Based on IQVIA’s Forecast Link, this article considers how the glaucoma market is expected to develop over the next 10 years, and how new product launches and generic entries are expected to shape market evolution.

Glaucoma is a progressive disease that damages the optic nerve and is the leading cause of irreversible blindness. By the end of 2020, approximately 76 million people globally will have the disease and this number is expected to increase to 112 million by 2040.¹ Currently, treatment focusses on lowering intraocular pressure (IOP) which can be achieved via pharmacological, laser and surgical approaches. Pharmacological therapy for glaucoma primarily involves the instillation of eye drops with drugs that reduce aqueous humor production or enhance its drainage through various outflow pathways. However, current pharmacological therapies possess significant drawbacks.² Topical ophthalmic administration can result in enough systemic absorption to produce serious side effects and these can be life-threatening in some cases. Furthermore, treatment adherence is one of the most significant challenges in the management of glaucoma and results from intolerable side effects and poor installation technique, which can be exacerbated by physical limitations such as arthritis or tremor. The availability of newer products, discussed below, should help to address these limitations, but these important unmet needs have not been completely abated.

Meanwhile, the use of innovative non-pharmacological treatments such as minimally invasive glaucoma surgery (MIGS) are on the rise. MIGS involves the implantation of a device which drains aqueous humor from the anterior chamber. Numerous new devices have been commercialized over the last decade and the MIGS device market is expected to grow at a CAGR of approximately 31.7% between 2020 and 2027 reaching $3.2 bn in value by 2027.³ MIGS is an alternative to drug therapy and traditional glaucoma surgeries such as trabeculectomy with more rapid recovery times. In comparison, the global glaucoma pharmaceutical market is estimated to grow at a CAGR of 2% in value terms between 2020 and 2029 reaching $7.2bn by 2029 according to IQVIA’s Forecast Link. This is down from a CAGR of 4% between 2016 and 2020. Regional value growth will move similarly with the exceptions of Europe and AUNZ, where the availability of new therapies will increase value growth above recent historical trends, and Japan, where price controls such as biennial price cuts will continue to have a negative impact.

Value growth will be impacted by slowing volume growth in terms of patient days (PATDAY) between 2020 and 2029. In the AUNZ region, historical volume growth was in fact negative and this has been directly attributed to a shift towards surgical and laser management of glaucoma.⁴ The growth rate in PATDAYs is expected to decelerate across all regions apart from AUNZ where new pharmacological therapies will restore positive prescription demand for drugs modestly. The uptake of surgical interventions such as MIGS is assumed to be captured in the baseline PATDAY volume trends since they have been available for many years and are undergoing incremental improvements.

Although surgical options are growing in popularity and are increasingly used earlier, questions remain about their cost-effectiveness and whether long-term outcomes are superior to drug therapy. Furthermore, surgical options do not cure the disease and only provide temporary relief from topical ophthalmic preparations. As a result, eye drops will remain an important treatment option for glaucoma. Until late 2017, there were no innovative new drug launches in the glaucoma market during the previous two decades based on mechanism of action. Since then, however, five new products have been launched that seek to address unmet needs and they are expected to launch in more geographies between 2020 and 2029.

In addition to these new product launches, eight molecules are expected to experience loss of protection (LoP) events between 2020 and 2029 opening the market to increased generic competition. Collectively, it is estimated these molecules will account for approximately $1.4bn or 23% of global glaucoma value sales in 2020. However, the new product launches will offset losses due to several reasons. First, in some cases they offer superior efficacy compared with existing treatments. Second, some possess innovative mechanisms of action meaning they offer an alternative method of treatment in patients unresponsive to existing therapies. Third, the mild side-effect profiles of these drugs offer additional options for patients experiencing intolerable side effects with other products. Fourth, the implant offers an alternative for patients who are non-adherent or finding eye drops too difficult to manage due to physical limitations. The new products’ average implied cost per patient day is 8 times that of existing therapies and as a result, a net positive impact for launch and LoP events are expected globally and across regions.

The net impact of launch and LoP events and the rising prevalence of glaucoma will drive positive volume and value growth in the drug market between 2020 and 2029 in most regions, but surgical interventions are gaining in popularity and being used earlier as a means of controlling the disease. Non-pharmacological interventions are constraining the volume growth of pharmacological treatments, but until a cure or long-term solution is realized, drug therapy will remain an important treatment option for patients with glaucoma. Fortunately, advances in both spheres are improving the quality of life for patients with this debilitating disease.

¹ Tham YC, Li X, Wong TY, et. al. Global Prevalence of Glaucoma and Projections of Glaucoma Burden through 2040: A Systematic Review and Meta-Analysis. Ophthalmology. 2014 Nov;121(11):2081-90.

² Lusthaus J, Goldberg I. Current management of glaucoma. Med J Aust. 2019 Mar;210(4):180-187. doi: 10.5694/mja2.50020. Epub 2019 Feb 14. PMID: 30767238.

³ Market Analysis and Insights: Global Micro Invasive Glaucoma Surgery (MIGS) Devices Market

⁴ Skalicy S and White A. Glaucoma Research: A Year of Progress (March 2018). https://glaucoma.org.au/news-details/research/glaucoma-research-a-year-of-progress

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