What's New In Glaucoma Surgery Presentation. A Continuing Education course for Optometrists presented by Patient-Focused Ophthalmologist, Dr. David Richardson. At the end of the presentation audience participants became familiar with the main benefits and risks of currently available glaucoma treatments as well as had awareness of the most promising potential future surgical glaucoma treatments. This OD CE Course was held at Green Street Tavern, Pasadena, CA last May 20, 2015. ========================= [Glaucoma Surgeon, California] Dr. David Richardson is a board certified Ophthalmologist and Eye Surgeon in California specializing in the treatment of Cataract and Glaucoma. He is the Medical Director of San Marino Eye (Vision Center), located in San Marino, California. He’s the former Chief of Surgery and now Vice Chief of Staff at San Gabriel Valley Medical Center. Dr. Richardson has performed thousands of advanced cataract and Canaloplasty glaucoma procedures with excellent results. More information about Dr. Richardson: http://David-Richardson-MD.com New Glaucoma Treatments is a GLAUCOMA HealthHub maintained by David Richardson, M.D. It’s primary purpose is to provide valuable information to glaucoma patients and their caregivers worldwide about the latest developments and treatments for glaucoma, while providing answers to commonly asked questions about glaucoma, care and treatment options. More information about new glaucoma treatments here: http://new-glaucoma-treatments.com

2. Dr. David Richardson, MD. is a Board-Certified
Ophthalmologist in San Marino, CA. He is
among an elite group of eye surgeons in the
country performing the highly specialized
canaloplasty procedure. In fact, patients have
travelled half way around the world to have
canaloplasty done by Dr. Richardson.
- Medical Director, San Marino Eye
- Vice Chief of Staff, SGVMC
- Harvard Medical Scholar
- USC Magna cum laude

3. At the end of the presentation audience
participants should be familiar with the main
benefits and risks of currently available
glaucoma treatments as well as have an
awareness of the most promising potential
future surgical glaucoma treatments.

4. Non-invasive Minimally Invasive Penetrating

5. Shunt Enhance Ablate

6.  Non-invasive (Enhance)
• Laser Trabeculoplasty
 Penetrating (Shunt)
• Trabeculectomy
• Glaucoma Drainage Devices

7.  Minimally Invasive
• Cyclophotocoagulation (Ablate)
• Trabectome (Ablate/Enhance)
• iStent (Enhance)
• Canaloplasty (Enhance)

8.  For open angle glaucoma
 Performed in 1 or 2 sessions
 May result in microscopic scars
 May limit future surgeries

9. Photo credit: ellex.com
 Primary open angle glaucoma
 Can be performed after ALT
 Less traumatic compared to ALT
 Less damage to the eye tissue

10. Photo credit: iridex.com
 Micro-pulses
 Less damage and scarring
 Minimal inflammation and post-operative
IOP elevation

11.  Fistula
 Bleb dependent
 Bleb failure
 Lifetime risk of infection
 Lifestyle Limitation

13. Photo credit: www.ahmedvalve.com and www.amo-inc.com.
 Non-Valved vs. Valved
 Movement of the implant
 Infection
 Scarring
 Double Vision

16.  For mild to moderate glaucoma
 Done with cataract surgery
 Modest or unpredictable
IOP Reduction
Photo credit: endooptiks.com

18.  For ocular hypertension or mild open
angle glaucoma
 Done with cataract surgery
 Limits future surgeries
 Expensive

20.  For ocular hypertension or mild open
angle glaucoma
 Done with cataract surgery
 Limits future surgeries
 Expensive

21. One Year Results (IOP < 22mmHg):
- Cataract surgery alone: 50%
- iStent plus CE/IOL: 72%

22. Two Year Results (IOP < 22mmHg):
- Cataract surgery alone: 61%
- iStent plus CE/IOL: 71%
 NOT statistically significant!

24.  “Non-Penetrating”
 No Hole. No Bleb
 Lower IOP. Fewer Drops
 Safer than traditional surgeries
 Pro-Active Lifestyle
Photo credit: ellex.com

28.  Trabecular Microbypass Stents
 Suprachoroidal Implants
• Ab Externo
• Ab Interno
 Subconjunctival Implants

29.  For those with mild, controlled glaucoma
undergoing cataract surgery
 As long as an eyelash, “scaffolding device “
 Done with cataract surgery
 Promising

32.  modest IOP lowering
 medication reducing (at best)
 benefits are time-limited
 very high rate of failure

33. • Soft, silicon material with micropores
• Few post-operative complications
• No long-term complications

35. PES and titanium
 Implanted alone or at the time
of cataract surgery
 IOP reduction of at least
• 20% (12 mos.)
• ~50% (18 mos. )

37.  Relatively fast, safe and effective
 Can be placed prior to or after most
other glaucoma surgeries

38.  Shunt restricts flow reducing risk of hypotony
 Essentially a modified trabeculectomy
 Requires bleb to work

40.  Stent designed to reduce risk of hypotony
 IOP reduction of 31-42% at 12 months
 Essentially an ab-interno trabeculectomy
 Still requires a bleb to achieve IOP lowering

44.  Comprehensive: treats trabecular
meshwork, Schlemm’s canal and collector
channels
 Better aqueous outflow
 No permanent implant or stent

46. Exam n Mean IOP (mm Hg) ± SD Mean Medications (n) ± SD
Baseline 70 20.3 ± 5.8 2.4 ± 0.9
1 Month 47 14.3 ± 3.7 0.5 ± 0.9
3 Months 23 13.0 ± 3.6 0.5 ± 0.9
6 Months 4 12.3 ± 3.8 0.5 ± 1.0
Source: Mark J. Gallardo, MD (El Paso Eye Surgeons, PA)
Ab-Interno Canaloplasty Case Series

47. Exam n Mean IOP (mm Hg) ± SD Mean Medications (n) ± SD
Baseline 54 20.2 ± 6.3 2.3 ± 0.9
1 Month 33 13.3 ± 3.1 0.0
3 Months 17 12.5 ± 2.1 0.0
6 Months 3 11.0 ± 3.5 0.0
Source: Mark J. Gallardo, MD (El Paso Eye Surgeons, PA)
Ab-Interno Canaloplasty Case Series (With No Medication)

48. Exam n Mean IOP (mm Hg) ± SD Mean Medications (n) ± SD
Baseline 18 25.2 ± 6.4 2.1 ± 1.0
12 Months 16 16.8± 4.9 0.5 ± 0.6
18 Months 16 15.5 ± 4.2 0.8 ± 0.8
24 Months 14 18.1 ± 5.4 1.0 ± 1.0
30 Months 11 15.5 ± 3.5 0.8 ± 0.9
36 Months 13 16.2 ± 3.3 1.1 ± 0.8
Source: R.A. Lewis, K. von Wolff, M. Tetz, N. Koerber, J.R. Kearney, B.J. Shingleton, T.W. Samuelson. Canaloplasty: three-year results of circumferential viscodilation and
tensioning of Schlemm’s canal using a microcatheter to treat open-angle glaucoma. J. Cataract Refract. Surg., 37 (2011), pp. 682-690.
Three-Year Treatment Outcomes – Ab-Externo Canaloplasty w/o Suture