FAQs / Does Canaloplasty cause “scarring”? Does it lose its effectiveness over time?

January 27, 2017

QUESTION:

I saw my Glaucoma MD yesterday and told him I had researched canaloplasty and would prefer that. He does not do those. He indicated he did not like canaloplasty because of “scarring,” and that the procedure loses its effectiveness over time. I have not read that. He also said that many specialists who did canaloplasties have abandoned the procedure. I also have not read that!

via Email

ANSWER:

These comments from surgeons who don’t perform canaloplasty become so tiresome! Many surgeons who have not bothered to climb the steep learning curve of this surgery (which is most glaucoma surgeons) simply will find a reasonable sounding excuse to justify their lack of effort. There is no objective reason to believe that canaloplasty fails any more frequently than trabeculectomy. Indeed, trabeculectomy has a 50% failure rate in as little as 5 years! That has definitely not been my experience with canaloplasty. As for scarring, the main concern with any eye surgery is that it could result in conjunctival scarring which would then limit the success of future trabeculectomy. This concern has been evaluated and debunked here.

The literature is quite clear: no glaucoma surgery works for everyone and most glaucoma surgeries fail over time. Given that, I prefer to offer a lower risk surgery that is unlikely to “close doors” on future surgical options. Canaloplasty meets that need.

As for surgeons abandoning canaloplasty, can you blame them when the US surgeon culture and insurance reimbursement (which is a driver of surgeon behavior) value speed of surgery and reimbursement per minute more than just about anything else? Indeed, many insurance companies reimburse less than the operating room, equipment, and staff time costs to perform canaloplasty.

No one can reasonably expect surgical centers to take a financial loss when there are other faster surgeries that will just as effectively lower IOP (albeit, at greater risk to the patient). Unfortunately, many skilled glaucoma surgeons who participate with insurance are most likely swamped with patients in need of surgery. As such, it is exceedingly difficult to incorporate a time consuming surgery such as canaloplasty into an already packed surgical schedule.

That’s one of the reasons I made the decision to stop participating with insurance networks. If I need to spend an hour or more so that my patients can achieve IOP lowering at significantly less risk than trabs or tubes, that’s what I’m going to do.

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

Posted in: Canaloplasty, Canaloplasty Safety and Efficacy