FAQs / Is Success an Assured Outcome with Canaloplasty?

QUESTION:

Dear Dr Richardson,

Thank you for your usual prompt response.

I have attached the reports on the ‘visual fields’. Hopefully that does not change your view on what can be done.

Based on the information you have is success a assured outcome and of course the definition of success (i.e: is that to stop deterioration).

Much appreciated,

******

ANSWER:

Dear Mr. ******,

Thank you for sending the visual field printouts. Fortunately they do not impact my sense that Mr. ****** would likely be a candidate for Canaloplasty.

With regard to anticipated outcome, no available glaucoma treatment is successful 100% of the time. With Canaloplasty one can expect to achieve a satisfactory reduction in IOP (with or without drops) in about 85% of those who undergo the procedure. This is similar to what can be expected with trabeculectomy (¨trab¨) or glaucoma drainage devices (¨tubes¨). All glaucoma surgeries also have a rate of failure. In the case of trabs and tubes one can expect about 50% to fail over the first 5 years. Canaloplasty alone appears to have a similar failure rate except that when it is combined with cataract surgery that failure rate drops in half. In general, when Canaloplasty is combined with cataract surgery one can expect both better IOP control and longer-term success.

The main benefits of Canaloplasty over trabeculectomy and glaucoma drainage devices are safety, lack of significant lifestyle limitations, and faster recovery. For example, trabeculectomy can significantly worsen dry eye syndrome which can be quite bothersome (even disabling) in someone who works in a hot, arid environment or must spend hours working on the computer or paperwork. After Canaloplasty, on the other hand, dry eye symptoms are only transiently worse and often improve compared to pre-operative experience.

I find it helpful to think of all glaucoma surgeries in terms of ¨What would be my next option if (when) this surgery stops working?¨ Yes, it is possible to have only one glaucoma surgery and have it work for life. The statistics, however, do not make that a high likelihood. Another benefit of Canaloplasty is that both trabs and tubes can be performed after Canaloplasty. The opposite, however, is not true. Canaloplasty is technically quite challenging after a trabeculectomy and may not be possible at all after a tube (unless the tube is actually removed from the eye). As such, a reasonable step-wise progression would be Canaloplasty -> trabeculectomy -> tube or even Canaloplasty -> tube -> second tube. By performing Canaloplasty first one is choosing to undergo the safest of the three glaucoma procedures with future options still available (if necessary).

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 5:48 AM

Posted in: Canaloplasty Safety and Efficacy, What Is Canaloplasty?