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Canaloplasty Surgery FAQ by Dr. David Richardson


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Answers to Your Most Burning Questions on Canaloplasty Surgery & Glaucoma Surgery. By Dr. David Richardson - visit

Answers to Your Most Burning Questions on Canaloplasty Surgery & Glaucoma Surgery. By Dr. David Richardson - visit

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  • 1. ??CANALOPLASTY surgeryFAQ ?
  • 2. Canaloplasty Surgery 1 5FAQ Click to Watch Online! 10 15What is Canaloplasty? 21Canaloplasty (pronounced Kah-NAL-oh-plas-tee)is a new glaucoma treatment that gives many people Lastwith this potentially blinding condition the hope ofsaving the vision they have. Canaloplasty can re-duce pressure in the eye (IOP) by nearly 40%, andmany glaucoma patients who have had Canaloplasty CANALOPLASTYno longer need medications. This “minimally inva- New Glaucoma Treatmentsive” procedure is available alone or can be donewith cataract extraction (phacocanaloplasty). It is a“non-penetrating” surgical procedure that does notrequire creation of a fistula nor result in a “bleb”such as with traditional trabeculectomy surgery. In-sertion of a micro-catheter into Schlemm’s canal(the eye’s internal drainage duct) facilitates exit of fluid through the natural outflow. The canal isthen dilated by injecting a sterile, gel-like material suture is placed within the canal system. Suture ten-called a viscoelastic. After the drainage channel is sion within this system keeps it open for years re-made larger the micro-catheter is removed and a sulting in a controlled eye pressure. © 2011 | call 626.289.2223 | CA 91776
  • 3. 1 5Why Canaloplasty? 10Safety. Canaloplasty is safer than traditional glau- 15coma surgery (trabeculectomy). If you are consid-ering glaucoma surgery to prevent further vision 21loss then choosing a surgery that has fewer risksmakes sense. LastAge. Younger patients need a better option thantraditional glaucoma surgery. Traditional glaucomasurgery is less likely to succeed in younger patientsand carries a lifetime risk of infection. Successwith Canaloplasty is not age dependent and there isno lifetime risk of infection.Active Lifestyle. If you are an energetic personwho enjoys such activities as watersports, it is im-portant for you to know that having traditional© 2011 | call 626.289.2223 | CA 91776
  • 4. 1glaucoma surgery will severely limit your ability to Difficulty with Glaucoma Medications. If 5participate in certain sports. No such limitation ex- you are having trouble tolerating or affording yourists with Canaloplasty. Once healed, patients who glaucoma medications, then Canaloplasty may 10have had Canaloplasty are able to return to their be an option for you. With traditional glaucomaprevious active lifestyles without restriction or lim- surgeries, the risk is just too high to consider for 15itation. reasons of financial hardship or side effects of medicines alone. 21Nearsighted. People who are very nearsighted(highly myopic) are at a much higher risk of vision- These are just some of the many reasons to con-threatening complications from traditional glauco- Last sider Canaloplasty. If you have open angle glau-ma surgeries. This is not true with Canaloplasty. coma (the most common type) and are considering glaucoma surgery, then you should explore yourEthnicity. Traditional glaucoma surgery has a high available options before making a decision. Al-failure rate among black patients. In contrast, Ca- though there are certainly instances where tradi-naloplasty has a well-established track record of tional glaucoma surgery is the best (or even only )success among many races. option available, most patients with glaucoma are candidates for Canaloplasty and should considerFear of Cataract. If you do not currently have a this safer option.cataract, you should know that the risk of devel-oping one increases substantially after traditionalglaucoma surgery. This risk is much lower withCanaloplasty. © 2011 | call 626.289.2223 | CA 91776
  • 5. 1 How long has Canaloplasty been fluid to flow from the inside of the front of the eye (anterior chamber) through the scleral hole to 1 around? The answer to this question is not as straightforward as it might seem. Al- a bleb (cyst, or blister-like elevation of the con- junctiva). From here the fluid somehow finds its 5though the iTrack catheter (required to performcanaloplasty) has only been FDA approved since way back into the venous system. These surgeries2008, the surgical technique used to perform Ca- are called “penetrating.” Canaloplasty, on the oth- 10naloplasty has been around for decades. The mod- er hand, is a non-penetrating (or “minimally inva-ern procedure is essentially a modification of vis- sive”) surgery because only a partial thickness flap 15cocanalostomy, which was first described by Dr. is created in the sclera. This flap is then sewn backStegmann in 1991. Because viscocanalostomy is a in place after Schlemm’s canal is opened so there is 21technically difficult surgery to perform, it was not no fistula created between the inside and outside ofvery popular among most eye surgeons. Howev- the eye. Instead, fluid in the eye drains out through Laster, with the invention (and FDA approval) of the the (newly opened) natural drainage system of theiTrack, the impressive results and superior safety eye. 3profile of Canaloplasty have convinced a numberof surgeons (myself included) to become adept at How long does Canaloplasty take?this procedure. Canaloplasty is not a quick surgery (at least2 by eye surgery standards). In order for the What does “Minimally Invasive” re- surgery to work properly, your surgeon must make a flap in the sclera (the white part of the eye) and ally mean? Traditional glaucoma surger- extend this all the way to a very thin and fragile ies (trabeculectomy or shunt surgery) re- membrane called Descement’s membrane withoutquire the creation of a full-thicknes hole (or fistula) tearing it. This flap is created just above a vascu-through the wall of the eye (sclera). This allows lar tissue (which easily bleeds) called the choroid. Fyodorov SN, Ioffe DI, Ronkina TI: [Glaucoma sur- All of this happens in a space no larger than thegery—- deep sclerectomy]. Vestn Oftalmol 4:6--10, 1982 fingernail on your “pinky” finger. It can be tedi- © 2011 | call 626.289.2223 | CA 91776
  • 6. 5ous and requires both skill and patience from your Is Canaloplasty surgery painful?surgeon. Thus, it can take anywhere between 45 1 No. During surgery your eye will be anes-minutes and two hours. The benefits, however, can thetized (numbed). After surgery you will belast a lifetime. given drops to reduced inflammation and prevent 54 pain. Generally, people do notice a “foreign body What if my natural drainage sensation” (scratchy sensation) under the upper 10 canal cannot be fully eyelid for up to a few weeks after surgery. This is caused by the slowly dissolving sutures and resolves 15 catheterized? To get the full benefit ofCanaloplasty, it is important for your surgeon to on its own. If you have Canaloplasty surgery andcanulate the full 360 degrees of Schlemm’s canal, have more severe pain than what is described here, 21 “dilate the canal with viscoelastic, and stent it open you should immediately contact your surgeon.with a suture. The inability to complete any one of Lastthese elements (say, from prior scarring of the ca-nal) can limit the effectiveness of the surgery. How-ever, even if a full Canaloplasty procedure cannotbe completed, your surgeon can most likely convert If something doesn’t work, thento either a traditional trabeculectomy or viscocana- try something else. Because thislostomy. A recent study confirmed that, while not new procedure is un-as effective as Canaloplasty, viscocanalostomy can believable. I can’t saysignificantly reduce the pressure in the eye provid-ing for some protection from glaucoma. enough about it. I’m just thrilled. It’s like Canaloplasty in One Eye Compared With Viscoca- giving me a new life!nalostomy in the Contralateral Eye in Patients With Bilateral Open-angle Glaucoma. Koerber, N. Journal of Glaucoma. Online ahead of print, January 26, 2011. © 2011 | call 626.289.2223 | CA 91776
  • 7. Canaloplasty 1 5ELIGIBILITY 10 156 I’ve had glaucoma laser surgery. is not placed, this is called viscocanalostomy. Al- 21 Can I have Canaloplasty? If you have though not as effective as canalopasty, it can still had either of the laser surgeries for open lower the IOP. Last 7angle glaucoma (Argon Laser Trabeculoplasty orSelective Laser Trabeculoplasty), you may still be I’ve already had traditional glau-a candidate for Canaloplasty. It depends, however, coma surgery (trabeculectomy).on how much scarring there is from the laser sur- Can I have Canaloplasty? The stand-gery. Although your surgeon can visually inspect ard answer would be “no.” However, it is possiblethe area around Schelmm’s canal using a special (though technically quite challenging) for Canalo-contact lens (a technique called gonioscopy), s/he plasty to be done in an eye that has already had acannot tell if there has been permanent scarring trabeculectomy that is no longer functioning. Ifof the canal itself. It may not be possible to fully you and your surgeon are considering this option itcatheterize the canal if there is dense scarring of is important for you to have realistic (guarded) ex-the canal (called stenosis). In that case, your sur- pectations of success. Many patients are interestedgeon would not be able to stent the canal open with in the option of Canaloplasty because (compareda suture, but would still inject a special gel (called a to other glaucoma surgeries) there are fewer risks.viscoelastic) into the partially opened canal. When But, if you are not the ideal candidate, there maythe canal cannot be fully canulated and the stent also be less of a potential benefit. © 2011 | call 626.289.2223 | CA 91776
  • 8. 18 I’ve used glaucoma drops for a very 5 long time. Will that affect the suc- cess of Canaloplasty? Possibly. There 10is growing evidence that Schelmm’s canal (the eye’snatural drainage duct) decreases in size with long- Find out if you 15term use of glaucoma medications. If there is or your loved onesignificant stenosis (scarring down) of the canal, 21then it may not be possible to thread the catheter qualifies forall of the way around the canal. However, even Canaloplasty ! Lastif a stent cannot be left in the canal it is generallypossible to dilate a significant portion of the canalwith viscoelastic. When the cathether cannot befully threaded and a stent is not placed, this proce- Evaluationdure is called viscocanalostomy. Viscocanalostomy Formhas been around since 1991 and is also an effectivetreatment for glaucoma (though less so than Cana- Dahan E, Drusedau MU: Nonpenetrating filtration surgery for glaucoma: control by surgery only. J Cataract Refract Surg 26:695--701, 2000 © 2011 | call 626.289.2223 | CA 91776
  • 9. Canaloplasty 1 5BENEFITS 10 159 Will my vision change after healed (about three months after surgery) an inter- 21 Canaloplasty? If you are hoping for bet- esting thing happens: some patients note that their ter vision after canaloplasty, it is important vision does seem better than it was prior to surgery. Lastto point out that the purpose of any glaucoma treat- This is likely because glaucoma drops worsen a con-ment (incuding Canaloplasty) is to preserve vision, dition called Tear Dysfunctional Syndrome that cannot improve it. That being said, your vision will cause blurred vision. After successful Canaloplastychange in the following ways after surgery. First, surgery the need for glaucoma drops is reduced (orexpect your vision to be worse the first few days (or even eliminated). Without these drops, Tear Dys-even weeks) after surgery. This is expected. When functional Syn-Schlemm’s canal is dilated some blood refluxes drome improvesback through the newly dilated canal into the eye. which canSome even consider this a sign of successful sur- result ingery. This blood eventually is cleared out the same clearerway it got into the eye. Another cause of (gener- visionally temporary) fluctuations in vision is surgically for someinduced astigmatism from the suture used to close patients.the surgical incision. This almost always resolvesby a month or so after surgery Once the eye is fully © 2011 | call 626.289.2223 | CA 91776
  • 10. 10 Will Canaloplasty cure my who undergo Canaloplasty have lower IOPs after surgery, but on average, they are able to stop just 1 glaucoma? No. To date there is no cure for glaucoma. The best any under two medications. What does “just under two” mean? Well, some people are able to stop one 5treatment can do is to halt (or slow) the progressionof this disease. The closer the IOP to 8mmHg, the drop, some two, others none and some are evenbetter (below that and the eye can lose vision from able to stop all of their drops. How many you will 10the pressure being too low). Studies have shown be able to stop if you have Canaloplasty cannot bethat for most glaucoma patients an IOP of less than predicted, though it’s likely that you will be able to 1515mmHg can be protective (a goal often achieved stop at least one of them if you are on multiplewith Canaloplasty). Some forms of glaucoma (such drops. 21 12as advanced, low tension, or normal tension glau-coma) require IOPs of less than 12mmHg in order How long will my IOP stay Lastto avoid loss of vision. Only your eye surgeon can controlled with Canalo-determine what your eye’s goal should be. plasty? Because Canaloplasty has11 only been FDA approved since 2008, we only have Will I be able to stop using three-year results. There is no reason, however, to glaucoma drops after Cana- believe that the surgery will “stop working.” In a loplasty? Possibly. Remember that study that looked at the long-term (7 year) resultsthe primary objective of any glaucoma surgery (in- of combined cataract surgery and viscocanalosto-cluding Canaloplasty) is to lower your IOP into a my (the less effective precursor to Canaloplasty),safer range and protect you from further loss of IOP was reduced by over 33% (on average) at thevision. A secondary goal would be to reduce (or last documented visit. We can reasonably expecteven eliminate) the use of glaucoma drops. Studies the long-term results of Canaloplasty and Phaco-have shown Canaloplasty to be effective at achiev- canaloplasty to be even better than those publisheding both of these goals. Not only do most people for viscocanalostomy and Phacoviscocanalostomy. © 2011 | call 626.289.2223 | CA 91776
  • 11. 13 What if Canaloplasty doesn’t surgery (and at least for a few days, but sometimes up to weeks after) your vision will be blurry in the 1 work? Can I still have tradi- eye that had canaloplasty. Therefore, any activities tional glaucoma surgery af- 5 that require good binocular vision (such as workingter Canaloplasty? Yes. Having Canaloplasty with heavy machinery) should be avoided until thedoes not affect your abil- vision improves. Addition- 10ity to have other types of ally, it is generally a goodglaucoma surgery at a later idea to keep the eye clean 15date as long as your Ca- and dry (no gardening ornaloplasty surgeon oper- swimming) for at least a 21ates in one of the superior few weeks. Once the inci-“quadrants” of the eye. sion has healed over (about LastSome Canaloplasty sur- a month after surgery) it isgeons, however, operate generally OK to resume allat what is called the 12:00 of your usual activities.position. This approachcan make it difficult (but Contrast this with tradi-not impossible) for a sur- tional glacuoma surgerygeon to perform tradition- (trabeculectomy) whichal glaucoma surgery at a later date. does limit your activities for the rest of your life.14 Because of the fragile nature of a bleb after trab- I’m a very active person. eculectomy (and the risk of rupture and/or infec- Will having Canaloplasty tion), once someone has had trabeculectomy sur- force me to limit my activities? gery s/he cannot participate in most water sportsThe answer to this question depends on what time, without high-quality protective eyewear.after surgery, you are referring. Immediately after © 2011 | call 626.289.2223 | CA 91776
  • 12. 15 I wear soft contact lenses. Can get intraocular pressures (IOPs) under 12mmHg. I continue to wear them after However, a recent head-to-head study comparing 1 one year results of Canaloplasty vs. trabeculectomy Canaloplasty? Yes, but you may showed no significant difference in average IOP 5have to wait until the eye is healed from surgery. between the two surgeries. Granted, average IOPHow soon you may restart use of contact lenses does not address the issue of the lowest IOP achiev- 10will be up to your surgeon. Additionally, it may be able. Nevertheless, some of my own patients whonecessary to get fitted for new contact lenses after have had Canaloplasty now have pressures betweenCanaloplasty as the surgery can sometimes change 8-10mmHg. This is by no means the average result, 15your refractive error. but does speak to the issue of whether it is possible for Canaloplasty to lower the IOP below 10mmHg. 21Contrast this with traditional glacuoma surgery 17(trabeculectomy). Because of the fragile nature of Lasta bleb after trabeculectomy (and the risk of rup- Is Canaloplasty really saferture and/or infection), once someone has had trab- than traditional glaucoma sur-eculectomy surgery s/he cannot wear soft contact gery (trabeculectomy)? Yes. Alenses after surgery for as long as the bleb is func- recent study compared one year results of Cana-tioning. Hard contact lenses, however, are gener- loplasty vs. trabeculectomy. Although there was noally OK to wear even with trabeculectomy (though significant difference in the final intraocular pres-a refitting may be needed after surgery). sures (IOPs) between the two surgeries (meaning both surgeries were equally good at lowering IOP), two differences were noted: (1) Canaloplasty patients16 I’ve heard that Canaloplasty experienced fewer side effects and complications compared to those who had trabeculectomy; and (2) is not as effective as more the patients who had Canaloplasty had better vision traditional glaucoma surgery than those patients who had trabeculectomy.(trabeculectomy). Is this true? No, althoughthis is widely believed by many surgeons who donot perform Canaloplasty. It has generally been Non-Penetrating Schlemm’s Canaloplasty versus Trab- eculectomy: A Head-to-Head Comparison. Tam D, Calafati J, thought that trabeculectomy is the only way to Ahmed I. [Submitted for publication, December 2009]. © 2011 | call 626.289.2223 | CA 91776
  • 13. RISKS 1 5Canaloplasty 10 15 21 18 What are Last 1. Bleeding in the eye. Almost 30% of people the Risks of who have Canaloplasty have some bleeding in the Canaloplasty? front of the eye. However, as mentioned earlier, Although it is true that there are this bleeding (called a hyphema or microhyphema) fewer risks with Canaloplasty than is pretty much to be expected (and may actually be there are with traditional glaucoma desired ). This resolves with time and rarely causes surgery (trabeculectomy), it is not any permanent reduction in vision. without risk. All surgeries (thereare no exceptions) have risks associated with them. 2. Intraocular pressure “spikes” during the heal-The important thing to consider when faced with ing period after surgery. About 5% (one in twenty)the need for surgery is the relative risk of the pro- people will have a short period after surgery whencedure compared to going without the procedure. Canaloplasty and Transient Anterior Chamber If your glaucoma is not under control then (given Haemorrhage: a Prognostic Factor? Koch J, Heiligenhaus enough time) you will lose vision. Glaucoma sur- A, Heinz C. Klinische Monatsblätter für Augenheilkunde geries offer a method of preventing that loss of (Clinical Journal of Ophthalmology) 2010 Nov 16. (online vision. The most commonly encountered risks of ahead of print).Canaloplasty are: © 2011 | call 626.289.2223 | CA 91776
  • 14. the IOP is actually higher than it was before sur- ways resolve on their own. If it is not spontane-gery. This almost always resolves. ously improving, it is generally possible for your 1 surgeon to inject a gas bubble in your eye to press3. The formation of a bleb (blister) on the sur- this membrane back against the cornea. 5face of the eye in the area of the incision (6%). Itis worth noting that with trabeculectomy, the for- 5. The need to perform traditional glaucoma 10mation of a stable bleb is necessary for success, surgery (4%). Less than one in twenty Canalo-while with Canaloplasty, it is considered to be an plasty surgeries “fail” and must be converted to 15undesireable outcome, or “risk.” These blebs rare- either trabeculectomy or a “shunt.” This may bely limit the effectiveness of Canaloplasty. Howev- done either at the time of initial surgery or at a 21er, blebs can be associated with Tear Dysfunctional later date. Your surgeon would make this decisionSyndrome (Dry Eye Syndrome) and could limit as clinically appropriate. Lastyour ability to participate in certain activities (suchas certain water sports). 6. Hypotony (IOP too low). “Too low?” you may be wondering, “I thought the problem was that4. Descemet’s Membrane Separation, or De- the pressure was too high?” Well, if the IOP dropstachment (3%). In order to open Schlemm’s canal, below 5mmHg (millimeters of Mercury) and staysa gel-like substance (called a viscoelastic) is injected there, vision can be lost from a condition known asinto the canal. If the canal is particularly “tight” “hypotony maculopathy.” Fortunately, this condi-it is possible for the get to follow the path of least tion is pretty rare with Canaloplasty (only one per-resistance and dissect beneath Descement’s Mem- son in 200 would be expected to have prolongedbrane (the thin film on the back of the cornea). If hypotony). Compare this to trabeculectomy inthis happens, the vision could be affected. How- which at least 1 out of every 10 people is likely toever, with time (weeks to months) these almost al- experience hypotony. © 2011 | call 626.289.2223 | CA 91776
  • 15. 7. Infection. To date, vision-threatening infec- als used to make the intraocular lenses (IOLs) intion of the eye (called “endophthalmitis”) has not modern cataract surgery. It is very unlikely that 1been documented with Canaloplasty. In theory, this suture would ever erode into or through thehowever, anytime an incision is made in the eye, an eye wall as it is securely threaded through Sch- 5infection could be possible. So, although the risk lemm’s canal. In the few reported cases where theseems to be less than 1 in 1,000, it’s probably not suture has eroded into the anterior chamber it sel- 10zero. Compare this to trabeculectomy which car- dom causes any problem. 15 20ries up to a 5% chance per year of developing aninfection called “blebitis” that (if not caught early What is the bigand treated) can result in endophthalmitis and loss deal about a 21of vision. bleb, anyway? With traditional glaucoma sur- LastIn summary, although not without risk, Canalo- gery (trabeculectomy), a blis-plasty is associated with significantly fewer risks ter-like fluid collection (called a(both in number and severity) than traditional glau- “bleb”) must be present on thecoma surgeries such as trabeculectomy surface of the eye for the surgery19 to work. Aqueous fluid (the fluid I’m afraid of having some- inside the eye) flows through the fistula into this thing placed in my eye. What bleb where it then finds its way out of the eye. If are the risks of the stent? Al- this bleb scars down, the the surgery fails and thethough this is an understandable concern, the only intraocular pressure (IOP) goes back up potential-thing left in the eye after Canaloplasty is a suture. ly causing a further loss of vision from glaucoma.The material used in this suture (polypropylene) has Unfortunately, the body wants to scar down thebeen used in eye surgery for decades and has a very bleb as part of the natural healing response. Ingood safety record. In fact, this material has been order to prevent this from happening most modernused in the eye far longer than most of the materi- trabeculectomy surgeons use a chemical called an © 2011 | call 626.289.2223 | CA 91776
  • 16. 1“antimetabolite” to preserve the bleb. The most infection of the inside of the eye (endophthalmitis, 5commonly used antimetabolite (Mitomycin-C, or up to 1% per year) if not successfully treated. En-MMC) causes permanent damage to the eye tissue dophthalmitis often leads to severe loss of visionin the area of the surgery. 10 or blindness. This risk continues for the life of the patient unless the bleb scars down (fails).The tissue exposed to MMC is very fragile and does 15not heal well. Fluid in the bleb exerts pressure Canaloplasty is a “blebless” (or bleb-free) pro-which can result in what is called a “high bleb.” cedure. With Canaloplasty no fistuas are created 21This is essentially a thin bubble-shaped bleb. These and there is no need to modify the natural healingcan cause (or may exacerbate) Tear Dysfunctional of the eye. Without a bleb, there is no worsening LastSyndrome resulting in chronic irritation, tearing, of Tear Dysfunctional Syndrome or risk of blebi-and blurred vision. Because the wall of the bleb is tis. Occasionally (about 6% of the time), a bleb willso thin any trauma to the eye can rupture it. Since spontaneously form with Canaloplasty. However,it does not heal well any damage to the bleb may because most Canaloplasty surgeons do not userequire surgical revision. MMC, the bleb is usually “shallow” and unlikely to result in Tear Dysfunctional Syndrom or blebitis.Finally, and most concerning, is that when MMCis used during trabeculectomy, there is up to a 5%risk per year of bleb leak which can progress to Greenfield DS, Suñer IJ, Miller MP, Kangas TA, Palmberg PF, Flynn HW Jr. Endophthalmitis after filtering surgery with mitomycin. Arch Ophthalmol 1996;114:943-949. © 2011 | call 626.289.2223 | CA 91776
  • 17. Surgeons References 1Canaloplasty 5 10 15 21 Last 21 Are all Canaloplasty surgeons Glaucoma Specialists? No. For example, Dr. Richardson is not a glaucoma specialist. A glaucoma specialist is someone who spends one to two additional years after resi- dency learning how to deal with advanced and unusual forms of glaucoma. Because Canaloplasty can most effectively treat ear- lier (less advanced) forms of the more common types of open angle glaucoma, it is often performed by general ophthalmolo- gists and/or cataract surgeons. Indeed, it is particularly effective when done at the same time as cataract surgery - in which case it is called “phacocanaloplasty.” © 2011 | call 626.289.2223 | CA 91776
  • 18. 22 What training is required to become an Interventional Ophthalmologist (Canalo-plasty Surgeon)? Interventional Ophthalmolo- 23 Where can I find a Canaloplasty surgeon near me? • Visit the iScience website. This site will provide a list of Canaloplasty surgeons near you. 1 5gists must first complete their training as EyeMDs 10 24(completion of a bachelor’s degree followed byfour years of medical school, one year of intern- How much does Canaloplasty 15ship, and three years of residency training in eye cost? The amount charged for ca-diseases and surgery). Once proficient as an eye naloplasty varies by surgeon and sur- 21surgeon, an ophthalmologist can request to be gery center. If you do not have insurance, the totaltrained in the technique of Canaloplasty. Doctors cost for canaloplasty can range from $5,000 to up- Lastare required to complete a “wet-lab” (practice on wards of $10,000 per eye. Fortunately, Medicarecadaver eyes) prior to performing Canaloplasty sur- and many insurances pay for Canaloplasty when gery on humans. Then, the first 10 surgical treatment of glaucoma is indicated. Even surgeries are conducted under the if you do not have insurance, however, Canalo- direct monitoring of a Clinical Spe- plasty can pay for itself over time simply by saving cialist. Only a fraction of surgeons you $1,000s per year in the cost of glaucoma drops who start the Canalo- that may no longer be necessary after this surgery. plasty training complete the monitoring require- ments and go on to be- come Canaloplasty sur- geons. © 2011 | call 626.289.2223 | CA 91776
  • 19. 25 Where can I learn more about Canaloplasty? Below are some additional resources that could help you to decide if Canaloplasty is right for you: 1 5 1. - Created by iScience, the manufacturer of the catheter used in Cana- 10 loplasty. This is where you would go to find a Canaloplasty surgeon near you. 15 2. - If you want to see what this surgery actually looks like (and aren’t too squeamish). 21 3. Google Alerts - You will need a Google account for this. Set up an alert with the word Last “canaloplasty” in it and Google will send you an email whenever it finds a new article, post, or video about Canaloplasty. Find out if you 4. Find a Canalplasty sur- geon and schedule a consul- or your loved one tation - There is no better way qualifies for to find out if Canaloplasty is Canaloplasty ! right for you than to have your eye evaluated by a surgeon cer- tified to perform Canaloplasty. Evaluation Form © 2011 | call 626.289.2223 | CA 91776
  • 20. Thank You for Reading!I hope you learned something of value. Dr. David Richardson has performed thousands of eye surgeries using the most advanced techniques. He is trusted not only by thousands of patients, but also by oth- er medical professionals. In a series of surveys, medical professionals were asked a simple question: “If you needed medical care, which doc- tor would you choose?” Based on the results of these sur- veys, Dr. Richardson was named a “Super Doctor” by his peers in the Los Angeles Magazine in 2010 2011. In a similar survey conducted by Pasadena Magazine, Dr. Ri- chardson was also voted as a “Top Doc” for the past 3 consecutive years (2008, 2009 and 2010). Actions, though, speak louder than words - Dr. Richardson is the personal eye surgeon for many of the Contact most respected doctors in the San Gabriel valley. Dr. David Richardson is among a select Dr. Richardson group of ophthalmologists in Southern California offering Canaloplasty as a treatment option for his glaucoma patients. For more canaloplasty information by Dr. David Rich- ardson, please visit