surgeryCANALOPLASTYFAQ?? ?
15101521Last© 2013 New-Glaucoma-Treatments.comCanaloplasty (pronounced Kah-NAL-oh-plas-tee)is a new glaucoma treatment tha...
15101521Last© 2013 New-Glaucoma-Treatments.comSafety. Canaloplasty is safer than traditional glau-coma surgery (trabeculec...
15101521Last© 2013 New-Glaucoma-Treatments.comglaucoma surgery will severely limit your ability toparticipate in certain s...
15101521Last© 2013 New-Glaucoma-Treatments.comHow long has Canaloplasty beenaround? The answer to this question isnot as s...
15101521Last© 2013 New-Glaucoma-Treatments.com“ous and requires both skill and patience from yoursurgeon. Thus, it can tak...
15101521Last© 2013 New-Glaucoma-Treatments.comCanaloplastyELIGIBILITYI’ve had glaucoma laser surgery.Can I have Canaloplas...
15101521Last© 2013 New-Glaucoma-Treatments.comI’ve used glaucoma drops for a verylong time. Will that affect the suc-cess ...
15101521Last© 2013 New-Glaucoma-Treatments.comWill my vision change afterCanaloplasty? If you are hoping for bet-ter visio...
15101521Last© 2013 New-Glaucoma-Treatments.comWill Canaloplasty cure myglaucoma? No. To date there is nocure for glaucoma....
15101521Last© 2013 New-Glaucoma-Treatments.commented visit.***We can reasonably expect the long-term results of Canaloplas...
15101521Last© 2013 New-Glaucoma-Treatments.comI wear soft contact lenses. Can Icontinue to wear them afterCanaloplasty? Ye...
15101521Last© 2013 New-Glaucoma-Treatments.comRISKSCanaloplastyWhat arethe Risks ofCanaloplasty?Although it is true that t...
15101521Last© 2013 New-Glaucoma-Treatments.comthe IOP is actually higher than it was before sur-gery. This almost always r...
15101521Last© 2013 New-Glaucoma-Treatments.com7. Infection. To date, vision-threatening infec-tion of the eye (called “end...
15101521Last© 2013 New-Glaucoma-Treatments.comto preserve the bleb. The most commonly usedantimetabolite (Mitomycin-C, or ...
15101521Last© 2013 New-Glaucoma-Treatments.comSurgeons & ReferencesCanaloplastyAre all Canaloplasty surgeons GlaucomaSpeci...
15101521Last© 2013 New-Glaucoma-Treatments.comWhat training is required tobecome an InterventionalOphthalmologist(Canalopl...
15101521Last© 2013 New-Glaucoma-Treatments.comWhere can I learn more about Canaloplasty?Below are some additional resource...
Dr. David Richardson has performed thousands of eye surgeries using the most advanced techniques. He is trusted not onlyby...
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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 http://new-glaucoma-treatments.com

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Canaloplasty Surgery FAQ by Dr. David Richardson

  1. 1. surgeryCANALOPLASTYFAQ?? ?
  2. 2. 15101521Last© 2013 New-Glaucoma-Treatments.comCanaloplasty (pronounced Kah-NAL-oh-plas-tee)is a new glaucoma treatment that gives many peoplewith 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 Canaloplastyno longer need medications. This “minimally inva-sive” 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 ofeye fluid through the natural outflow. The canal isthen dilated by injecting a sterile, gel-like materialcalled a viscoelastic. After the drainage channel ismade larger the micro-catheter is removed and aCanaloplasty SurgeryFAQsuture is placed within the canal system. Suture ten-sion within this system keeps it open for years re-sulting in a controlled eye pressure.What is Canaloplasty?CANALOPLASTYNew GlaucomaTreatmentGo to http://new-glaucoma-treatments.com/canaloplasty/See how Canaloplasty is done.Watch Dr. Richardson’s video online
  3. 3. 15101521Last© 2013 New-Glaucoma-Treatments.comSafety. Canaloplasty is safer than traditional glau-coma surgery (trabeculectomy). If you are consid-ering glaucoma surgery to prevent further visionloss then choosing a surgery that has fewer risksmakes sense.Age. 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 traditionalWhy Canaloplasty?
  4. 4. 15101521Last© 2013 New-Glaucoma-Treatments.comglaucoma surgery will severely limit your ability toparticipate in certain sports. No such limitation ex-ists with Canaloplasty. Once healed, patients whohave had Canaloplasty are able to return to theirprevious active lifestyles without restriction or lim-itation.Nearsighted. People who are very nearsighted(highly myopic) are at a much higher risk of vision-threatening complications from traditional glauco-ma surgeries. This is not true with Canaloplasty.Ethnicity. Traditional glaucoma surgery has a highfailure rate among African American patients. Incontrast, Canaloplasty has a well-established trackrecord of success among many races.Fear of Cataract. If you do not currently have acataract, you should know that the risk of devel-oping one increases substantially after traditionalglaucoma surgery. This risk is much lower withCanaloplasty.Difficulty with Glaucoma Medications. Ifyou are having trouble tolerating or affording yourglaucoma medications, then Canaloplasty maybe an option for you. With traditional glaucomasurgeries, the risk is just too high to consider forreasons of financial hardship or side effects ofmedicines alone.These are just some of the many reasons to con-sider Canaloplasty. If you have open angle glau-coma (the most common type) and are consideringglaucoma surgery, then you should explore youravailable options before making a decision. Al-though there are certainly instances where tradi-tional glaucoma surgery is the best (or even only )option available, most patients with glaucoma arecandidates for Canaloplasty and should considerthis safer option.
  5. 5. 15101521Last© 2013 New-Glaucoma-Treatments.comHow long has Canaloplasty beenaround? The answer to this question isnot as straightforward as it might seem. Al-though the iTrack catheter (required to performcanaloplasty) has only been FDA approved since2008, the surgical technique used to perform Ca-naloplasty has been around for decades*. The mod-ern procedure is essentially a modification of vis-cocanalostomy, which was first described by Dr.Stegmann in 1991. Because viscocanalostomy is atechnically difficult surgery to perform, it was notvery popular among most eye surgeons. Howev-er, with the invention (and FDA approval) of theiTrack, the impressive results and superior safetyprofile of Canaloplasty have convinced a numberof surgeons (myself included) to become adept atthis procedure.What does“Minimally Invasive” re-ally mean? Traditional glaucoma surger-ies (trabeculectomy or shunt surgery) re-quire the creation of a full-thicknes hole (or fistula)through the wall of the eye (sclera). This allows* Fyodorov SN, Ioffe DI, Ronkina TI: [Glaucoma sur-gery—- deep sclerectomy]. Vestn Oftalmol 4:6--10, 1982fluid to flow from the inside of the front of theeye (anterior chamber) through the scleral hole toa bleb (cyst, or blister-like elevation of the con-junctiva). From here the fluid somehow finds itsway back into the venous system. These surgeriesare called “penetrating.” Canaloplasty, on the oth-er hand, is a non-penetrating (or “minimally inva-sive”) surgery because only a partial thickness flapis created in the sclera. This flap is then sewn backin place after Schlemm’s canal is opened so there isno fistula created between the inside and outside ofthe eye. Instead, fluid in the eye drains out throughthe (newly opened) natural drainage system of theeye.How long does Canaloplasty take?Canaloplasty is not a quick surgery (at leastby eye surgery standards). In order for thesurgery to work properly, your surgeon must makea flap in the sclera (the white part of the eye) andextend this all the way to a very thin and fragilemembrane called Descement’s membrane withouttearing it. This flap is created just above a vascu-lar tissue (which easily bleeds) called the choroid.All of this happens in a space no larger than thefingernail on your “pinky” finger. It can be tedi-123
  6. 6. 15101521Last© 2013 New-Glaucoma-Treatments.com“ous and requires both skill and patience from yoursurgeon. Thus, it can take anywhere between 45minutes and two hours. The benefits, however, canlast a lifetime.What if my natural drainagecanal cannot be fullycatheterized? To get the full benefit ofCanaloplasty, it is important for your surgeon tocanulate the full 360 degrees of Schlemm’s canal,dilate the canal with viscoelastic, and stent it openwith a suture. The inability to complete any one ofthese 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 convertto either a traditional trabeculectomy or viscocana-lostomy. A recent study**confirmed that, while notas effective as Canaloplasty, viscocanalostomy cansignificantly reduce the pressure in the eye provid-ing for some protection from glaucoma.** Canaloplasty in One Eye Compared With Viscoca-nalostomy in the Contralateral Eye in Patients With BilateralOpen-angle Glaucoma. Koerber, N. Journal of Glaucoma.Online ahead of print, January 26, 2011.Is Canaloplasty surgery painful?No. During surgery your eye will be anes-thetized (numbed). After surgery you willbe given drops to reduce inflammation and preventpain. Generally, people do notice a “foreign bodysensation” (scratchy sensation) under the uppereyelid for up to a few weeks after surgery. This iscaused by the slowly dissolving sutures and resolveson its own. If you have Canaloplasty surgery andhave more severe pain than what is described here,you should immediately contact your surgeon.5If something doesn’t work, thentry something else. Because thisnew procedure is un-believable. I can’t sayenough about it. I’mjust thrilled. It’s likegiving me a new life!4
  7. 7. 15101521Last© 2013 New-Glaucoma-Treatments.comCanaloplastyELIGIBILITYI’ve had glaucoma laser surgery.Can I have Canaloplasty? If you havehad either of the laser surgeries for openangle glaucoma (Argon Laser Trabeculoplasty orSelective Laser Trabeculoplasty), you may still bea candidate for Canaloplasty. It depends, however,on how much scarring there is from the laser sur-gery. Although your surgeon can visually inspectthe area around Schelmm’s canal using a specialcontact lens (a technique called gonioscopy), s/hecannot tell if there has been permanent scarringof the canal itself. It may not be possible to fullycatheterize the canal if there is dense scarring ofthe canal (called stenosis). In that case, your sur-geon would not be able to stent the canal open witha suture, but would still inject a special gel (called aviscoelastic) into the partially opened canal. Whenthe canal cannot be fully canulated and the stentis not placed, this is called viscocanalostomy. Al-though not as effective as canalopasty, it can stilllower the IOP.I’ve already had traditional glau-coma surgery (trabeculectomy).Can I have Canaloplasty? The stand-ard answer would be “no.” However, it is possible(though technically quite challenging) for Canalo-plasty to be done in an eye that has already had atrabeculectomy that is no longer functioning. Ifyou and your surgeon are considering this option itis important for you to have realistic (guarded) ex-pectations of success. Many patients are interestedin the option of Canaloplasty because (comparedto other glaucoma surgeries) there are fewer risks.But, if you are not the ideal candidate, there mayalso be less of a potential benefit.67
  8. 8. 15101521Last© 2013 New-Glaucoma-Treatments.comI’ve used glaucoma drops for a verylong time. Will that affect the suc-cess of Canaloplasty? Possibly*. Thereis growing evidence that Schelmm’s canal (the eye’snatural drainage duct) decreases in size with long-term use of glaucoma medications. If there issignificant stenosis (scarring down) of the canal,then it may not be possible to thread the catheterall of the way around the canal. However, evenif 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-dure is called viscocanalostomy. Viscocanalostomyhas been around since 1991 and is also an effectivetreatment for glaucoma (though less so than Cana-loplasty).* Dahan E, Drusedau MU: Nonpenetrating filtrationsurgery for glaucoma: control by surgery only. J CataractRefract Surg 26:695--701, 20008 Fill out our brief onlineevaluation form to see ifyou or your loved one isa candidate for thisexciting new surgery.Go to http://new-glaucoma-treatments.com/canaloplasty-evaluation/Visit OnlineEvaluation Form
  9. 9. 15101521Last© 2013 New-Glaucoma-Treatments.comWill my vision change afterCanaloplasty? If you are hoping for bet-ter vision after canaloplasty, it is importantto point out that the purpose of any glaucoma treat-ment (incuding Canaloplasty) is to preserve vision,not improve it. That being said, your vision willchange in the following ways after surgery. First,your vision will likely be worse the first few days (oreven weeks) after surgery. This is expected. WhenSchlemm’s canal is dilated some blood refluxesback through the newly dilated canal into the eye.Some even consider this a sign of successful sur-gery. This blood eventually is cleared out the sameway it got into the eye. Another cause of (gener-ally temporary) fluctuations in vision is surgicallyinduced astigmatism from the suture used to closethe surgical incision. This almost always resolvesby a month or so after surgery Once the eye is fullyCanaloplastyBENEFITS9healed (about three months after surgery) an inter-esting thing happens: some patients note that theirvision does seem better than it was prior to surgery.This is likely because glaucoma drops worsen a con-dition called Tear Dysfunctional Syndrome that cancause blurred vision. After successful Canaloplastysurgery the need for glaucoma drops is reduced (oreven eliminated). Without these drops, Tear Dys-functional Syn-drome improveswhich canresult inclearervisionfor somepatients.
  10. 10. 15101521Last© 2013 New-Glaucoma-Treatments.comWill Canaloplasty cure myglaucoma? No. To date there is nocure for glaucoma. The best any treat-ment can do is to halt (or slow) the progression ofthis disease. The closer the IOP to 8mmHg, thebetter (below that and the eye can lose vision fromthe pressure being too low). Studies have shownthat for most glaucoma patients an IOP of less than15mmHg can be protective (a goal often achievedwith Canaloplasty). Some forms of glaucoma (suchas advanced, low tension, or normal tension glau-coma) require IOPs of less than 12mmHg in orderto avoid loss of vision. Only your eye surgeon candetermine what your eye’s goal should be.WillIbeabletostopusing glau-coma drops after Canaloplasty?Possibly. Remember that the primaryobjective of any glaucoma surgery (including Ca-naloplasty) is to lower your IOP into a safer rangeand protect you from further loss of vision. A sec-ondary goal would be to reduce (or even eliminate)the use of glaucoma drops. Studies have shownCanaloplasty to be effective at achieving both ofthese goals. Not only do most people who undergoCanaloplasty have lower IOPs after surgery, but onaverage, they are able to stop just under two medi-cations. What does “just under two” mean? Well,some people are able to stop one drop, some two,others none and some are even able to stop all oftheir drops. How many you will be able to stop ifyou have Canaloplasty cannot be predicted, thoughit’s likely that you will be able to stop at least one ofthem if you are on multiple drops.How long will my IOP stay con-trolled with Canaloplasty? Be-cause Canaloplasty has only been FDAapproved since 2008, we only have three-year re-sults**. There is no reason, however, to believe thatthe surgery will “stop working.” In a study thatlooked at the long-term (7 year) results of com-bined cataract surgery and viscocanalostomy(theless effective precursor to Canaloplasty), IOP wasreduced by over 33% (on average) at the last docu-** Three-year results of circumferential viscodilationand tensioning of Schlemm canal using a microcatheter totreat open-angle glaucoma. Richard A. Lewis, Kurt vonWolff, Manfred Tetz, Norbert Koerber, John R. Kearney,Bradford J. Shingleton, Thomas W. Samuelson. Journal ofCataract & Refractive Surgery - April 2011 (Vol. 37, Issue4, Pages 682-690, DOI: 10.1016/j.jcrs.2010.10.055)111210
  11. 11. 15101521Last© 2013 New-Glaucoma-Treatments.commented visit.***We can reasonably expect the long-term results of Canaloplasty and Phacocanaloplastyto be even better than those published for viscoca-nalostomy and Phacoviscocanalostomy.What if Canaloplasty doesn’twork? Can I still have tradi-tional glaucoma surgery afterCanaloplasty? Yes. Having Canaloplasty doesnot affect your ability to have other types of glau-coma surgery at a later date as long as your Cana-loplasty surgeon operates in one of the superior“quadrants” of the eye. Some Canaloplasty sur-geons, however, operate at what is called the 12:00position. This approach can make it difficult (butnot impossible) for a surgeon to perform tradition-al glaucoma surgery at a later date.I’m a very active person.Will having Canaloplasty forceme to limit my activities?*** Seven-year follow-up of combined cataract extrac-tion and viscocanalostomy. Manijeh S. Wishart, EvgeniosDagres. Journal of Cataract & Refractive Surgery - De-cember 2006 (Vol. 32, Issue 12, Pages 2043-2049, DOI:10.1016/j.jcrs.2006.08.035)The answer to this question depends on what time,after surgery, you are referring. Immediately aftersurgery (and at least for a few days, but sometimesup to weeks after) your vision will be blurry in theeye that had canaloplasty. Therefore, any activitiesthat require good binocular vision (such as work-ing with heavy machinery) should be avoided untilthe vision improves. Additionally, it is generally agood idea to keep the eye clean and dry (no garden-ing or swimming) for at least a few weeks. Oncethe incision has healed over (about a month aftersurgery) it is generally OK to resume all of yourusual activities.Contrast this with traditional glacuoma surgery(trabeculectomy) which does limit your activitiesfor the rest of your life. Because of the fragile na-ture of a bleb after trabeculectomy (and the risk ofrupture and/or infec-tion), once someonehas had trabeculec-tomy surgery s/hecannot participatein most water sportswithout high-qualityprotective eyewear.1314
  12. 12. 15101521Last© 2013 New-Glaucoma-Treatments.comI wear soft contact lenses. Can Icontinue to wear them afterCanaloplasty? Yes, but you mayhave to wait until the eye is healed from surgery.How soon you may restart use of contact lenseswill be up to your surgeon. Additionally, it may benecessary to get fitted for new contact lenses afterCanaloplasty as the surgery can sometimes changeyour refractive error.Contrast this with traditional glacuoma surgery(trabeculectomy). Because of the fragile nature ofa bleb after trabeculectomy (and the risk of rup-ture and/or infection), once someone has had trab-eculectomy surgery s/he cannot wear soft contactlenses after surgery for as long as the bleb is func-tioning. Hard contact lenses, however, are gener-ally OK to wear even with trabeculectomy (thougha refitting may be needed after surgery).I’ve heard that Canaloplasty isnot as effective as more tradi-tional glaucoma surgery(trabeculectomy). Is this true? No, althoughthis is widely believed by many surgeons who donot perform Canaloplasty. It has generally beenthought that trabeculectomy is the only way toget intraocular pressures (IOPs) under 12mmHg.However, a recent head-to-head study ****comparingone year results of Canaloplasty vs. trabeculectomyshowed no significant difference in average IOPbetween the two surgeries. Granted, average IOPdoes not address the issue of the lowest IOP achiev-able. Nevertheless, some of my own patients whohave had Canaloplasty now have pressures between8-10mmHg. This is by no means the average result,but does speak to the issue of whether it is possiblefor Canaloplasty to lower the IOP below 10mmHg.Is Canaloplasty really safer thantraditional glaucoma surgery(trabeculectomy)? Yes. A recentstudy*****compared one year results of Canaloplastyvs. trabeculectomy. Although there was no significantdifference in the final intraocular pressures (IOPs)between the two surgeries (meaning both surgerieswere equally good at lowering IOP), two differenceswere noted: (1) Canaloplasty patients experiencedfewer side effects and complications compared tothose who had trabeculectomy; and (2) the patientswho had Canaloplasty had better vision than thosepatients who had trabeculectomy.**** Non-Penetrating Schlemm’s Canaloplasty versusTrab-eculectomy: A Head-to-Head Comparison. Tam D, Calafati J,Ahmed I. [Submitted for publication, December 2010].151617
  13. 13. 15101521Last© 2013 New-Glaucoma-Treatments.comRISKSCanaloplastyWhat arethe Risks ofCanaloplasty?Although it is true that there arefewer risks with Canaloplasty thanthere are with traditional glaucomasurgery (trabeculectomy), it is notwithout risk. All surgeries (thereare no exceptions) have risks associated with them.The important thing to consider when faced withthe need for surgery is the relative risk of the pro-cedure compared to going without the procedure.If your glaucoma is not under control then (givenenough time) you will lose vision. Glaucoma sur-geries offer a method of preventing that loss ofvision. The most commonly encountered risks ofCanaloplasty are:1. Bleeding in the eye. Almost 30% of peoplewho have Canaloplasty have some bleeding in thefront of the eye. However, as mentioned earlier,this bleeding (called a hyphema or microhyphema)is pretty much to be expected (and may actually bedesired *). This resolves with time and rarely causesany permanent reduction in vision.2. Intraocular pressure“spikes”during the heal-ing period after surgery. About 5% (one in twenty)people will have a short period after surgery when* Canaloplasty and Transient Anterior ChamberHaemorrhage: a Prognostic Factor? Koch J, HeiligenhausA, Heinz C. Klinische Monatsblätter für Augenheilkunde(Clinical Journal of Ophthalmology) 2010 Nov 16. (onlineahead of print).18
  14. 14. 15101521Last© 2013 New-Glaucoma-Treatments.comthe IOP is actually higher than it was before sur-gery. This almost always resolves.3. The formation of a bleb (blister) on the sur-face of the eye in the area of the incision (6%). Itis worth noting that with trabeculectomy, the for-mation of a stable bleb is necessary for success,while with Canaloplasty, it is considered to be anundesireable outcome, or “risk.” These blebs rare-ly limit the effectiveness of Canaloplasty. Howev-er, blebs can be associated with Tear DysfunctionalSyndrome (Dry Eye Syndrome) and could limityour ability to participate in certain activities (suchas certain water sports).4. Descemet’s Membrane Separation, or De-tachment (3%). In order to open Schlemm’s canal,a gel-like substance (called a viscoelastic) is injectedinto the canal. If the canal is particularly “tight”it is possible for the gel to follow the path of leastresistance and dissect beneath Descement’s Mem-brane (the thin film on the back of the cornea). Ifthis happens, the vision could be affected. How-ever, with time (weeks to months) these almost al-ways resolve on their own. If it is not spontane-ously improving, it is generally possible for yoursurgeon to inject a gas bubble in your eye to pressthis membrane back against the cornea.5. The need to perform traditional glaucomasurgery (4%). Less than one in twenty Canalo-plasty surgeries “fail” and must be converted toeither trabeculectomy or a “shunt.” This may bedone either at the time of initial surgery or at alater date. Your surgeon would make this decisionas clinically appropriate.6. Hypotony (IOP too low). “Too low?” you maybe wondering, “I thought the problem was thatthe pressure was too high?” Well, if the IOP dropsbelow 5mmHg (millimeters of Mercury) and staysthere, vision can be lost from a condition known as“hypotony maculopathy.” Fortunately, this condi-tion is pretty rare with Canaloplasty (only one per-son in 200 would be expected to have prolongedhypotony). Compare this to trabeculectomy inwhich at least 1 out of every 10 people is likely toexperience hypotony.
  15. 15. 15101521Last© 2013 New-Glaucoma-Treatments.com7. Infection. To date, vision-threatening infec-tion of the eye (called “endophthalmitis”) has notbeen documented with Canaloplasty. In theory,however, anytime an incision is made in the eye, aninfection could be possible. So, although the riskseems to be less than 1 in 1,000, it’s probably notzero. Compare this to trabeculectomy which car-ries up to a 5% chance per year of developing aninfection called “blebitis” that (if not caught earlyand treated) can result in endophthalmitis and lossof vision.In summary, although not without risk, Canalo-plasty is associated with significantly fewer risks(both in number and severity) than traditional glau-coma surgeries such as trabeculectomyI’m afraid of having somethingplaced in my eye. What are therisks of the stent? Although this isan understandable concern, the only thing left inthe eye after Canaloplasty is a suture. The materialused in this suture (polypropylene) has been usedin eye surgery for decades and has a very good safe-ty record. In fact, this material has been used inthe eye far longer than most of the materials usedto make the intraocular lenses (IOLs) in moderncataract surgery. It is very unlikely that this suturewould ever erode into or through the eye wall as itis securely threaded through Schlemm’s canal. Inthe few reported cases where the suture has erod-ed into the anterior chamber it seldom causes anyproblem.What is the bigdeal about ableb, anyway?With traditional glaucoma surgery(trabeculectomy), a blister-likefluid collection (called a “bleb”)must be present on the surface ofthe eye for the surgery to work.Aqueous fluid (the fluid inside theeye) flows through the fistula into this bleb where itthen finds its way out of the eye. If this bleb scarsdown, the the surgery fails and the intraocular pres-sure (IOP) goes back up potentially causing a fur-ther loss of vision from glaucoma. Unfortunately,the body wants to scar down the bleb as part ofthe natural healing response. In order to preventthis from happening most modern trabeculectomysurgeons use a chemical called an “antimetabolite”1920
  16. 16. 15101521Last© 2013 New-Glaucoma-Treatments.comto preserve the bleb. The most commonly usedantimetabolite (Mitomycin-C, or MMC) causes per-manent damage to the eye tissue in the area of thesurgery.The tissue exposed to MMC is very fragile and doesnot heal well. Fluid in the bleb exerts pressurewhich can result in what is called a “high bleb.”This is essentially a thin bubble-shaped bleb. Thesecan cause (or may exacerbate) Tear DysfunctionalSyndrome resulting in chronic irritation, tearing,and blurred vision. Because the wall of the bleb isso thin any trauma to the eye can rupture it. Sinceit does not heal well any damage to the bleb mayrequire surgical revision.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 filteringsurgery with mitomycin. Arch Ophthalmol 1996;114:943-949.infection of the inside of the eye (endophthalmitis,up to 1% per year) if not successfully treated. En-dophthalmitis often leads to severe loss of visionor blindness. This risk continues for the life of thepatient unless the bleb scars down (fails).Canaloplasty is a “blebless” (or bleb-free) pro-cedure. With Canaloplasty no fistuas are createdand there is no need to modify the natural healingof the eye. Without a bleb, there is no worseningof Tear Dysfunctional Syndrome or risk of blebi-tis. Occasionally (about 6% of the time), a bleb willspontaneously form with Canaloplasty. However,because most Canaloplasty surgeons do not useMMC, the bleb is usually “shallow” and unlikely toresult in Tear Dysfunctional Syndrom or blebitis.
  17. 17. 15101521Last© 2013 New-Glaucoma-Treatments.comSurgeons & ReferencesCanaloplastyAre all Canaloplasty surgeons GlaucomaSpecialists? No. For example, Dr. Richardson isnot fellowship trained but does specialize in treat-ing glaucoma with advanced procedures such as Canaloplasty. A“fellowship trained” glaucoma specialist is someone who spendsone to two additional years after residency learning how to dealwith advanced and unusual forms of glaucoma. Because Canalo-plasty can most effectively treat earlier (less advanced) forms ofthe more common types of open angle glaucoma, it is often per-formed by general ophthalmologists and/or cataract surgeons.Indeed, it is particularly effective when done at the same time ascataract surgery - in which case it is called “phacocanaloplasty.”21
  18. 18. 15101521Last© 2013 New-Glaucoma-Treatments.comWhat training is required tobecome an InterventionalOphthalmologist(CanaloplastySurgeon)?Interventional Oph-thalmologists must first complete their training asEyeMDs (completion of a bachelor’s degree fol-lowed by four years of medical school, one year ofinternship, and three years of residency training ineye diseases and surgery). Once proficient as aneye surgeon, an ophthalmologist can request to betrained in the technique of Canaloplasty. Doctorsare required to complete a “wet-lab” (practice oncadaver eyes) prior to performing Canaloplasty sur-gery on humans. Then, the first 10surgeries are conducted under thedirect monitoring of a Clinical Spe-cialist. Only a fraction of surgeonswho start the Canalo-plasty training completethe monitoring require-ments and go on to be-come Canaloplasty sur-geons.Where can I find aCanaloplasty surgeonnear me? Visit the iScience web-site*. This site will provide a list of Canaloplastysurgeons near you.How much does Canaloplastycost? The amount charged for cana-loplasty varies by surgeon and surgerycenter. If you do not have insurance, the total costfor canaloplasty can range from $4,000 to upwardsof $8,000 per eye. Fortunately, Medicare and manyinsurances pay for Canaloplasty when surgical treat-ment of glaucoma is indicated. Even if you do nothave insurance, however, Canaloplasty can pay foritself over time simply by saving you thousands ofdollars per year in the cost of glaucoma drops thatmay no longer be necessary after this surgery.* http://canaloplasty.com/iscience/find_a_physician.php22 2324
  19. 19. 15101521Last© 2013 New-Glaucoma-Treatments.comWhere can I learn more about Canaloplasty?Below are some additional resources that could help you to decide if Canaloplasty is right foryou:1. Canaloplasty.com - Created by iScience, the manufacturer of the catheter used in Cana-loplasty. This is where you would go to find a Canaloplasty surgeon near you. 2. YouTube.com - If you want to see what this surgery actually looks like (and aren’t toosqueamish).3. New-Glaucoma-Treatments.com - This website was created by Dr. Richardson in orderto provide a ‘one stop solution’ for those patients looking for the latest information about Ca-naloplasty. Dr. Richardson updates this site weekly with the latest news about this and otherglaucoma treatments.4. Find a Canaloplasty sur-geon and schedule a consul-tation - There is no better wayto find out if Canaloplasty isright for you than to have youreye evaluated by a surgeon cer-tified to perform Canaloplasty.25Go to http://new-glaucoma-treatments.com/canaloplasty-evaluation/Fill out our brief onlineevaluation form to see ifyou or your loved one isa candidate for thisexciting new surgery.Visit OnlineEvaluation Form
  20. 20. Dr. David Richardson has performed thousands of eye surgeries using the most advanced techniques. He is trusted not onlyby thousands of patients, but also by other medical professionals. Dr. Richardson was named a “Super Doctor” by his peers in theLos Angeles Magazine in 2010, 2011, 2012 and 2013. In a similar survey conducted by Pasadena Magazine, Dr. Richardson wasalso voted as a “Top Doc” for the past 6 consecutive years (2008-2013). Actions, though, speak louder than words - Dr. Richard-son is the personal eye surgeon for many of the most respected doctors in the San Gabriel valley. Dr. David Richardson is amonga select group of ophthalmologists in Southern California offering Canaloplasty as a treatment option for his glaucoma patients.Do you want to receive other patient-focused materials regarding glaucoma or cataract? Visit -> drmd.me/newsletter-pdfexperience the Dr. Richardson difference...Impeccable Personalized CareNewsletterSign-up

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