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QUESTION:
Through reading [online] posts (including suggestions by MDs) and conducting my own research, it appears that Glaucoma specialists may differ on their preferences for surgical interventions (especially with Trabs).
How might I find a Glaucoma Specialist who is “Canaloplasty Friendly?” I’m not looking for someone who will tell me what I want to hear, rather than what might be best. I am looking for someone who will give every consideration to Canaloplasty, or some other less invasive (than Trab) surgery when advising me (rather than just giving me “Trabs the standard”).
Thanks!
ANSWER:
Hello ******,
You will find that if you ask two glaucoma surgeons about treatment options you will receive three opinions. In truth the vast majority of glaucoma specialists reflexively proceed to trabeculectomy once drops and laser are no longer effective. Canaloplasty simply doesn’t enter the conversation in most examination rooms. Why is that? Well, you may be told that it’s because Canaloplasty ¨doesn’t work¨ which is, frankly, a cop out. A large peer-reviewed study published years ago clearly showed that it does work:
A more reasonable explanation is that ¨it doesn’t work as well as trabeculectomy¨ Hmm…really? Take a look at this table comparing the two surgeries:
Trabs and Canaloplasty were similar in IOP lowering but with one key difference: risks were lower in the Canaloplasty group. Even if we concede the passionately repeated mantra that ¨a trab is more likely to get the IOP into the single digits¨ we must do so while at the same time accepting that those extra points of IOP lowering come at a high price: surgical risks.
So, why do most surgeons recommend trabeculectomy when there is a safer alternative? Here are a few reasons:
So why do I recommend Canaloplasty over trabeculectomy? Because one of the first things I was taught in medical school is to ¨first do no harm.¨ I wish I could say that we all remember that lesson. In my unsophisticated manner of thinking I am willing to trade the ¨potential¨ of achieving an IOP in the single digits without drops for the safety offered by Canaloplasty. If it doesn’t work then there is still the possibility of going on to a ¨trab¨ or ¨tube¨ but at least I did not place my patient in more jeopardy than absolutely necessary.
How to choose a surgeon? Find one that is going to treat you, not just your IOP. If you can find one who is also skilled at (not just dabbled with) Canaloplasty, so much the better. If you’ve found such a surgeon and s/he then recommends trabeculectomy then you can be confident that it is a reasonable option for you.
I hope this was helpful.
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: Wed, Feb 18, 2015 at 9:55 PM
Posted in: Canaloplasty, Canaloplasty and Other Surgeries, Canaloplasty Safety and Efficacy, Canaloplasty Surgeons
