Is Canaloplasty Worthwhile?

February 28, 2009

Have you seen the videos for this procedure?  I think I’m a decent surgeon, and I don’t like trabeculectomy any more than the next guy, but that looks hard and tedious. Sounds to me this procedure is strictly for the glaucoma guys. And I still think that since I only take the sickest eyes to surgery (as I can control the vast majority with drops, laser and straight phaco), I don’t think this procedure will reliably get my patients down to 12 like a trabeculectomy. So it looks like we are still stuck with trabs. I heard of a promising procedure that creates a nice bypass to the suprachoroidal space using a very small shunt device that is implanted into the angle after you finish the phaco. No bleb! No touching of conjunctiva! Nice!

 

 



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34 Responses to “Is Canaloplasty Worthwhile?”

  • I have had cataract surgery. I had three cataract surgeries on my left eye. They finally
    had to suture the lens to keep it from floating in my eye. My glaucoma is at 17 and 18
    on both eyes. I can see my vision getting worst. Am I a candidate for canaloplasty.
    The doctor just started me on some eye drops that burn my eyes and my vision is blurred. Is their a doctor in AZ…. that does the canaloplasty.

  • Lisa George

    Hi, I am also trying to find doctors in the Seattle area for a 2nd opinion. I have glaucoma and cataract in one eye (other eye has no sight due to failure of traubeculectomy five years ago). They want to do another traub in this eye along with cataract surgery, optic nerve is showing some bleeding although drops have been keeping pressure around 15. I am 80 yrs old and want to protect what eyesight I have left in this eye. Is canaloplasty an option that would be less prone to complications?

  • ari

    if pressure 29, i dont think canaloplasty is a good idea. i doubt you will get adequate lowering.
    call any of the bascom palmer glaucoma specialists and ask if they do the canaloplasty.

  • Moise l joseph

    Happy to find this site….I am 39 years old an I live in miami beach,,I ve been diagnosed with glaucoma since I was 13…I wear 5 drops in my right bad eye, the pressure have been around the high teens…last week I went to see my doctor and the pressure was 29 in the right eye…he s advising me to do a trabeculectomy surgery,,,,,based on all the research I ve done online,,,I have a feeling that this surgery doesn’t fit my lifestyle ….I love sports and I am very active…I had laser surgery done before in the eye in 2000,,, it was only effective for a while….I am considering a canloplasty based on your previous comments….I d like to know if I am a candidate at my eye…and also I am of Afro carribean ethnicity…..and moreover do you k ow of a specialist I can consult in Miami Area….I looked on bas com palmer website, no where I see any info on canaloplasty….Can someone help please…….? I am fairly young and panicking….thks in advance

  • ari

    for sure, at bascom palmer in florida, the best eye hospital in the u.s., you can find someone or maybe get a referral to someone in your area.

  • Barbara Lamar

    12 year history of open angle glaucoma, have changed meds numerous times. IOP alway in 16-19 range. Bad news today. Central visual field deterioration,in left eye…. referred for surgery consult. HELP!!! Is there someone in Atlanta area or Southeast U.S. who has done a lot of successful canaloplasties? thx BARBARA

  • I agree with Dr. Weitzner. Although canaloplasty can be performed after trabeculectomy by an experienced canaloplasty surgeon, it is unlikely that it alone could get the IOP down below 12mmHg. Combined with cataract surgery or drops it might achieve that goal.

    After a failed trab either a repeat trab or placement of a “tube” (Ahment, Baerveldt, or Molteno) would generally be considered the most prudent next option. Even those may not get the IOP to the goal without additional drop therapy.

  • ari

    after a failed trab, canaloplasty unlikely to get you to 12. your best bet is to insert an ahmed valve.

  • Jan

    I am 42 and have had normal tension glaucoma for 20 years. In march 2011 i had a trabeculectomy to my right eye as i had run through all drops and my pressures where rising over my safe 12. I have sig nerve and field loss on my right eye, slight damage to left. Eyesight remains fine however. The trab had alot of complications – leaking, stitching, needling. I got the desired pressure for three months then needed to resume drops as it started to rise. It is now out of control and at 21 in left (good) eye and 15 in right. My Dr is saying to do a second Trab but I’m very reluctant however I obviously need to do something ( to at least save my good eye long term). Been put on Pilocarpine in the last two months ( in addition to allergan and travatan) but pressure still rising (gone from 14 to 21 in two months). I’m excited to read this post but dont want to get my hopes up if its not for me? Thanks – from Scotland.

  • Dear Robert,

    Following are two doctors near you that should be able to provide an opinion about the appropriateness of canaloplasty after examing you:

    GENERAL OPHTHALMOLOGIST
    Bradley P. Gardner, M.D.
    Idaho Eye Center
    2025 E. 17th Street
    Idaho Falls, ID  83404
    208-524-2025 phone
     
    GLAUCOMA SPECIALIST
    Adam C. Reynolds, M.D. (I believe he has done hundreds of canaloplasty surgeries)
    Intermountain Eye Centers
    999 N. Curtis Road
    Suite 205
    Boise, ID  83706
    208-373-1200 phone

  • Robert Strange

    I am a glaucoma patient and my Doc is having trouble getting the IOP down low enough. My RNFL Thickness numbers continue on the downward trend. I am considering canaloplasty and have read with interest the comments here.

    How do I find a surgeon who is past the Learning Curve?

    What number of surgeries does it require for most surgeons?

    CP sounds like a real option for me as the meds are causing me both sinus and hearing difficulties, although the specialist seems to discount that but has recommended that I (pinch the nose) for 60 seconds after taking the drops to prevent them from going into the sinus cavities.

    Shortly after taking the drops my ears feel as though I came down from an airplane flight but the ears do not adjust for the altitude change. Usually in the morning upon awaking my ears seem quite normal until I take the drops.

    I was taking Travatan Z, Timolol and Alphagan when the sinus became so agitated (constant discharge) that I finally dropped the Alphagan and now take only the Travatan (1x both eyes) and Timolol (1x both eyes). I still have both sinus and hearing difficulty and when I do not do the pinch, I notice a definite increase in the sinus and hearing problem.

    Please forgive me to intruding on your professional blog site but this seemed the perfect place to get answers to my questions. Any information will be greatly appreciated. I live in the Idaho Falls, Idaho area.

    Thank you and God bless you in the great work you are doing.

  • ari

    you certainly make perfectly valid points. my only criticism is that although there are no “rules” on this website, i think its fairer if financial disclosures are made, for the same reason they are made in all legitimate conferences/journals– human nature dictates that there may be bias when there is a financial relationship, and its up to the listener/reader to make that judgement call.

  • Dr. Patel,

    I can certainly understand your concerns and will address them as best I can. Although it is true that I am now a paid consultant to iScience, my initial May 2010 post preceded my consulting arrangement which was not effective until late 2010/early 2011. My enthusiasm for the procedure is the reason that iScience asked me to consult for them, not the other way around. If you go back and read my initial post again, it is clear that I was very enthusiastic about this procedure long before iScience ever asked me to speak at a conference or offered to pay me for my time.

    With regard to who “ab” is, I cannot say, as I don’t know the answer to that question. Adam Bernstein is a Regional Business Manager for iScience and the initial match is suggestive, but I will have to leave that as the conjecture it is for lack of direct knowledge.

    I also have great respect for the work of Ike Ahmed. I do not know what his current view toward canaloplasty is but he did author a poster that compared trab+MMC to canaloplasty which showed that at one year the patients actually fared better with canaloplasty. Considering that the JCRS 3 year data support the long-term sustained IOP reduction seen at 1 year with canaloplasty there is little reason to suggest that the procedure does not work (other than conjecture, which is exactly why there are peer-reviewed studies such as the ones I just referenced).

    Furthermore, if you are going to damn what I post (prior to or after my consulting agreement with iScience) then you should in all fairness be willing to take an equally harsh view toward the statements of Ike Ahmed (as well as just about every speaker at every major meeting) as Dr. Ahmed is a consultant to many glaucoma companies (and I have no doubt that what I make in consulting fees pales in comparison to his fees). Again, I cannot speak for what Ike Ahmed’s surgical preferences are, but there are plenty of well-respected surgeons who have been advocates of canaloplasty for years. Dr. Stegmann, for example (who has tirelessly worked to find a solution to glaucoma in some of the most extreme conditions that we will fortunately never have to practice) believes very strongly that canloplasty can work more effectively and for a longer duration than either trabeculectomy or tubes. I look forward to him publishing his data, but in the meantime have no reason to question his statements.

    As for the surgeon drop out rate, I do not know the answer to that question as I am a consultant to iScience, (not an employee of iScience). I have no doubt, however, that the dropout rate is significant as this is a procedure that frankly scares most doctors. It appears to be much more difficult than it is. For those who make it through the learning curve it can be a very rewarding surgery. But, it’s not for everyone. Perhaps it’s not for you.

    I also think it is unreasonable for you to compare the IOP reduction of surgeons who have only performed 15-50 cases to those who have performed 100s. Were your first 50 phaco cases anywhere as good as your 100th or 200th?

    If you want reasons not to perform a surgery such as canaloplasty you’ll find them everywhere you look. There is only one good reason to force yourself through the learning curve, and that’s because you want to provide a safer, blebless alternative to trabeculectomy and tubes. I guarantee that your patients would prefer a bleb-free surgery to a bleb-dependent surgery. The only remaining question is whether you want to be the one to provide it.

    David

  • Dr. Ari Weitzner

    i was not aware that dr richardson is a paid consultant. also was not aware that dr. ahmed has abandoned the procedure or that ab is not a doctor. maybe we will get a response from these individuals

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