“How long has canaloplasty been around?” That’s a question I get asked quite a bit, and I understand why. Anytime there’s a new procedure, the concern is, “Will it last? What’s the long term safety profile?” and these are good concerns to have. Well, the interesting thing about canaloplasty is, the answer to that question is not as straightforward as one might imagined. The FDA has approved the procedure since 2008. So we do have three year results which were published in 2011 and were very encouraging. Both in terms of efficacy, which means the effectiveness of the surgery, as well as its safety profile. But the surgery itself is actually based on a surgery called viscocanalostomy that has been around since 1990. This procedure was first described by Dr. Stegman and has since become quite popular in places such as South Africa, Europe and part of the reason for that is that, it has a good track record of success itself. Seven year results are out and those results look very good with many people having a sustained reduction in their pressure of up to 30%.
So if this procedure, viscocanalostomy, is so popular elsewhere, well why has it never really taken off in the US? A part of the reason for that is the technical difficulty of it. It was just simply too challenging. And the reimbursement structure that US doctors have to deal with is such that it just never quite made sense to get over the steep learning curve to go ahead and do so. Up until recently, viscocanalostomy, as well as the newer canaloplasty, did not even have a reimbursement code in the US. And without the reimbursement code it means that the insurance, Medicare included, won’t pay for it. And if they won’t pay for it, it’s pretty much not done because very few people have the means to pay for surgery, whether it’s here in the United States or elsewhere; if it’s not at least paid, in part, by third party such as insurance or Medicare.
Another factor is the technology. It was not until recently that iScience created the iTrack catheter that really revolutionized viscocanalostomy and turned it into the highly effective and easier to perform canaloplasty. Based on the results that I’ve seen, as well as the results that have been published, canaloplasty is a wonderful procedure to consider – both because of its safety profile and its effectiveness. Ultimately the real question that you need to ask yourself, if your patient is considering glaucoma surgery, is not just how long a procedure has been around but what is the safety profile and what are the results that surgeons – both individual as well as those in studies, are achieving with this surgery versus the other surgeries regardless of how long they’ve been around.
I hope this has been helpful and the answer to one of your questions which I know, at least among my patients, I get asked quite a bit.