PARKHURST NUVISION

iDose TR

Travoprost intracameral implant

Gurpal Virdi, MD

Glaukos · FDA-approved Dec 2023 · U.S. launch 2024

The problem drops don't solve

iDose TR is a pillar of "interventional glaucoma" — moving from drops to procedures earlier

Adherence. Roughly half of glaucoma patients aren't taking drops as prescribed within a year.
Preservative toxicity & ocular surface disease. Chronic BAK exposure drives redness, burning, and unstable tear film.
Prostaglandin-associated periorbitopathy (PAP). Orbital fat atrophy, deepened sulcus, lash changes.
The pitch: a one-time, in-office implant that removes the daily-drop burden while it works.

What it is

Titanium implant, 1.8 × 0.5 mm — smaller than a grain of rice.
75 mcg of preservative-free travoprost held in a reservoir.
Elutes continuously into the anterior chamber by membrane-controlled diffusion — steady drug level, no daily dosing.
Implanted through the trabecular meshwork and back wall of Schlemm's canal, anchored in scleral tissue.

1.8 × 0.5 mm

Titanium reservoir implant

75 mcg

Preservative-free travoprost

Continuous

Membrane-controlled elution

Glaukos · FDA-approved December 2023, U.S. launch 2024.

Travoprost & the prostaglandin analogs

Travoprost is a prostaglandin F2α analog — same class as latanoprost, bimatoprost, tafluprost, and the most potent topical IOP-lowering class (~25–33%).
Prodrug → FP-receptor agonist. Corneal esterases convert it to travoprost free acid, which lowers IOP mainly by increasing uveoscleral outflow.
Delivery is the differentiator, not the molecule — efficacy across PGAs is broadly similar; iDose changes how the drug is delivered.
Preservative-free, intracameral, negligible systemic exposure — plasma travoprost stays below the assay limit (<10 pg/mL); it bypasses the ocular surface.

Fewer surface & cosmetic effects than drops: much less hyperemia, and trials saw none of the iris / periorbital pigmentation typical of topical PGAs — though the label still lists possible, likely-permanent iris pigmentation.

Source: iDose TR prescribing information (Glaukos), 1/2026.

How it goes in

Clear corneal incision, aseptic conditions — in-office or OR.
Delivered across the angle and anchored at the iridocorneal angle.
Gonioscopy-visible — confirm position at the slit lamp.
Standalone or combined with cataract surgery.

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Implantation across the angle — watch on YouTube

Who it's for

Mild-to-moderate open-angle glaucoma or ocular hypertension needing better IOP control.
Patients with poor adherence or intolerance to topical drops.
Ocular surface disease, dexterity limits, or cost barriers to daily drops.
Can be performed with or without cataract surgery.

Contraindications & cautions

Contraindicated

Active or suspected ocular / periocular infection
Corneal endothelial dystrophy — Fuchs, guttata
Prior corneal transplant or DSAEK
Hypersensitivity to travoprost

Use caution / counsel

Narrow angles or angle abnormalities
Monitor routinely to confirm implant position
Iris pigmentation can occur — likely permanent
MRI conditional — a handy practical pearl

Why the corneal ones: the implant sits by the corneal endothelium — Fuchs/guttata and prior grafts have too little endothelial reserve to absorb further cell loss.

Sources: iDose TR HCP prescribing information; Glaukos.

Just changed — Jan 28, 2026

Re-administration is now approved

FDA approved a labeling supplement allowing re-administration in the same eye — the old label said don't re-dose.
Requires specular microscopy: the eye must meet an age-based minimum endothelial cell density; re-dosing is withheld if there's ≥10% ECD loss or prior device dislocation.
No more than once per year.
Backed by no clinically significant endothelial cell loss through 3 years across the phase 3 / 2b studies.
Exchange study: place the new implant first, then remove the old one — safe and tolerated over 12 months.

Sources: Glaukos; PentaVision. FDA approval Jan 28, 2026.

Where iDose sits in sustained-release glaucoma

System	Drug & format	Duration	Status
iDose TR	Travoprost — titanium, non-biodegradable, re-dosable	Label ~3 yr	FDA approved 2023
Durysta	Bimatoprost — biodegradable intracameral	~3–4 mo	FDA approved 2020
OTX-TIC	Travoprost — biodegradable hydrogel	4–6 mo	Phase 3 (missed endpoint)
ENV515	Travoprost XR — biodegradable	~6 mo	Phase 2a
SpyGlass	Bimatoprost — drug-eluting IOL pads (at cataract)	Up to 3 yr	Phase 1/2

Takeaway: iDose & Durysta are the only FDA-approved intracameral implants — iDose is the only non-biodegradable, re-administrable one, giving it by far the longest duration.

Investigational agents shown for context; landscape per published reviews.

Our clinic's perspective — not Glaukos data

How iDose fits our MIGS toolkit

Option	Indication	On a med?	IOP drop	Notes
iDose TR	Mild–moderate OAG + ocular HTN	Not required	~20–25%	Continuous travoprost; can get OHT / one-med patients off drops
iStent Infinite (3 stents)	Mild–moderate OAG	Required — must be on a med	~15–20% (if lucky)	Not for ocular HTN; best when noncompliant or poor ocular surface
OMNI	Ocular HTN + mild–moderate	Not required	Largest drop	Usually 2+ meds / more moderate disease; ↑ hyphema & cyclodialysis-cleft risk → historically after iStent
ECP	Closed-angle cases	—	—	For closed angles; also driven by insurance coverage

Our clinic's perspective — not Glaukos data

What we see in clinic

iDose — for ocular hypertension or a one-med patient, we can often get them off drops entirely. Labeling supports ~3 years; in our hands we typically see ~2 years of effect.
iStent — anecdotally a temporary drop holiday, but many are back on a drop within 1–2 years.
OMNI gives the biggest IOP reduction — we reserve it for 2+ meds / more moderate disease, and historically place it after iStent given higher hyphema and cyclodialysis-cleft risk.
ECP — we use in closed-angle eyes, and where insurance coverage favors it.

Enrolling now · Parkhurst NuVision

Our iDose + iStent study

The study

All qualifying patients receive iDose TR; 20% randomized to also get 3 iStent infinite stents
One eye · 12-month follow-up
Goal: safety & IOP-lowering efficacy of iDose TR + iStent infinite
Patients reimbursed $1,050

Who qualifies — refer if…

Age 18+, any sex
Glaucoma or ocular hypertension
On 0–2 IOP-lowering medications
No prior incisional glaucoma surgery

Have a patient who fits? Send them to Parkhurst NuVision for screening.

Study sponsored by Glaukos; conducted at Parkhurst NuVision.

Managing the postop patient

Postop course resembles other trabecular MIGS — minimal inflammation, quick recovery.
Expect gradual IOP lowering as travoprost releases; effect may not be immediate.
Continue preop drops initially, then taper based on IOP response and your discretion.
Monitor IOP, inflammation, corneal status at routine intervals (POD1 if combined, then 1–4 wks).
Gonioscopy confirms implant position if IOP response is suboptimal.
Reinforce this is not a cure — ongoing glaucoma monitoring is still required.

Coverage & coding

Medicare + true supplemental insurance cover iDose — minimal out-of-pocket for most patients.
Available buy-and-bill or via specialty pharmacy (physician isn't paid for the drug if via specialty pharmacy).

Sources: Eyes On Eyecare; American Academy of Ophthalmology; our clinic's billing experience.

Who to send us

Great candidates

Mild-to-moderate OAG / ocular hypertension
Poor compliance / drop-intolerant
Uncomfortable eyes — poor or damaged ocular surface
Dexterity or cost barriers
Anyone heading to cataract surgery — combine it

Not for

Fuchs / guttata
Prior corneal graft
Narrow angles
Advanced disease needing a low target

Refer for an iDose TR consultation

Thank you

Let's connect — Gurpal Virdi, MD · scan to follow or reach out

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