SPOTLIGHT ON MIGS
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Transcript of SPOTLIGHT ON MIGS
MIGS is Growing UpIke K Ahmed MD University of Toronto
IK Ahmed MD
DisclosuresAdeTherapeutics: CAccelerated Vision: CACE Vision Group: CAlcon: C, RAMO: C, R, SAerie: CAllergan: C, RAquesys: C, RBausch & Lomb: CCarl Zeiss: C, R, SClarity Medical Systems: CCroma Pharma: CEnvisia Therapeutics: CEyelight: CForSight Labs: C
Glaukos: C, R, SInnFocus: CIridex: C, RIvantis: C, R, SLayerBio: CNew World Medical: ROmega Ophthalmics: CONO Pharma: CPolyActiva: CSanoculis: CScience Based Health: CSOLX: C, RStroma: CTranscend: C, RTrueVision: C
C = ConsultantR = Research Support
S = Speakers Honorarium
60,000,000$6,000,000,000
IK Ahmed MD
Interventional GlaucomaMedications
Lasers
Trabeculectomy / Tubes
MicroInvasive GlaucomaSurgery
Cardiovascular MedicineCoronary Stents CABGMeds
IK Ahmed MD
Defining MIGS• Ab-interno approach• Minimally traumatic• At least modest efficacy• Extremely high safety
profile• Rapid recovery
IK Ahmed MD
Outcome MeasuresLower IOP & eliminate/reduce meds
IK Ahmed MD
3 MIGS Outflow Targets
Schlemm’s CanalConventional Outflow
iStentiStent inject
HydrusTrabectomeGoniotomy
Suprachoroidal SpaceNon-conventional Outflow
Cypass + Cypass VxiStent Supra
Scleral/SubconjunctivalXen MMC MIGS
“Plus”Internal MIGS (iMIGS)
IK Ahmed MD
IK Ahmed MD
GKOS (NYSE):Financial Strength to Support Continued Global Growth
TOTAL NET SALES(in millions)
Q1 2013 Q2 2013 Q3 2013 Q4 2013 Q1 2014 Q2 2014 Q3 2014 Q4 2014 Q1 2015 Q2 2015 Q3 2015 Q4 2015 $0
$6
$11
$17
$22
$91.1as of 12/31/15
CASH, CASH EQUIVALENTS & SHORT-TERM INVESTMENTS(in millions)
$21.0M
$45.6M
$71.7M
IK Ahmed MD
How Big is the Market?Current? Potential?
IK Ahmed MD
Understanding the Market
Combo cataract surgery700K / year
Standalone procedures?2+M / year
IK Ahmed MD
80%
21%
Comorbid Cataract & Glaucoma• 15-20% of patients
undergoing cataract surgery have glaucoma
• 3.7 million cataract surgeries in the US per year
• 500-700,000 comorbid with glaucoma
Centers for Medicare and Medicaid Services. 2002 – 2007. Medicare Standard Analytical File. Baltimore, MD. 2007Tseng, V. L., Yu, F., Lum, F., & Coleman, A. L. JAMA. 2012;308:493–501.
Trabs; 63,000
ExPRESS; 18,000
Other; 42,000iStent; 80,000
Tubes; 50,000
US Glaucoma Surgeries
250,000 / year
IK Ahmed MD
US Glaucoma Prevalence
2% over 40yo 3M —> 6M
3Million USGlaucoma Patients
140KTrabs/Tubes
500KLasers
PotentialMIGS
Large TreatmentGap and
Opportunity in Glaucoma
Intervention
>=2meds; 1,011,408
SLT/ALT Laser; 541,998
Trab/Tube;
110,000
MIGS/Others; 123,200
Glaucoma Treatment MethodsPotential MIGS Patients
Marketscope
>=2meds; 5,085,230
SLT/ALT Laser; 1,902,897
Trab/Tube; 371,300
MIGS/Others; 197,734
US Patients Global
<0.65
>-6dB
0.7-0.85
-6 to -12dB
0.9+
<-12dB/10° Fixn
Glaucoma Disease & Prevalence Mild Moderate Advanced
0.3
OHT
2million 1.5million 750,0003millionMarketscope
IK Ahmed MD
The Glaucoma Pyramid: Target IOP Guides Therapy
Ocular Hypertension
Mild
Moderate
Advanced
Safety Highest Priority
Safety and IOP lowering needed
Max IOP lowering needed
1.5M
2.0M
750K
3.0M
US
Pop
ulat
ion
12
15
18
21
Targ
et IO
P (m
mH
g)
IK Ahmed MD
What is the Incidence of Glaucoma?
IK Ahmed MD
The Cycle of Glaucoma Therapy• Glaucoma is a life-long chronic
disease• Re-treatment rates are high• Multiple drops and interventions
over a lifetime
~ 200K newly diagnosed glaucomaper year
IK Ahmed MD
IK Ahmed MD
Glaucoma Treatment Algorithm
1 Med MultipleMeds SLT Multiple
Meds Trab 2nd Trabor Tube
1 MedSLT
DrugDelivery MIGS MIGS Plus Trab
or Tube
Phaco + MIGS
Now & Potentially in 5 years
Level of Invasiveness
IK Ahmed MD
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