The minimally invasive procedures enable patients to heal in a week, with little interruption to their lifestyles.
Anita Campbell, MD, often sees glaucoma patients whose conditions have started to impact their vision.
With modern procedures — two of which have received FDA approval within the past 18 months — she can often help preserve their vision with little to no change to their lifestyles.
“In the past 15 years, there have been so many technologies developed that have been very beneficial for patients,” says Dr. Campbell, who joined Grene Vision Group in September 2015, after completing medical and specialized ophthalmology training at the University of Kansas School of Medicine and a fellowship at The Ohio State University. “They no longer have only two options. The older surgeries that we call traditional surgeries were invasive and involved making larger incisions that took months to heal. With the minimally invasive surgeries, the incisions are extremely small and heal within a week.”
The procedures — known as minimally invasive glaucoma surgery, or MIGS — are typically done simultaneously with cataract surgery.
More about MIGS
Glaucoma surgery relieves and lowers intraocular pressure (IOP) caused by a buildup of aqueous humor. If left untreated, the pressure can lead to optic nerve damage and blindness.
The two traditional surgeries for creating new outflow channels for the fluid are trabeculectomy and tube shunt implantation. In a trabeculectomy, a patient’s natural tissue is used to create a new outflow passage, while a silicone tube is implanted with the other surgery.
Although traditional surgeries are still being performed, MIGS are becoming a much safer way to treat glaucoma patients, Dr. Campbell notes. Microincisions mean less risk of bleeding and scarring.
“There’s also not much change in the lifestyle of the patient, as far as postsurgery restrictions or having to wear a shield at night.”
Stent implants are now as small as 1 mm, with the largest being 6 mm. The traditional tube shunt implantation, for example, involves making a 90-degree incision to the patient’s eye, pulling back the skin of the eyeball, inserting the stent and then suturing the skin. “It’s very invasive,” Dr. Campbell says.
Ophthalmologists also have more options to choose from with MIGS. The four MIGS that Dr. Campbell now offers are endocyclophotocoagulation (ECP), iStent implantation, CyPass implantation and XEN 45 gel stent implantation.
“With all of the procedures now available for treating glaucoma, I’m a strong proponent of using the ones that are covered by a patient’s insurance to avoid high out-of-pocket expenses,” Dr. Campbell says. That has led to her delaying the offering of some procedures, even after FDA approval, as she waited for Kansas insurance companies to cover MIGS.
Here is a look at each of those procedures:
- In some glaucoma patients, too much aqueous humor is formed by the ciliary body. In ECP, Dr. Campbell uses an endoscope to go behind the iris to locate the ciliary body, which has a teeth-like appearance, and then shrinks it with a laser to decrease fluid production.
- In an iStent implantation, a 1-mm titanium stent is placed into the trabecular meshwork (TM), allowing direct fluid outflow to the Schlemm’s canal. TM is the tissue area located around the eye’s anterior chamber angle.
- CyPass implantation, approved in 2016 by the FDA and offered in Wichita for the first time by Dr. Campbell in fall of 2017, involves implanting a 6-mm polyimide stent that allows flow into the supraciliary space, a unique space that has not been accessed successfully in the past, according to Dr. Campbell. “This is really revolutionary,” she says.
- Approved by the FDA in 2016, the XEN 45 gel stent procedure will be offered by Dr. Campbell starting Jan. 1, 2018. The 6-mm implant will enter the subconjunctival space through the anterior chamber, which will spare the conjunctiva for other traditional surgeries, if needed.
Both the CyPass and XEN 45 stent procedures are done only in conjunction with cataract surgery.
Anita Campbell, MD, performs a minimally invasive glaucoma surgery (MIGS): Dr. Campbell is using a gonioprism to better visualize the trabecular meshwork. This patient is having a CyPass Micro-Stent (white injector) implantation. This is a 6-mm tube that will drain aqueous fluid to improve eye pressure control.
The Importance of Annual Exams
Because open-angle glaucoma doesn’t have any symptoms, it often goes undetected and untreated. It is estimated that more than 3 million Americans have glaucoma but only half of them know it. More than 120,000 Americans have gone blind from the disease.
“The best thing is to detect glaucoma early through regular screenings and annual checkups,” Dr. Campbell says. “If you can detect it early, you can prevent vision loss.”
For more information about glaucoma treatment options or to make a referral, contact Grene Vision Group at 316-684-5158 or visit grenevisiongroup.com.