Part 13 of 14 of “Adjusting the Faucet or Opening the Drain – Currently Available Methods to Treat the Plumbing Problem of Open Angle Glaucoma” | A San Gabriel Valley Optometric Society (SGVOS) Continuing Education Dinner Event – 2 hours CE | Featured Speaker: Dr. David Richardson, MD | April 12, 2017

Next Generation Plumbing | What’s “In the Pipeline” of Medications and Surgery

Glaucoma Surgeries

But what’s really exciting and what I’m going to end on here is the next generation of plumbing – the surgeries.

iStent® Supra®

The iStent Supra® is basically the the Glauko’s version of the Cypass® and it’s exciting but we’ve seen Cypass®—this isn’t that different. I’m sure there’s some nuances and one may end up working better than the other—have fewer complications—but what interests me is what follows.

Hydrus™ Microstent

The Hydrus™ Microstent – this is actually a way of stenting the canal. So we’ve seen with the Ab-interno Canaloplasty (ABiC) how we could dilate the canal but the problem is: you’ve dilated—that’s nice—angioplasty of the heart remember, many times the vessels would scar back down. So then they started putting stents in the vessels in the heart. Well, the same thing (we hope) we’ll be able to do with the Schlemm’s canal: dilate the canal and leave a stent. So, in this case, it’s a small little stent, only as long as an eyelash. It’s done with cataract surgery, seems quite promising. Another Ike Ahmed video, which is again fun to watch but given the time I think that we’ll hold off unless somebody wants to see it after the talk. I’m willing to stay around and do some theatre here.

InnFocus MicroShunt®

The other is the InnFocus MicroShunt®—These things are not yet FDA-approved but they’re in trials and then maybe. The InnFocus MicroShunt® is essentially— it’s an Ab-externo, unfortunately. It’s essentially a controlled trabeculectomy. So instead of creating a flap and punching a hole, you essentially place this device that limits flow. So very much like the XEN® Gel Stent, which you could do from inside the eye. This is similar but requires that you come from the outside of the eyes. Now, personally, now that the XEN® Gel Stent has been approved, I can’t imagine why anybody would want to take the trouble to use this but it might have… it might have a following—we’ll see. The Xen® Gel has the advantage of both being an Ab-interno – so quick and easy to do, as well as the fact that it’s already FDA-approved. So it’s kind of you know first one the market. So, if I was an investor I would not be investing on the InnFocus but I’m not.

08.16.2018 NEWS UPDATE: Hydrus microstent wins FDA approval. The FDA has approved the use of the Hydrus microstent in conjunction with cataract surgery to reduce IOP in patients with mild to moderate primary open-angle glaucoma. Source:

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