Dr. David Richardson, MD. is a Board-Certified

Ophthalmologist in San Marino, CA. He is

among an elite group of eye surgeons in the

country performing the highly specialized

canaloplasty procedure. In fact, patients have

travelled half way around the world to have

canaloplasty done by Dr. Richardson.

- Medical Director, San Marino Eye

- Vice Chief of Staff, SGVMC

- Harvard Medical Scholar

- USC Magna cum laude

At the end of the presentation audience

participants should be familiar with the main

benefits and risks of currently available

glaucoma treatments as well as have an

awareness of the most promising potential

future surgical glaucoma treatments.

Non-invasive Minimally Invasive Penetrating

Shunt Enhance Ablate

Non-invasive (Enhance)

• Laser Trabeculoplasty

Penetrating (Shunt)

• Trabeculectomy

• Glaucoma Drainage Devices

Minimally Invasive

• Cyclophotocoagulation (Ablate)

• Trabectome (Ablate/Enhance)

• iStent (Enhance)

• Canaloplasty (Enhance)

For open angle glaucoma

Performed in 1 or 2 sessions

May result in microscopic scars

May limit future surgeries

Photo credit: ellex.com

Primary open angle glaucoma

Can be performed after ALT

Less traumatic compared to ALT

Less damage to the eye tissue

Photo credit: iridex.com

Micro-pulses

Less damage and scarring

Minimal inflammation and post-operative

IOP elevation

Fistula

Bleb dependent

Bleb failure

Lifetime risk of infection

Lifestyle Limitation

Photo credit: www.ahmedvalve.com and www.amo-inc.com.

Non-Valved vs. Valved

Movement of the implant

Infection

Scarring

Double Vision

For mild to moderate glaucoma

Done with cataract surgery

Modest or unpredictable

IOP Reduction

Photo credit: endooptiks.com

For ocular hypertension or mild open

angle glaucoma

Done with cataract surgery

Limits future surgeries

Expensive

For ocular hypertension or mild open

angle glaucoma

Done with cataract surgery

Limits future surgeries

Expensive

One Year Results (IOP < 22mmHg):

- Cataract surgery alone: 50%

- iStent plus CE/IOL: 72%

Two Year Results (IOP < 22mmHg):

- Cataract surgery alone: 61%

- iStent plus CE/IOL: 71%

NOT statistically significant!

“Non-Penetrating”

No Hole. No Bleb

Lower IOP. Fewer Drops

Safer than traditional surgeries

Pro-Active Lifestyle

Photo credit: ellex.com

Trabecular Microbypass Stents

Suprachoroidal Implants

• Ab Externo

• Ab Interno

Subconjunctival Implants

For those with mild, controlled glaucoma

undergoing cataract surgery

As long as an eyelash, “scaffolding device “

Done with cataract surgery

Promising

modest IOP lowering

medication reducing (at best)

benefits are time-limited

very high rate of failure

• Soft, silicon material with micropores

• Few post-operative complications

• No long-term complications

PES and titanium

Implanted alone or at the time

of cataract surgery

IOP reduction of at least • 20% (12 mos.)

• ~50% (18 mos. )

Relatively fast, safe and effective

Can be placed prior to or after most

other glaucoma surgeries

Shunt restricts flow reducing risk of hypotony

Essentially a modified trabeculectomy

Requires bleb to work

Stent designed to reduce risk of hypotony

IOP reduction of 31-42% at 12 months

Essentially an ab-interno trabeculectomy

Still requires a bleb to achieve IOP lowering

Comprehensive: treats trabecular

meshwork, Schlemm’s canal and collector

channels

Better aqueous outflow

No permanent implant or stent

Exam n Mean IOP (mm Hg) ± SD Mean Medications (n) ± SD

Baseline 70 20.3 ± 5.8 2.4 ± 0.9

1 Month 47 14.3 ± 3.7 0.5 ± 0.9

3 Months 23 13.0 ± 3.6 0.5 ± 0.9

6 Months 4 12.3 ± 3.8 0.5 ± 1.0

Source: Mark J. Gallardo, MD (El Paso Eye Surgeons, PA)

Ab-Interno Canaloplasty Case Series

Exam n Mean IOP (mm Hg) ± SD Mean Medications (n) ± SD

Baseline 54 20.2 ± 6.3 2.3 ± 0.9

1 Month 33 13.3 ± 3.1 0.0

3 Months 17 12.5 ± 2.1 0.0

6 Months 3 11.0 ± 3.5 0.0

Source: Mark J. Gallardo, MD (El Paso Eye Surgeons, PA)

Ab-Interno Canaloplasty Case Series (With No Medication)

Exam n Mean IOP (mm Hg) ± SD Mean Medications (n) ± SD

Baseline 18 25.2 ± 6.4 2.1 ± 1.0

12 Months 16 16.8± 4.9 0.5 ± 0.6

18 Months 16 15.5 ± 4.2 0.8 ± 0.8

24 Months 14 18.1 ± 5.4 1.0 ± 1.0

30 Months 11 15.5 ± 3.5 0.8 ± 0.9

36 Months 13 16.2 ± 3.3 1.1 ± 0.8 Source: R.A. Lewis, K. von Wolff, M. Tetz, N. Koerber, J.R. Kearney, B.J. Shingleton, T.W. Samuelson. Canaloplasty: three-year results of circumferential viscodilation and tensioning of Schlemm’s canal using a microcatheter to treat open-angle glaucoma. J. Cataract Refract. Surg., 37 (2011), pp. 682-690.

Three-Year Treatment Outcomes – Ab-Externo Canaloplasty w/o Suture