Download - Glaucoma is a Lifestyle Disease 2011
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David Richardson, M.D. new-glaucoma-treatments.com
626.289.7856
CANALOPLASTYCANALOPLASTYNew Glaucoma New Glaucoma
TreatmentTreatment
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(Disclosure)
I am a consultant for iScience
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ExpensiveGenerics available, but …
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LaserLaser
ALT
SLT
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TrabeculectomyTrabeculectomy
Hypotony
Chronic irritation
Endophthalmitis
Lifestyle limitations
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Shunts/TubesShunts/Tubes
Hypotony
Diplopia
Chronic irritation
Corneal decompensation
Chronic iritis
Late erosion
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Is this BAD?
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“I’d rather go blind”
Primum non nocere?
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ORDERS!
Paternalism is Dead
Irritating “I”s
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Baby Boomer Psychodynamics
• “Ageless Explorers”
• “Never call an older
buyer old”
• Ignore consequences
of advancing years
www.nytimes.com/2008/01/06/weekinreview/06duhigg.html
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Now!ActiveAmbivalent
“Are you calling me old?”
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Give them what they want...Give them what they want...
FIX.FIX. Maintained Lifestyle.Maintained Lifestyle.
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Ideal Glaucoma Ideal Glaucoma TreatmentTreatment
Surgical
Safe
Long lasting Few side effects
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Non-Penetrating Glaucoma Non-Penetrating Glaucoma SurgeriesSurgeries
Surgical
Safe
Long lasting Few side effects
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Non-Penetrating Glaucoma Non-Penetrating Glaucoma SurgeriesSurgeries
Technically challenging
Not equivalent to
trabeculectomy
No CPT code = No
reimbursement
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CouldCould Canaloplasty Canaloplasty Change That?Change That?
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Canaloplasty Procedure OverviewCanaloplasty Procedure Overview
1. Creation of the outer flap
2.Creation of the inner flap & Descemetic window
3.Catheterization of Schlemm’s Canal with Dilation
4.Suture placement & tensioning
5. Closure of the outer flap
Photo from Robert Stegmann, MD
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iTrack MicrocatheteriTrack Microcatheter
• 250-micron flexible microcatheter with lighted beacon tip
• Passed through the canal 360°
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Injection of ViscoelasticInjection of Viscoelastic
Injects viscoelastic to dilate the canal and collector systemPasses tensioning suture through canal
iTrack™ 250A Canaloplasty Microcatheter
Illuminating tip of microcatheter in canal
• Injects viscoelastic to dilate the canal and collector system
• Passes tensioning suture through canal
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Suture TensioningSuture Tensioning
Suture in canal
• 9-0 or10-0 polypropylene suture introduced into canal using microcatheter
• Maintains inward radial force on trabecular meshwork
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Canaloplasty is:Canaloplasty is:
Surgical
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Safety Summary at 3 Safety Summary at 3 YearsYears
Early Post-operative / Surgical Complications (≤90 Days)
Canaloplasty(1) Trabeculectomy(2)
Early elevated IOP 6.4% Not reportedHyphema 10.2% 24.6%Descemetic membrane detachment / perforation
3.2% N/A
Suture extrusion through trabecular meshwork 1.3% N/AHypotony 0.6% 24.3%Flat / shallow anterior chamber 0% 24.1%Choroidal detachment 0% 14.1%Endophthalmitis 0% 0.1%
Late Post-operative Complications (>90 days post-op) Canaloplasty Trabeculectomy Late elevated IOP 6.4% Not reportedBlebs at 3 years 2.5% (100%)Suture extrusion through trabecular meshwork 0.6% N/AEndophthalmitis 0% 0.2% Choroidal effusion 0% 0%Hypotony 0% 0%Hyphema 0% 0%
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Canaloplasty is:Canaloplasty is:
Surgical
Safe
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Data Point Baseline 6 Month 12 Month 24 Month
36 Month
Canaloplasty Only
N 103 86 91 89 89
Mean IOP 23.5 +/- 4.5
16.1 +/- 3.4
16.1 +/- 3.9
16.1 +/- 4.0
15.5 +/- 3.5
Mean Medications
1.9 +/- 0.8 0.4 +/- 0.7 0.6 +/- 0.8
0.6 +/- 0.8
0.9 +/- 0.9
PhacoCanaloplasty™Canaloplasty combined with cataract removal
N 30 25 27 25 27
Mean IOP 23.5 +/- 5.2
12.8 +/- 2.9
13.6 +/- 4.1
13.4 +/- 3.2
13.6 +/- 3.6
Mean Medications
1.5 +/- 1.0 0.1 +/- 0.3 0.1 +/- 0.4
0.2 +/- 0.4
0.3 +/- 0.5
3-Year Clinical Results3-Year Clinical Results
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Canaloplasty is:Canaloplasty is:
Surgical
Safe
Long lasting
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Canaloplasty is:Canaloplasty is:
Surgical
Safe
Long lasting Few side effects
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How Does It Compare to How Does It Compare to
Trab+MMC?Trab+MMC?
Presented at ASCRS 2010:
•One Year Results of Head-to-Head comparison
•101 eyes randomized (50 canaloplasty, 51 trab + MMC)
•Similar mean pre-op IOP and medication use
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Comparison of IOP & MedsComparison of IOP & Meds
• IOP Results at One Year:• Trab + MMC: 12.3 mmHg• Canaloplasty: 13.4 mmHg• (Statistically insignificant difference)
• Medication use at One Year:• Trab + MMC: 0.7• Canaloplasty: 0.6• (Statistically insignificant difference)
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Comparison of VisionComparison of Vision
• Visual recovery was FASTER in the Canaloplasty group
• BCVA was BETTER in the Canaloplasty group at 1 year.
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Canaloplasty is:Canaloplasty is:
Technically challenging
IS as effective as
trabeculectomy
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Canaloplasty is:Canaloplasty is:
Technically challenging
IS as effective as
trabeculectomy
New CPT code:
66175
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