocular pressure (IOP) without the need to create a conjunctival incision or a scleral flap. PURPOSE The purpose of this study was to evaluate the safety, feasibility, and preliminary performance of a novel surgical system, the minimally invasive micro sclerostomy (MIMS), in an in vivo porcine experimental model. MATERIALS AND METHODS MIMS is an ab externo stentless filtration procedure. An activation system is used to operate a handpiece that includes a 600 µm needle containing an injectable 300 µm triangular blade that spins around its longitudinal axis. The needle is inserted into the subconjunctival space and the blade is injected at the limbal area creating a drainage channel at the sclerocorneal junction, connecting the anterior chamber to the subconjunctival space. The first generation of the MIMS surgical system was assessed in a porcine experimental model, firstly on 6 pigs and thereafter on 10 pigs. All adverse events, IOP measurements, and bleb descriptions were recorded for up to 14 weeks. The shape and location of the scleral tunnel, the subconjunctival bleb, and the healing process were examined by slit-lamp examination, by histopathologic analysis, and by anterior segment optical coherence tomography imaging. RESULTS No device malfunctions were recorded. Scleral tunnels were repeatedly achieved in all models. No significant intraoperative or postoperative complications were recorded. Effective fluid percolation was achieved in all eyes. The mean IOP statistically significantly decreased from 19.0±3.2 mm Hg preoperatively to 11.1±4.9 mm Hg on the first follow-up visit (P=0.0046) in the first leg of the study, and from 18.5±3.8 to 13.3±1.9 mm Hg in the second leg (P=0.0165). In both, IOP gradually returned to preoperative values toward the end of the follow-up period, as expected in a porcine experimental model. Histologic analysis of the analyzed tissue was not associated with significant tissue reaction. CONCLUSIONS The MIMS procedure exhibited a consistent and relatively high safety, feasibility, and efficacy profiles. In the future, the MIMS procedure may provide a novel solution for uncontrolled IOP.