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.

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.

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.

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.

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.

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.

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