[Glaucoma Research Award 2014 awarded to Professor Norbert Körber by a non-profit patient organization, Bundesverband Auge, for his pioneering work in the field of Canaloplasty. The ceremony took place during the 112th Kongresses der Deutschen Ophthalmologischen Gesellschaft (DOG) on 09.27.2014 in Leipzig. Source: ops / Bundesverband eV eye / Christian Schneider]

Trabeculectomy Dethroned by Canaloplasty

For almost 50 years trabeculectomy has reigned as the king of glaucoma surgery. Commonly described by eye surgeons as the “gold standard” of glaucoma surgery, it nevertheless has been tarnished by what many consider to be an unacceptably high risk of loss of vision. I have been arguing for years that a peaceful revolution should take place among glaucoma surgeons to remove trabeculectomy as king and elect Canaloplasty as the new ruler of glaucoma surgery.

Glaucoma surgeons, however, generally prefer the often outstanding IOP reductions possible with trabeculectomy despite its significant risks. As with subjects under a tyrant king, most glaucoma surgeons are willing to trade the perceived security of intraocular pressure (IOP) lowering for the injustice of high risk. Thus, no revolution has occurred or is likely to occur from within the ruling class of eye surgeons.

Those with glaucoma, however, are not so willing to accept the harsh demands imposed by trabeculectomy including hypotony, long-term risk of infection, permanent lifestyle modifications, and potential loss of vision. The revolution in glaucoma surgery, it seems, may come from patients.

German patient advocacy group recognized Canaloplasty as the new “Gold Standard”

In the Fall of 2015, a German patient advocacy group, Bundesverband Auge, celebrated the work of Professor Norbert Körber, MD, by awarding him the prestigious “Glaukom-Forschungspreis” (for glaucoma research). This award was primarily in recognition of his groundbreaking work in the area of Canaloplasty. What is more striking, however, is that this patient advocacy group took a stance on where Canaloplasty should stand in the hierarchy of glaucoma surgeries:

The German Federate Eye Association (Bundesverband Auge) recognized Canaloplasty as the new “Gold Standard” in the surgical treatment of glaucoma.

Die Kanaloplastik ist eine neue Operationsmethode zur Behandlung des Glaukoms (Grüner Star). Diese Methode wird inzwischen an vielen Universitäts-Augenkliniken und Privatkliniken bereits angewandt. “Das für die Patienten sehr schonende Verfahren, führt durch die Verbesserung und Wiederherstellung des natürlichen Dränagesystems im Auge zu einer Verminderung des Augeninnendrucks. “Dadurch können die gefährlichen Druckspitzen im Auge verhindert werden und die Patienten brauchen weniger oder gar keine Glaukom-Augentropfen mehr um den Augeninnendruck zu regulieren. Gegenüber herkömmlichen Glaukomoperationen besteht ein geringeres Risikopotential, verminderte Narbenbildung und zukünftige Behandlungsalternativen sind nicht ausgeschlossen “, berichtet Professor Körber.

English translation: “Canaloplasty is a new surgical technique for the treatment of glaucoma. This method is now already in use at many University Eye Hospital and private clinics. The process is gentle to the patient – through the improvement and restoration of the natural drainage system in the eye to reduce intraocular pressure. As a result, the dangerous pressure peaks in the eye can be prevented and patients need less or no glaucoma eyedrops anymore to regulate intraocular pressure. Compared to conventional glaucoma surgery, there is potentially lower risk, reduced scarring and future treatment alternatives are not ruled out, “says Professor Körber.

Source here

A number of studies have now shown that Canaloplasty glaucoma surgery can lower IOP into the same range as can trabeculectomy[1][2][3]. These same studies have also demonstrated that the much feared risks of hypotony and loss of vision are less likely with Canaloplasty. There should be little question that Canaloplasty is a more just and fair glaucoma surgical option from the patient’s perspective. But it has taken a patient advocacy group (rather than a collection of glaucoma surgeons) to point this out.

Trabeculectomy has enjoyed almost a half century of rule as the king (or “gold standard”) of glaucoma surgery. Back in 1968 it was revolutionary and provided (at that time) a safer alternative to “full-thickness” glaucoma surgeries that were even riskier than trabeculectomy. Times have changed, however, and a similarly effective yet safer glaucoma surgery now exists in Canaloplasty.

It’s time for trabeculectomy, the tyrant king of glaucoma surgery, to step down.

References
  1. Non-Penetrating Schlemm’s Canaloplasty versus Trabeculectomy: A Head-to- Head Comparison. Tam D, Calafati J, Ahmed I. [Submitted for publication, December 2009].
  2. Ayyala RS, Chaudhry AL, Okogbaa CB, et al. Comparison of surgical outcomes between canaloplasty and trabeculectomy at 12 months’ follow-up. Ophthalmology. 2011;118:2427–2433.
  3. Schoenberg ED, Chaudhry AL, Chod R, Zurakowski D, Ayyala RS. Comparison of Surgical Outcomes Between Phacocanaloplasty and Phacotrabeculectomy at 12 Months’ Follow-up: A Longitudinal Cohort Study. J Glaucoma. 2015;24(7):543-549.

About the Author: David Richardson, MD

Medical Director, San Marino Eye

David Richardson MD - Top Glaucoma SurgeonDavid Richardson, M.D. is widely recognized as one of the top cataract and glaucoma surgeons in the US and is among an elite group of glaucoma surgeons in the country performing the highly specialized canaloplasty procedure. Morever, Dr. Richardson is one of only a few surgeons in the greater Los Angeles area that performs Micropulse® "Cyclophotocoagulation" (MP3) glaucoma laser surgery. Dr. Richardson graduated Magna Cum Laude from University of Southern California and earned his Medical Degree from Harvard Medical School. He completed his ophthalmology residency at the LAC+USC Medical Center/ Doheny Institute. Dr. David Richardson is also an Adjunct Assistant Professor of Clinical Ophthalmology at Keck School of Medicine of USC. Twice weekly, he treats veterans at the VA Greater Los Angeles Veterans Healthcare System.

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