Questions and Answers | Q&As

November 7, 2016

QUESTION:

Hello, my name is M*** and my grandmother is suffering for glaucoma. One of her eyes has lost total vision and the other one is soon going to be lost too. Is their anyway she could be able to get treated and have her sight back?

via Email

ANSWER:

A glaucoma drainage device “tube” can be more compatible than a trabeculectomy with contact lens use. Canaloplasty can be even more compatible. There used to be a wonderful canaloplasty surgeon in Florida but he has recently moved to another state. The closest canaloplasty surgeon I can now recommend is in Baton Rouge, Louisiana.

I’ve copied my nurse, Ana, on this email in case you need further assistance.

Warm regards,
David Richardson, MD
Patient-Focused Ophthalmologist

San Marino Eye
2020 Huntington Drive
San Marino, CA 91108
626.289.7856

Patient-Focused Websites:
New-Glaucoma-Treatments.com
About-Eyes.com

February 26, 2017

QUESTION:

I asked you about canaloplasty surgery and you did reply to me quickly, thank you. Based on what you’ve described, it appears that my friend’s case may not be suitable for the procedure. The diagnostics of her eyes is “primary angle-closure glaucoma.” Two trabeculectomies were performed twice in Dec, 2009 and Mar, 2012, for her left eye. But after a year or so, the effectiveness of both surgeries was gone. Currently she is using 2 medicines to reduce pressures, as you can image they should not be effective as desired. Do you have any suggestions recommendations on new treatment methods that could be possibly applicable for her? If it is deemed appropriate, you would be her first choice of surgeon to consider.

via Email

ANSWER:

It appears that your friend has, unfortunately, a complex type of glaucoma. As such, and given that I have not had the opportunity to examine her myself, I am unable to offer treatment guidelines. I am sorry I cannot be of greater assistance. I wish your friend well in her search for an effective treatment.

Warm regards,
David Richardson, MD
Patient-Focused Ophthalmologist

San Marino Eye
2020 Huntington Drive
San Marino, CA 91108
626.289.7856

Patient-Focused Websites:
New-Glaucoma-Treatments.com
About-Eyes.com

March 15, 2017

QUESTION:

Hi Dr. Richardson, in your opinion which is better- tube shunt or trabeculectomy? I am left with a decision and neither one looks better to me but from what I been told my only choice left do to my drainage system is no longer working. Trabectome failed and so did Laser and drops aren’t keeping me in a good number. Any info would be appreciated. Thanks from your time

via Email

ANSWER:

There is no clear “winner” in the trabeculectomy vs. glaucoma drainage device face-off. Trabeculectomy seems to provide a slightly greater IOP benefit but at the cost of greater risk.

Warm regards,
David Richardson, MD
Patient-Focused Ophthalmologist

San Marino Eye
2020 Huntington Drive
San Marino, CA 91108
626.289.7856

Patient-Focused Websites:
New-Glaucoma-Treatments.com
About-Eyes.com

ANSWER:

Dear ******,

In general that is true if Mitomycin-C (MMC) is used. However, that extra IOP lowering comes at a cost and I’m not talking about dollars. The price is paid in risk: risk of loss of vision, hypotony with associated maculopathy, lifetime (of the bleb) risk of infection, increased ocular surface disease (dry eye irritation), etc. There is at least one study, however, that showed no difference between the average IOP reduction from Trab+MMC and Canaloplasty. This study was performed by one of the most skilled eye surgeons I know, Ike Ahmed (in Canada):

• Nonpenetrating Schlemm Canaloplasty Versus Trabeculectomy: Head-toHead Comparison. Tam D, Calafati J, Ahmed I. Poster, American Society of Cataract and Refractive Surgeons (ASCRS) Annual Meeting, April 2010

In addition, it’s simply not true that you cannot achieve an IOP below 10mmHg off drops after Canaloplasty. I have a number of patients who are now years out from Canaloplasty who have IOPs in the

Warm regards,
David Richardson, MD
Patient-Focused Ophthalmologist

San Marino Eye
2020 Huntington Drive
San Marino, CA 91108
626.289.7856

Patient-Focused Websites:
New-Glaucoma-Treatments.com
About-Eyes.com

Date: Mon, Feb 9, 2015 at 6:00 AM

ANSWER:

Dear ******,

This is not a question that can be answered with a simple “yes” or “no”. It depends upon whether the canal was cut through during creation of the trabeculectomy site. In general it is much easier to perform Canaloplasty after an Ex-PRESS mini shunt is used as the shunt is inserted anterior (in front of) the canal. So long as the canal is intact it should be possible to fully catheterize and stent it open during Canaloplasty. That being said, it is still possible (though exceedingly challenging) to perform Canaloplasty after a trabeculectomy that has cut out a portion of the canal. More information can be found here:

• http://www.ncbi.nlm.nih.gov/pubmed/23221902
• https://ascrs.confex.com/ascrs/15am/webprogram/Paper11038.html

Warm regards,
David Richardson, MD
Patient-Focused Ophthalmologist

San Marino Eye
2020 Huntington Drive
San Marino, CA 91108
626.289.7856

Patient-Focused Websites:
New-Glaucoma-Treatments.com
About-Eyes.com

Date: Fri, May 15, 2015 at 12:39 PM