Google, Alcon, and the Smart Lens Project

Ever since Google announced back in January, 2014, that they had made plans to create a smart contact lens project, I have been quite interested in how tech and health companies were looking to use digital health to address the blood glucose monitoring process. I mean, pharmacists on a daily basis have patients that come into the pharmacy that will pick up blood glucose monitors for SMBG (Self-Monitoring Blood Glucose) and associated supplies (e.g., test strips, lancets, alcohol wipes) for home testing. I have spent much time talking to patients about their devices, read their results in the clinic, and can completely understand when patients express fatigue with daily testing. It’s tough, and some companies I feel have done a good job of revitalizing the process at least, like One Drop, a new start-up focused on SMBG supplies for patients with diabetes.

But even then, when Google said they wanted to create a smart lens that would enable patients to get rid of the SMBG process, and have continual and unnoticed testing occurring in the background of a patients everyday life, I thought it was tremendous news. And yet, now in November of 2018, Google Verily just updated their blog to announce that they were halting the partnership with Alcon [Novartis] to create the smart lens. They will continue to focus on two other projects with Alcon on the smart lens project, including wireless electronics and miniaturized sensors, and focus on presbyopia and post-catract surgery monitoring. But the glucose monitoring component will be put on hold, and the reason was rather interesting:

…challenges of obtaining reliable tear glucose readings in the complex on-eye environment. For example, we found that interference from biomolecules in tears resulted in challenges in obtaining accurate glucose readings from the small quantities of glucose in the tear film. In addition, our clinical studies have demonstrated challenges in achieving the steady state conditions necessary for reliable tear glucose readings.

Now that is quite interesting, as it seems that they were not getting the results they wanted, and I think after four years of giving this a go, it may be best to put it on hold - especially with media asking for years when this may come to fruition.

In any event, ever since Google talked about this project, they actually joined with other companies in the Continuous Glucose Monitoring (CGM) space such as Dexcom and Onduo (Sanofi). I think it makes more sense to work with at least plausible technology now than trying to create from scratch.

So is that it? No more Glucose sensing Tech for the eye?

Well, as I mentioned, when Google mentioned they were getting into this business back in 2012, I have been keeping my eyes on any other novel forms of glucose sensing tech coming to market. Most of this falls under the CGM market, and I would say companies like Dexcom and Abott (Freestyle Libre) have made the most news in recent years, but there are a few other odd ones out there.

• Senseonics - This is a CGM company, but instead of a patch or similar device worn by a patient to sense glucose, they instead get an implantable sensor in the upper arm that lasts up to 3-months. This is their Eversense Long-Term CGM System, and is really interesting with the implantable aspect of CGM technology at this time.

• GluSense - Another implantable CGM company, though not as much information available about their Glyde CMG technology.

• Integrity Applications - Well this one really caught me off guard, as this companys product is focused on pain free glucose monitoring that uses a sensor attached to the ear called GlucoTrack.

• Gentag - NFC skin patches, with one aim to be glucose monitoring, by placing a patch under the skin.

But what about they eye? Fine fine…

So one other company that is similar to the Verily Smart Lens project is from Noviosense, who are creating a flexible spring like device that fits under the lower eye lid to detect glucose levels in the fluid collected from around the eye. They are currently conducting small clinical trials, and one was recently published this year:

Kownacka AE, Vegelyte D, Joosse M, et al. Clinical Evidence for Use of a Noninvasive Biosensor for Tear Glucose as an Alternative to Painful Finger-Prick for Diabetes Management Utilizing a Biopolymer Coating. Biomacromolecules. 2018;19(11):4504-4511.

Now, if you are quite interested in the science of this project, I recommend you read the paper. Otherwise, to summarize, this is a 3-wire device less than 2cm long that fits under the bottom eye lid in the fornix and gets data from tear fluids. In its small study it compared similarly to the Abbott Freestyle Libre, but this was only in five patients.

Overall I would say that Noviosense, who have been working on this since 2012, seems to have a lot riding on this project. Their main competitor would have been Google, but now they seem to have the field open to them. That being the case, from a marketing standpoint, I think the idea of a sensor shaped like a contact lens rather than a flexible rod placed under the eye will be the biggest difference in presentation at this time.

In any event, I think the next few years will be interesting with the CGM market. We are likely to see a number of ways to detect glucose enter the market, ranging from traditional direct patches, implants, to novel means. Ultimately, I think the areas that will make a winner include patient control (administering at home versus a clinic), longevity of system (days versus weeks versus months), how the data is collected (patch, wearable sensor), and pain of use.

As always, I welcome your thoughts!