Canaloplasty New Glaucoma Treatment – HealthTalk at San Gabriel Valley Medical Center
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This document discusses canaloplasty, a new minimally invasive glaucoma treatment. It provides background on glaucoma, risk factors for the disease, and current treatment options like laser surgeries, trabeculectomy, and drainage devices. The document then focuses on canaloplasty, describing it as a non-penetrating procedure that uses a flexible microcatheter to pass through the eye's drainage canal 360 degrees. It notes the benefits of canaloplasty include lower intraocular pressure and fewer medication requirements compared to traditional surgeries, with a safer profile and no complications. A quote from the inventor of canaloplasty praises it as the closest procedure to having no complications.
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Canaloplasty New Glaucoma Treatment – HealthTalk at San Gabriel Valley Medical Center
- 1. Canaloplasty New Glaucoma Treatment San Gabriel Valley Medical Center Dr. David Richardson Patient-Focused Ophthalmologist
- 2. Anatomy of the Eye Retina Optic Nerve Iris Lens Pupil Cornea Ciliary Body
- 3. Optic Nerve of the Eye Source: athenseyehospital.gr Normal Optic Nerve Damaged Optic Nerve in Advanced Glaucoma “Cupping” occured
- 5. 2.7 million people in the U.S. have glaucoma Source: Prevent Blindness America | http://www.visionproblemsus.org/
- 6. 50% Know 50% Don’t Know
- 7. It’s a silent thief
- 9. Are you at Risk? • Age • Race • Family History • Medical History
- 10. How is it Detected? • Intraocular Pressure • Visual Fields Exam • Optic Nerve Exam • Optic Nerve Scans
- 11. How is it Treated?
- 12. Laser Surgeries • ALT • SLT
- 13. Trabeculectomy • Invasive • Severe bleeding • Bleb failure • Lifetime risk of infection • Lifestyle Limitation
- 14. Drainage Devices • Movement of the implant • Infection • Scarring • Double Vision
- 16. Trabectome
- 18. iStent
- 19. Canaloplasty
- 20. • 250-Micron flexible microcatheter with lighted beacon tip • Passed through the canal 360° Minimally Invasive
- 22. Benefits of Canaloplasty? • “Non-Penetrating” • No Hole. No Bleb • Lower IOP. Fewer Drops • Safer than traditional surgeries
- 23. Benefits of Canaloplasty? • Pro-Active Lifestyle
- 26. “It is vital to find a safer, more predictable operation with preferably no complications at all. This is the closest I have ever come to that.” ~ Robert C. Stegmann, M.D. Father of Canaloplasty Chairman, Medical University of Southern Africa
- 27. Thank you! (626) 289-7856 2020 Huntington Dr., San Marino, CA 91108 David-Richardson-MD.com
Editor's Notes
- It is common… Estimated Number of Glaucoma Cases in the United States, Age ≥ 40: 2,719,379 Source: Prevent Blindness America | http://www.visionproblemsus.org/
- It is common… Estimated Number of Glaucoma Cases in the United States, Age ≥ 40: 2,719,379 Source: Prevent Blindness America | http://www.visionproblemsus.org/
- Normal vs. cupped out image of the Optic Nerve
- What Is Glaucoma? Glaucoma is a common disease of the eye which results from the dysfunction in the eye’s drainage system that leads to irreversible blindness. Clogging of this drainage system eventually results in an increase in intraocular pressure (IOP) which damages the eye’s delicate structures, especially the nerve responsible for vision (optic nerve). Read more: http://david-richardson-md.com/glaucoma-treatments/guidelines/#ixzz3IZlehHpo
- Why You Should Care? It is common… Estimated Number of Glaucoma Cases in the United States, Age ≥ 40: 2,719,379 Source: Prevent Blindness America | http://www.visionproblemsus.org/
- …but only half of those know they have it.
- It’s silent Glaucoma is often called “the sneak thief of sight.” That’s because people usually do not notice any signs of the disease until they have already lost significant vision.
- It’s blinding In the U.S., more than 120,000 are blind from glaucoma, accounting for 9% to 12% of all cases of blindness. Glaucoma is the second leading cause of blindness in the world, according to the World Health Organization. Is There a Cure For Glaucoma? To date there is no cure for glaucoma. The best any treatment can do is to halt (or slow) the progression of this disease. The closer the IOP to 8mmHg, the better (below that and the eye can lose vision from the pressure being too low). Studies have shown that for most glaucoma patients an IOP of less than 15mmHg can be protective (a goal often achieved with Canaloplasty). Some forms of glaucoma (such as advanced, low tension, or normal tension glaucoma) require IOPs of less than 12mmHg in order to avoid loss of vision. Only your eye surgeon can determine what your eye’s goal should be. Read more: http://david-richardson-md.com/glaucoma-treatments/guidelines/#ixzz3IZlkoIbp Source: http://www.glaucoma.org/glaucoma/glaucoma-facts-and-stats.php
- Who’s At Higher Risk? Factors that increase the glaucoma risk include: • Age (Individuals over 40) • Race (Hispanic & African American) • Family history of glaucoma • Diabetes • Eye Trauma • Long-term use of steroid medications • Nearsightedness • Elevated fluid pressure within the eye Source: http://www.thevisioncouncil.org/content/glaucoma
- How is it detected? Screening - IOP - Optic nerve exam - Visual fields - Optic nerve scans
- How is it treated? - Drops and pills - Laser - Surgery - Minimally invasive/Non Penetrating
- Argon and Selective Laser Trabeculoplasty (ALT & SLT) Laser trabeculoplasty uses wavelengths of light focused on the trabecular meshwork (drainage grate inside the eye). For reasons that are not entirely understood, this allows fluid to more easily leave the eye. IOP reductions are modest (usually around 10-15%, or 1-3mmHg) but the procedure is painless, fast, and relatively safe. As such, it can be offered to almost anyone with open angle glaucoma at any stage in the disease. Many doctors will even offer it as “first line” therapy instead of drops. Unfortunately, the effect does not last. After a few years another treatment is generally needed to lower the IOP. Source: http://david-richardson-md.com/glaucoma-treatments/surgeries-procedures/#ixzz3IXaCkOtB
- Trabeculectomy If the eye pressure cannot be controlled with drops, laser, or other surgeries, then a “penetrating surgery”, called trabeculectomy is done. The oldest of modern glaucoma surgeries, trabeculectomy rapidly decreases intraocular pressure by punching a hole in the eye . A flap is left in place in order to control the amount of fluid that percolates under the thin surface layer of tissue (called the “bleb”). Due to the invasive nature of the procedure, there is the danger of severe bleeding, bleb failure due to sudden decompression post operatively as well as formation of scar tissue. Moreover, trabeculectomy places the eye at increased lifetime risk for infection. Source: http://david-richardson-md.com/glaucoma-treatments/surgeries-procedures/#ixzz3IXtp6gEF
- Glaucoma Drainage Devices, “Tubes” or Stents (aka Setons) An alternative to trabeculectomy are the glaucoma drainage devices (or “GDDs”), examples of which are the molteno tube and baerveldt shunt. GDDs are made of a light silicone biomaterial. This surgery involves placing a silicon tube in the eye which allows fluid to flow just underneath the surface of the eye along a plate that is sewn onto the eye wall (sclera). The device acts like a garden hose that continuously drains excess fluid out. Generally, this surgery can achieve IOPs in the mid-teens. However the rapid egress of fluid also poses a risk of a condition called hypotony (dangerously low IOP) which can lead to loss of vision. Newer models like the Ahmed shunt possess a valve which provides better control of the drain’s flow rate. However, as with all body implants, there are the risks associated with movement of the implant, infection, as well as scarring that could result in double vision. Source: http://david-richardson-md.com/glaucoma-treatments/surgeries-procedures/#ixzz3IY1sMaEh
- Glaucoma Drainage Devices, “Tubes” or Stents (aka Setons) An alternative to trabeculectomy are the glaucoma drainage devices (or “GDDs”), examples of which are the molteno tube and baerveldt shunt. GDDs are made of a light silicone biomaterial. This surgery involves placing a silicon tube in the eye which allows fluid to flow just underneath the surface of the eye along a plate that is sewn onto the eye wall (sclera). The device acts like a garden hose that continuously drains excess fluid out. Generally, this surgery can achieve IOPs in the mid-teens. However the rapid egress of fluid also poses a risk of a condition called hypotony (dangerously low IOP) which can lead to loss of vision. Newer models like the Ahmed shunt possess a valve which provides better control of the drain’s flow rate. However, as with all body implants, there are the risks associated with movement of the implant, infection, as well as scarring that could result in double vision. Source: http://david-richardson-md.com/glaucoma-treatments/surgeries-procedures/#ixzz3IY1sMaEh
- Trabectome This procedure uses a small instrument that opens a section of the trabecular meshwork (the small filter inside the eye that can get “clogged” resulting in high IOP). Once the meshwork is open the fluid in the eye should be able to get to the “collector channels” thereby reducing the IOP. In general, this procedure (when combined with cataract surgery) can lower the IOP into the high teens. Often there is bleeding inside of the eye that can blur vision after Trabectome but it generally resolves in a week or two. The major downside of this surgery is that once it is done other glaucoma surgeries such as Canaloplasty and placement of an iStent cannot be done. In other words, this procedure “closes doors” on the ability to use other promising glaucoma treatments. Source: http://david-richardson-md.com/glaucoma-treatments/surgeries-procedures/#ixzz3IXv16cU8
- EndoCycloPhotocoagulation (ECP) This procedure uses a small laser probe to heat up and destroy the ciliary body (the tissue that produces fluid in the eye). As with Trabectome, the IOP after ECP is generally in the upper teens. Although a fast procedure, it does result in significant inflammation after surgery which can be both uncomfortable for the patient as well as temporarily blurring the vision. Source: ://david-richardson-md.com/glaucoma-treatments/surgeries-procedures/#ixzz3IXvBRHga
- Glaukos iStent Recently FDA approved, this snorkel-shaped device can be implanted into the eye’s drainage canal with seemingly miminal risk or additional time. The downside is that it only lowers the IOP by a couple of points so the effect is limited. Multiple stents can be placed (with additive effect) outside of the United States. In the USA, however, only one stent can be placed in the eye and only at the time of cataract surgery. Additionally, a major downside of this surgery is that once it is done other glaucoma surgeries such as Canaloplasty cannot be done. In other words, this procedure “closes a door” on the ability to use a significantly more effective procedure if needed in the future. Source: http://david-richardson-md.com/glaucoma-treatments/surgeries-procedures/#ixzz3IXvF5FVy
- What Is Canaloplasty? Canaloplasty is an advanced minimally invasive glaucoma treatment. It is a “non-penetrating” glaucoma surgery which means it does not require creation of a hole in the eye (fistula) nor does it result in a “bleb” (blister) as required with the more traditional glaucoma surgery called trabeculectomy (“trab” for short). Source: http://david-richardson-md.com/canaloplasty-treatment-for-glaucoma/canaloplasty-for-glaucoma/#ixzz3IZOTelyB
- What Is Canaloplasty? Canaloplasty is an advanced minimally invasive glaucoma treatment. It is a “non-penetrating” glaucoma surgery which means it does not require creation of a hole in the eye (fistula) nor does it result in a “bleb” (blister) as required with the more traditional glaucoma surgery called trabeculectomy (“trab” for short). Source: http://david-richardson-md.com/canaloplasty-treatment-for-glaucoma/canaloplasty-for-glaucoma/#ixzz3IZOTelyB
- How is Canaloplasty Performed? Canaloplasty uses a micro-catheter to open the eye’s natural drainage system (“Schlemm’s canal”). This canal is then opened using a sterile, gel-like material (“viscoelastic”). The iTrack® micro-catheter is then removed while a suture is threaded through Schlemm’s canal. The suture is then tied down resulting in tension on the the inner wall of the canal – just as you might pull on the strings of a “hoodie” to close the hood over your face. The suture placed in the eye’s drainage canal can keep the canal stretched open for years. Once this canal is opened, the eye’s fluid can exit through a more natural process allowing the pressure in the eye to drop to a more normal level. Source: http://david-richardson-md.com/canaloplasty-treatment-for-glaucoma/canaloplasty-for-glaucoma/#ixzz3IZOe1LrM
- Benefits of Canaloplasty? • It uses the eye’s natural drainage system • It is a “non-penetrating” procedure that does not create a permanent fistula in the wall of the eye • It does not require a bleb (a blister-like fluid collection) • Provides long-term reduction in IOP (see three year results below) • Reduces the need for medications to keep the IOP controlled • Is a good option for those patients who are not yet ready for more trabeculectomy or tube shunts • Is safer than traditional glaucoma surgeries (Canaloplasty vs Trabeculectomy) Source: http://david-richardson-md.com/canaloplasty-treatment-for-glaucoma/canaloplasty-for-glaucoma/#ixzz3IZOiIntn
- Benefits of Canaloplasty? • It uses the eye’s natural drainage system • It is a “non-penetrating” procedure that does not create a permanent fistula in the wall of the eye • It does not require a bleb (a blister-like fluid collection) • Provides long-term reduction in IOP (see three year results below) • Reduces the need for medications to keep the IOP controlled • Is a good option for those patients who are not yet ready for more trabeculectomy or tube shunts • Is safer than traditional glaucoma surgeries (Canaloplasty vs Trabeculectomy) Source: http://david-richardson-md.com/canaloplasty-treatment-for-glaucoma/canaloplasty-for-glaucoma/#ixzz3IZOiIntn
- Canaloplasty is safe. Studies which compared the results of Canaloplasty vs. trabeculectomy (the traditional glaucoma surgical treatment) showed that Canaloplasty patients experienced fewer side effects and complications compared to those who had trabeculectomy. And patients who had Canaloplasty had better vision than those patients who had trabeculectomy. For those who are candidates for Canaloplasty, it offers greater safety over trabeculectomy with similar benefits. Source: http://david-richardson-md.com/canaloplasty-treatment-for-glaucoma/canaloplasty-for-glaucoma/#ixzz3IY7wb2bV
- Canaloplasty is effective. Canaloplasty showed very impressive results in the published 3 Year Clinical Study. Below are just some of the highlights. The number of medications required to keep the IOP under control was reduced by 53% … this sustained reduction in drops used means that the cost of canaloplasty could easily be paid just with the cost savings from using fewer medications to control IOP. The reduction in intraocular pressure (IOP) after canaloplasty was 34% – this was the lowest average IOP! The IOP in those patients who underwent Phacocanaloplasty™ was reduced by almost half (42%)! 88% of patients achieved IOP control without drops three years after canaloplasty! Source: http://david-richardson-md.com/canaloplasty-treatment-for-glaucoma/canaloplasty-for-glaucoma/#ixzz3IY804GV0
- Benefits of Canaloplasty? • It uses the eye’s natural drainage system • It is a “non-penetrating” procedure that does not create a permanent fistula in the wall of the eye • It does not require a bleb (a blister-like fluid collection) • Provides long-term reduction in IOP (see three year results below) • Reduces the need for medications to keep the IOP controlled • Is a good option for those patients who are not yet ready for more trabeculectomy or tube shunts • Is safer than traditional glaucoma surgeries (Canaloplasty vs Trabeculectomy) Source: http://david-richardson-md.com/canaloplasty-treatment-for-glaucoma/canaloplasty-for-glaucoma/#ixzz3IZOiIntn
- Thank you
- San Marino Eye Supports National Diabetes Awareness Month