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Canaloplasty Glaucoma Surgery – Frequently Asked Questions

Dr. David Richardson took the time (lots of time!) to record these videos. We hope they address all your questions regarding canaloplasty. 

We strongly suggest you download the eBook version so you can read these FAQs even when you are not in front of your computer. Simply provide your name and email and you will be able to instantly download the eBook.

(Video Transcriptions are provided below (just click the + sign).)

Can I Continue To Wear Soft Contact Lenses After Canaloplasty?

One of the unfortunate things about traditional glaucoma surgeries such as trabeculectomy and tubes or shunts, is that, if you’re a soft contact wearer now, after surgery you may not able to wear soft contact lenses. It is possible for some people to wear hard or rigid gas permeable contact lenses after traditional surgery, but because of the bleb soft lenses are generally not a good idea. One of the benefits of canaloplasty is that in general, if you’re a soft contact lenses wearer before surgery, once the eyes healed from surgery, you should be able to be refit for a new pair of contact lenses after the eye is healed.

I already had traditional glaucoma surgery, trabeculectomy. Can I have Canaloplasty?

If you already had standard glaucoma surgery called trabeculectomy, then generally, you’re not a good candidate for canaloplasty. The reason for that is that trabeculectomy actually removes a portion of the canal. And that scarring can make it difficult for your surgeon to achieve dilation catheterization of that natural drainage canal. That being said, it is possible in certain cases for surgeon to perform canaloplasty after traditional glaucoma surgery. You should speak to your surgeon about whether or not you might be a candidate for canaloplasty after trabeculectomy.

I Have Had Glaucoma Laser Surgery, Can I Have Canaloplasty?

If you had one of the two most common glaucoma laser surgeries: argon laser trabeculoplasty or the newer selective laser trabeculoplasty, you are still a candidate for Canaloplasty surgery. The main concern that we as surgeons had in those patients who have had a prior laser, is that the lasers can occasionally cause some scarring of the natural drainage canal. If we cannot get full catheterization of the canal, we can still complete the surgery, but without placing the stent. And recent studies have shown that canaloplasty without placement of a stent can still be effective in reducing pressure, though not as much as with the stent placed.

I Have Heard That Canaloplasty Is Not As Effective As Trabeculectomy

There’s an impression that traditional glaucoma surgery trabeculectomy is more effective at lowering pressure than canaloplasty. This impression is based on the fact that trabeculectomy can get pressures very low, sometimes even, too low in the eye. But recent studies which have compared canaloplasty directly against trabeculectomy do not show a significant difference in final pressure or in the final number of drops that people used after surgery. So in recent academic studies that even presented in national meetings and published in pure review journals, there’s no evidence that trabeculectomy is actually better than canaloplasty. One thing that is worth noting however, is that study after study, shows that canaloplasty is a safer option than trabeculectomy.

I Have Used Glaucoma Drops for a Long Time, Will That Affect the Success of Canaloplasty?"

If you’ve been using glaucoma drops for many years, it’s possible that your surgeon may not achieve full catheterization during canaloplasty. That’s because using drops can have some long term effects on the natural drainage system. That being said, even if full catheterization cannot be achieved, generally pressure reduction can still be achieved by incomplete catheterization and dilation of the canal. This effect, long term of using drops, has more surgeons considering offering canaloplasty earlier before the long term damage has been done to the natural drainage canal. You may want to ask your surgeon whether or not you will be a candidate for canaloplasty earlier on in your glaucoma treatment.

What Are the Risks of Canaloplasty?

Although canaloplasty is a safer surgery when compared with more traditional glaucoma surgeries such as trabeculectomy and tubes, it is surgery, and so there are risks needed to be associated with it. It is important to note that with glaucoma, left untreated, vision will eventually be lost and blindness would result. So, glaucoma must be treated either with drops or surgery. Canaloplasty, as mentioned thus have a fewer risks, so let’s go through some of those risks.

RISK OF CANALOPLASTY

Although not exhaustive, some of the risks of canaloplasty include, bleeding in the eye, pressure elevation or spike, the formation of a bleb, descemet’s membrane detachment, the need to perform traditional glaucoma surgery, hypotony or pressure that is too low and infection.

BLEEDING IN THE EYE

Bleeding in the eye. Bleeding in the eye can occur up to a third of the time after canaloplasty. Although I mentioned this is a risk, it’s actually something that we expect and even want to see. Generally, when the canal is opened, and the fluid is able to communicate with some of the venous blood system, some of the blood refluxes back into the eye. This is a good thing, since it tells me, the surgeon, that indeed the canal has opened up. Generally, this blood in the eye will go away within a week, usually two weeks at the most, and the vision returns to what it was.

IOP SPIKE OR ELEVATION

Intra Ocular Pressure spike or elevation. It is possible most often shortly after surgery or few weeks after, to have a pressure elevation possibly than higher than it was before surgery. Generally, this is not concerning to me, the surgeon, and can even be expected. By two to three months out, most everyone who’s gone through canaloplasty has pressures that are lower than they were before surgery.

FORMATION OF A BLEB

Formation of a bleb. About 6% of the time, a bleb can form after canaloplasty. Generally, if a bleb forms after canaloplasty, it is not associated with irritation, redness and the chronic conditions that can be seen with a bleb associated with trabeculectomy.

DESCEMET’S MEMBRANE DETACHMENT

Descemet’s membrane detachment or separation. During the visco dilation process of canaloplasty where a special gel is actually used to open the canal, just like a balloon is used to open the artery in angioplasty. Sometimes this gel can dissect underneath the cornea, resulting to a blister, what’s called a descemet’s membrane detachment. Generally, this is not something that affects vision and it often resolved on its own. In a few cases where it does not resolved on its own, it can generally be pushed out of the way or flatten with an injection of gas bubble in the eye.

NEED TO PERFORM TRADITIONAL GLAUCOMA SURGERY

The need to perform traditional glaucoma surgery. Because most people who choose canaloplasty are doing so in order to avoid traditional glaucoma surgery, this can actually be considered a risk. The good news is that less than one in twenty people who had canaloplasty need to go on traditional surgery. Now, this maybe decided at the time of surgery or it maybe years down the line. The vast majority of people that had canaloplasty do not need additional glaucoma surgery.

What Does Minimally Invasive Mean?

So canaloplasty is often described as a “minimally invasive surgery”. What does that mean, “minimally invasive”? Well, in order to understand that we really need to compare it to the traditional surgeries of trabeculectomy and tubes or shunts.

Traditional surgeries require creating a full thickness hole or fistula in the wall of the eye. That hole is then left open, although it is guarded – either by flap or by a valve or sometimes temporarily by a suture. That guard however is not a complete guard, and so fluid does essentially have a straight flow out of the eye. It flows underneath the surface of the top layer of the eye, called the conjunctiva. This conjunctiva forms what is called the bleb in the case of a trabeculectomy or covers the actual plate of a shunt allowing a reservoir of fluid to collect. That fluid then drains out. Exactly how? We’re not exactly sure, but somehow it does get out of that reservoir and back into the venous system.

Canaloplasty as well as viscocanalostomy and other non-penetrating surgeries, do not require a creation of a full thickness, fistula. As a matter of fact the incision, once the drainage system has been opened, the drainage system being Schlemm’s canal, which is the natural aqua duct that fluid leaves the eye through. Once that has been opened with a gel (in a case of both viscocanalostomy and canaloplasty) as well as with a suture stenting it open (in the case of canaloplasty) then the flap that was created to gain access to the canal is closed back down with the suture. So there really is no full thickness flow from the inside of the eye to the outside of the eye. And any flow that does go from inside to the outside of the eye is temporary during healing process. And once the eye has been healed, the flow really should be through the natural drainage duct, Schlemm’s canal into what are called collector channels and then into the venous system. So that’s what meant by minimally invasive or non-penetrating.

What If Canaloplasty Doesn't Work, Can I Still Have Traditional Glaucoma Surgery?

If you had Canaloplasty surgery, but are one of the few patients where, it doesn’t work to bring your pressures down sufficiently, it’s important to note that you can still have traditional glaucoma surgery such as trabeculectomy or tubes also called shunts or setons. There’s nothing about canaloplasty that would keep you from having those surgeries or limit the success of those surgeries later on. So if you are a candidate for canaloplasty now, it’s worth discussing this option with your surgeon, if you’re also considering more traditional glaucoma surgery.

What If My Natural Drainage Canal Cannot Be Fully Catheterized?

To get the full benefit of Canaloplasty, it is important for your surgeon to fully catheterize your natural drainage canal. Once that’s done, your surgeon can then dilate the canal just as with angioplasty. And following that, leave a stent in the canal which leaves it open after surgery. If anyone of these steps cannot be fully performed, then the effect of the surgery can be reduced. That being said, even if a stent cannot be placed in the canal, a recent study has shown that the pressure lowering effect can still be good, if not as good as Canaloplasty with stent. Also, your surgeon does have the option at his or her discretion of converting to a more traditional glaucoma surgery such as Trabeculectomy if he or she feels that that’s appropriate.

What Is the Big Deal About a Bleb Anyway?

One of the benefits of canaloplasty is that it’s essentially a bleb-free procedure. It’s rare for anyone to develop a bleb. Almost everyone after canaloplasty is able to wear soft contact lenses if they desire, is able to continue with their activities including water sports once the eyes is healed up. And in general, dry eye or ocular surface disease is not only “not made worst”, but in some cases is better after canaloplasty because patients are not using as many drops after the surgery.

Why Should You Choose Canaloplasty?

INTRODUCTION

If you’ve been told that you need glaucoma surgery, you have a number of different surgical options to choose from. So why would you choose canaloplasty? Well, if you’re like one of my patients there are many good reasons to choose it. We’ll go over a few now.

SAFETY

Safety. This is probably one of your biggest concerns. If you’ve read about traditional glaucoma surgeries such as trabeculectomy, then you’re probably frightened of the many risks associated with those surgeries. It’s good to know then, that in studies comparing canaloplasty to trabeculectomy, canaloplasty had been showing to be a safer surgery, with fewer risks and fewer long term side effects.

AGE

Age. If you’re a younger patient, trabeculectomy may not be the best option for you, simply because younger patients tend to heal better than older patients. Since trabeculectomy require a non-healing bleb, that healing response works against you. Eventually the body does heal that bleb down. And if you’re younger, that means that some point during your lifetime, the bleb will fail. And you would most likely need to go on for additional glaucoma surgery. Canaloplasty does not require a bleb to work. Because there’s no bleb required, your youth does not work against you.

ACTIVE LIFESTYLE

Active lifestyle. If you have an active lifestyle and enjoy activities such as water sports, you need to know that trabeculectomies may limit your ability to stay active. Blebs, are very fragile and certain activities such as water sports that include diving or scuba diving even snorkeling, may not be safe after trabeculectomy. Since canaloplasty does not involve the formation of a bleb, these activities are perfectly fine to continue after the eye has healed from surgery.

MYOPIA (NEARSIGHTEDNESS)

Myopia or nearsightedness. If you’re nearsighted, you maybe at a significantly higher risk of vision loss after trabeculectomy from either bleeding in the back of the eye or a pressure that stays too low after surgery. Both of these risks are much less likely with canaloplasty than they are with traditional trabeculectomy.

ETHNICITY

Ethnicity. Traditional bleb depended glaucoma surgeries have a high rate of failure amongst certain ethnicities such as African Americans. Because canaloplasty does not depend on a bleb to lower pressure this simply is not an issue.

DIFFICULTY WITH GLAUCOMA MEDICATIONS

Difficulty with glaucoma medications. Glaucoma medications have side effects and the cost associated with them. If you find that this side effects of your glaucoma medications are affecting your vision, your life style or are just irritating enough that you’re not using your drops as often as you should, then it may be time to consider a lower risk procedure like canaloplasty. Also, if you find that your drops are too expensive and you’re not always able to refill them on time, you may be putting your optic nerve at risk of further loss and eventual loss of vision. So inability to tolerate the cost or the side effects of your drops maybe a good reason to consider canaloplasty.

CLOSING

These are just some of the reasons to consider canaloplasty. If you have open angle glaucoma and have been told that you need glaucoma surgery, then canaloplasty is worth discussing with your glaucoma surgeon. Although there are some people where their only real choice is trabeculectomy, most patients with glaucoma of the open angle type are candidates for canaloplasty.

Why Do I Perform Canaloplasty as My Primary Glaucoma Surgery?

One of things I find most frustrating about glaucoma is that, in the early stages it’s a disease without symptoms. So just like high blood pressure, diabetes, we as doctors end up treating a condition that has no symptoms and the treatment itself results in worsening symptoms. Take for example drops. Drops can be irritating, worsen dry eyes, they’re expensive and sometimes they can even have significant systemic side effects. As a doctor I find it difficult to treat a symptom free disease, with something that results in symptoms. Also the traditional glaucoma surgeries have significant risks associated with them. And it’s very difficult for me to recommend a surgery that has a significant risk of loss of vision, to somebody who currently, may not have notable loss of vision. Canaloplasty really hits that sweet spot for me. It’s a lower risked surgery that can actually reduce the symptoms of other treatments such as drops. So combining this safety profile, the low symptom profile and a condition which starts of symptom free, I really find that canaloplasty meets the needs of not only me as a doctor looking out for the protection of my patients vision, but also the needs of my patients.

Why Choose Canaloplasty?

So why choose canaloplasty over other more traditional glaucoma surgeries such as trabeculectomy or tubes? Well, there are number of reasons but the main one is SAFETY. Canaloplasty is simply a safer surgery and there are multiple studies that look at its safety profile and this can easily be compared with those of trabeculectomy and tubes shunts. For example, it’s very very rare for anyone to lose vision from canaloplasty; it’s not so rare with trabeculectomy. As a matter of fact, with trabeculectomy there’s a lifetime risk of loss of vision from what’s called endophthalmitis. Such a risk does not exist with canaloplasty.

Age is another factor to consider when choosing among glaucoma surgeries. For example, when you’re younger, trabeculectomy tends not to be such a good choice. There are a number of reasons for this. One is that younger people tend to have a more aggressive healing response and healing works against you with trabeculectomy. The only way to avoid that healing response is to use something called an “antimetabolite”, which results in a permanent loss of ability to heal in the area of the eye where the trabeculectomy was performed. This then put somebody in a lifetime risk of infection and loss of vision. Someone who’s very young has many years to be concerned about such a thing. So, for that reason, age factors in favor of canaloplasty, which does not have those lifetime risks that trabeculectomy does.

Another thing to consider is one’s refractive error. For example, people who are very near-sighted or myopic tend not to do well with trabeculectomy. Because of the risk of vision-threatening complications; in particular, one called hypotony or a very low pressure. These complications are simply more common in somebody who is myopic or near sighted and goes ahead with trabeculectomy. Although hypotony can occasionally be seen with canaloplasty, the risk is nowhere near as high as with trabeculectomy. So in general, those with open angle glaucoma, who are near sighted, are better off with canaloplasty than trabeculectomy. If you have an active life style, it’s very important that you consider your glaucoma surgery options carefully. Certain types of glaucoma surgeries, such as trabeculectomy, do not go together well with active lifestyles; especially if that lifestyle involves water sports. Because with trabeculectomy, a small blister-like structures form on the eye that is very delicate and can easily be ruptured. Any kind of activity that could potentially damage that bleb should be avoided. Diving into the water without goggles is one such activity. Therefore, if you have trabeculectomy, for the rest of your life you will need to wear protective goggles, with any type of water sport. Such a restriction simply does not exist with canaloplasty….

Why Should You Choose Canaloplasty?

INTRODUCTION

If you’ve been told that you need glaucoma surgery, you have a number of different surgical options to choose from. So why would you choose canaloplasty? Well, if you’re like one of my patients there are many good reasons to choose it. We’ll go over a few now.

SAFETY

Safety. This is probably one of your biggest concerns. If you’ve read about traditional glaucoma surgeries such as trabeculectomy, then you’re probably frightened of the many risks associated with those surgeries. It’s good to know then, that in studies comparing canaloplasty to trabeculectomy, canaloplasty had been showing to be a safer surgery, with fewer risks and fewer long term side effects.

AGE

Age. If you’re a younger patient, trabeculectomy may not be the best option for you, simply because younger patients tend to heal better than older patients. Since trabeculectomy require a non-healing bleb, that healing response works against you. Eventually the body does heal that bleb down. And if you’re younger, that means that some point during your lifetime, the bleb will fail. And you would most likely need to go on for additional glaucoma surgery. Canaloplasty does not require a bleb to work. Because there’s no bleb required, your youth does not work against you.

ACTIVE LIFESTYLE

Active lifestyle. If you have an active lifestyle and enjoy activities such as water sports, you need to know that trabeculectomies may limit your ability to stay active. Blebs, are very fragile and certain activities such as water sports that include diving or scuba diving even snorkeling, may not be safe after trabeculectomy. Since canaloplasty does not involve the formation of a bleb, these activities are perfectly fine to continue after the eye has healed from surgery.

MYOPIA (NEARSIGHTEDNESS)

Myopia or nearsightedness. If you’re nearsighted, you maybe at a significantly higher risk of vision loss after trabeculectomy from either bleeding in the back of the eye or a pressure that stays too low after surgery. Both of these risks are much less likely with canaloplasty than they are with traditional trabeculectomy.

ETHNICITY

Ethnicity. Traditional bleb depended glaucoma surgeries have a high rate of failure amongst certain ethnicities such as African Americans. Because canaloplasty does not depend on a bleb to lower pressure this simply is not an issue.

DIFFICULTY WITH GLAUCOMA MEDICATIONS

Difficulty with glaucoma medications. Glaucoma medications have side effects and the cost associated with them. If you find that this side effects of your glaucoma medications are affecting your vision, your life style or are just irritating enough that you’re not using your drops as often as you should, then it may be time to consider a lower risk procedure like canaloplasty. Also, if you find that your drops are too expensive and you’re not always able to refill them on time, you may be putting your optic nerve at risk of further loss and eventual loss of vision. So inability to tolerate the cost or the side effects of your drops maybe a good reason to consider canaloplasty.

CLOSING

These are just some of the reasons to consider canaloplasty. If you have open angle glaucoma and have been told that you need glaucoma surgery, then canaloplasty is worth discussing with your glaucoma surgeon. Although there are some people where their only real choice is trabeculectomy, most patients with glaucoma of the open angle type are candidates for canaloplasty.

How Long Does Canaloplasty Take?

One very common question I’m asked is, “how long does canaloplasty take?” Well, by eye surgery standards, it’s a pretty long surgery. It can last anywhere from 45 minutes to two hours, depending upon the complexity of one’s anatomy, as well as the skill of one’s surgeon. Canaloplasty is not a surgery that can be rushed. It’s a very delicate surgery. And the surgeon is working along membranes that are very very easy to rupture or cut through. The success of the surgery depends on careful dissection and a very good view and understanding of the anatomy. That being said, with a careful surgeon and the skills necessary, the results of Canaloplasty can be quite satisfying.

One other thing to consider with Canaloplasty in terms of the time of the surgery is that in general, the patient is anaesthetized, either with a general or with a local anesthetic and IV sedation. Therefore, most people really are unaware or sleep through much of the surgery. And it really should not be uncomfortable. So the time that it takes to perform a surgery is really less important than, that the surgery itself be done carefully and without rushing.

How Long Has Canaloplasty Been Around?

Canaloplasty is a form of Non-Penetrating Glaucoma Surgery (NPGS). “Non-penetrating” just means that the wall of the eye is not cut all the way through. In theory (and often in practice) this means that a bleb and its associated risks are avoided. NPGS was developed specifically to avoid the high risks of “penetrating” surgery.

So, How Long Has Canaloplasty Been Around?

One of the first attempts at creating a successful non-penetrating glaucoma surgery was reported by Dr. J. E. Cairns in 1968. Dr. Cairns wished to avoid the complications of penetrating surgery. Additionally, he felt that it was “unnecessary and unphysiologic to create a bypass to eliminate the activity, therefore, of the collector channels from the Canal of Schlemm.” In other words, he wished to maintain as much of the eye’s natural drainage function as possible.

Because it was felt that the main restriction to fluid exiting the eye was located at the trabecular meshwork[2] Dr. Cairns’ developed a glaucoma surgery which was intended to cut out a portion of the trabecular meshwork. Removing a section of the trabecular meshwork created an opening in the Canal of Schlemm through which aqueous could pass unobstructed into the collector channel system and out of the eye. He specifically wished to restore the integrity of the wall of the eye (sclera) by suturing it “firmly back into place, the intention being to secure a watertight union.”

How Long Will my IOP Stay Controlled With Canaloplasty?

Canaloplasty has been approved by the FDA since 2008. So as of 2012, we have three-year published results, which indicate that the pressure lowering effect of canaloplasty is stable over those three years. Now, three years may not sound like very long, but the older style of surgery, viscocanalostomy, on which canaloplasty is an improvement, has results seven years out. And the seven-year results look very good for that surgery. Since canaloplasty adds to viscocanaloplasty by restoring the natural drainage duct and keeping it open with a stent, we can only imagine that the long term results of canaloplasty are going to be even more impressive.

How Will I Need To Limit My Activities After Canaloplasty?

Immediately after any glaucoma surgery including canaloplasty, you’re going to want to be careful with any kind of activity that requires good stereo vision. Since the vision in the eye that you’ve had surgery maybe blurred, it’s important to avoid activities such as driving or working with heavy machinery, until your vision is clear again. Also, until the incision is healed it’s going to be important to avoid any kind of activities that involved submerging the head under water such as swimming or diving or getting the eye dirty such as being out in the dirt gardening. It is however, okay after surgery for you to wash your face, take a shower, wash your hair, go to the hairdresser, things like that.

Is Canaloplasty Really Safer than Trabeculectomy?

If you’re considering surgery to treat your glaucoma, then no doubt you’re concern about the risks of surgery. In traditional surgeries such as trabeculectomy and tubes, do come with significant risks. One of the things that make canaloplasty of interest to people, who are considering glaucoma surgery, is that, it is a safer surgery. Is it really safer? Well, there’s a study that answered that, that study performed by Ike Ahmed, a very well respected glaucoma surgeon in Canada, compared trabeculectomy with canaloplasty. In his study showed canaloplasty is safer, as fewer side effects and the interesting thing, not only was the pressure reduction the same as with trabeculectomy, and the number of drops used after surgery is the same. But the vision in those patients with canaloplasty was better than the vision in those patients with trabeculectomy. If you’re considering trabeculectomy, you may want to ask your surgeon whether or not you’re a candidate for canaloplasty.

Is Canaloplasty Surgery Painful?

Canaloplasty surgery should be a painless procedure, in a sense that your eye will be numbed at the time of surgery. This can be done either with an injection around the eye or with drops. Additionally, most surgeons do have an anesthesiologist present, who could give you something in the IV, by vein, to keep you nice and relax during surgery. Now, you may have a scratchy sensation or some discomfort after surgery, once the patch is taken off. This is often just from some of the sutures that are placed on the surface of the eye that should dissolve over time in most cases. Your surgeon will also give you some drops to use to help reduce inflammation and pain. If you have more than just a scratchy sensation or a slight ache in the eye that Tylenol does not take care of, then you should call your surgeon.

Is Eliminating Drops Worth the Risk of Having Canaloplasty?

Canaloplasty is surgery. And as a surgery it does have some risks. So the question is to whether or not it’s worth taking the risk, if your glaucoma is currently controlled on drops is one that needs to be individually addressed by you as well as your glaucoma surgeon or specialist. Drops themselves are not without risks. Some of the drops even the ones that had been around for a very long times such as the beta-blockers, can result in low blood pressure, low heart rate, fatigue, depression. Other classes of drops have their own side effect profile. There’s the expensive drop to consider, if your drops are too expensive for you to take on a regular basis, then you’re not really getting the effect. And if you’re not getting the effect, then your glaucoma maybe progressing. Other things to consider are of course lifestyle issues, if the glaucoma drops are resulting in dry irritated eyes, that could be causing some blurred vision then, they may not actually to be the best treatment option for you.

One of the aspects about canaloplasty that’s exciting is that in a sense it’s a restorative procedure. It restores the canal to its natural function, and once it’s open, fluid can exit the eye the way it was meant to, into the natural drainage canals. Once that happens the pressure is reduced. And by reducing the pressure most patients with canaloplasty are able to stop some or all of their drops. Then whatever issues they are having for their drops be it be expense, lifestyle involvement, irritation, are also reduced.

So again, although canaloplasty is surgery, and surgery does have risks, these risks needs to be balanced with the lifestyle effects, financial considerations and other side effects of drops. These things are worth discussing with your surgeon or glaucoma specialists, if you feel that you’re having difficulty with your drop therapy.

Is Trabeculectomy an Option After Canaloplasty?

Is Trabeculectomy an Option after Canaloplasty? One of the common misconceptions about Canaloplasty is that it eliminates the future option a Trabeculectomy . It’s also, sadly, one of the more common reasons patients chose not to have Canaloplasty when their glaucoma is severe enough that it requires surgical treatment. Surgeons who do not perform (or only infrequently perform) Canaloplasty may have the impression that trabeculectomy cannot be performed after Canaloplasty. Why would this be so? Well, as a general rule, once you have had surgery on the conjunctiva it is technically more challenging to perform trabeculectomy due to the scarring from prior surgery. Even if the surgery can be successfully performed, trabeculectomies after prior eye surgery are more likely to fail. As Canaloplasty is performed by creating a conjunctival flap in the area of the eye commonly used for other glaucoma surgeries, it’s reasonable for surgeons who have little experience with Canaloplasty to assume that trabeculectomy would also be difficult or prone to failure after Canaloplasty.

Experienced Canaloplasty surgeons, however, have been aware for years that the conjunctiva in the area of prior Canaloplasty has a very normal appearance with minimal scarring. This is very different than the expected conjunctival scarring seen after other glaucoma, retinal or older style cataract surgeries. Among experienced Canaloplasty surgeons it has also been accepted that Canalolplasty does not limit a skilled surgeon’s ability to perform either a trabeculectomy or placement of a tube implant (Ahmed, Baerveldt, or Molteno) in the area of prior Canaloplasty surgery. Unfortunately, this was considered hearsay by most glaucoma surgeons with little or no experience with Canaloplasty.

Will Canaloplasty Cure My Glaucoma?

Today there are no cures for glaucoma. Both drops and surgeries work to protect your vision from further loss of vision by lowering the pressure in the eye. Now, one of the advantages of surgeries such as canaloplasty is that there’s mountain of evidence that the pressure stays low throughout the day. Whereas with drops there can be quite a bit of fluctuations during the day. Additionally, canaloplasty has the added advantage of restoring your natural drainage system and opening it up so that it can work the way it used to before you developed glaucoma.

Will I Be Able To Stop Using Glaucoma Drops After Canaloplasty?

One of the most common questions that I get from my patients is, “Will I able to stop all of my drops after Canaloplasty?” It’s important to recognize that the primary goal of any glaucoma surgery, including Canaloplasty, is to protect the eye from further loss of vision by lowering the pressure. Now, once the pressure is lowered, it’s often possible to also stop some drops. Most patients who have Canaloplasty, especially those who had Canaloplasty and cataract surgery together, are able to stop the majority of their drops. Some are actually able to stop all of those drops. It is difficult to predict before surgery whether or not you’ll be one of those patients. But this is something that I would discuss with your surgeon.

Will My Insurance Cover Canaloplasty?

The good news with regard to insurance coverage is that canaloplasty is covered by most major insurances including Medicare. Although there are some smaller insurance companies and HMOs that do not currently cover canaloplasty as of early 2012, more are adding canaloplasty as a covered benefit every month. Simply because, it works so well, and it is a safer option compared to other glaucoma surgeries. I’ve also had patients who have paid for canaloplasty without their insurance helping them, simply because the cost of drops was so high for them, that overtime, canaloplasty was an option that actually paid for itself.

Will My Vision Change After Canaloplasty?

It’s important to recognize that the purpose of any glaucoma surgery, including canaloplasty is to prevent further loss of vision not to improve vision. It’s also important to recognize that after any glaucoma surgery including canaloplasty, the vision immediately after surgery, will likely be worse than it was before surgery. In the case of canaloplasty, this is generally because there’s some bleeding inside the eye after surgery. As awful as these sounds, this is actually a good thing. Because bleeding in the eye indicates that the natural drainage canal has been opened, and is connected to the venous collector system. Once that blood goes away which generally is within about one or two weeks, the vision should improve. Another thing that can limit vision after surgery, usually temporarily, is what we call induced astigmatism, which just requires a new pair of glasses to bring your vision back up to what it was before. The interesting and exciting thing about canaloplasty though, is that once you’ve gotten rid of some, or all of your drops, because your pressure’s lower after surgery, your tear film may improve. And if your tear film improves from lack of using all of those drops, then it may be possible for your vision to be a little clear. That’s one of the more exciting thing about canaloplasty as compared to some of the more traditional surgeries which generally do not result in an improve tear film.

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