What’s New in Glaucoma Surgery [Introduction]

What we’re going to be talking about tonight is: What’s new in glaucoma surgery and you know glaucoma is really kind of the underdog of surgical treatment. We all hear about cataract surgery and femtosecond and even with retinal surgery – epiretinal membrane peeling and, there’s a lot that’s really sexy and exciting but glaucoma… doesn’t really generate that kind of buzz, that kind of excitement.

Tonight, I’m going to introduce you to some things that I think are actually pretty exciting. Now if you’d told me five years ago that glaucoma was exciting. I would have said you needed Lexapro or something.

About The Speaker

Just briefly this this information here, everyone here, I believe, knows me, David Richardson Now, the “patient-focused ophthalmologist” – that’s not just kind of a “tagline” Most of you are aware that a couple years ago I actually completely turned my practice upside down. And the reason I did that was because I found that when I was in the exam room I could no longer be focused on my patients. I was too busy thinking about what kind of code am I going to use or you know what kind of documentation check marks do I need, did I meet all the criteria for the exam and I just it was too distracting for me and I’m a little OCD and that was just not good for me. So I’ve actually, as many of you know, changed my practice so that patients who come and see me… it’s just between me and the patient. So I’m not involved with any insurances or even Medicare and so when I’m in the room with a patient, I can truly be focused on the patient and I found, at least for me, again with my own kind of neuroses to be very freeing experience and I hope that those of us who share patients that your patients also tell you that that’s the experience they’ve had but it’s truly- if you ever get the chance to have that experience, whether through volunteering or something else, it’s something that… it’s just… it’s an epiphany to have.

So, anyway, a little bit about my background… many of you know me already – personally and professionally. I grew up here in Southern California and Santa Paula, a little town of 20,000 and my father was a self-proclaimed ditch digger for one of the local utility companies and I’m very fortunate; he was so dedicated and so supportive and you know really it’s my mother pushed me academically and they saved and they scrimped enabled me to get an outstanding education I consider myself to be one of the products of, you know, the American dream. Two generations from abject poverty and so every chance that I get to give back – i try to do so. And I hope that – in those of you, again, who (you know) do regularly share patients with me, know my practice is not a concierge practice, where I only treat the wealthy of San Marino.   My office may be, in San Marino but I very much enjoy keeping my fees at a level where people such as my parents could afford to come and see me. Alright; and I do – on a patient-by-patient basis see people at no charge. And so if you ever have somebody who feel you know, you really want them to see me don’t hesitate to give me a call, speak to me on the phone, and (you know) I enjoy what I do.

Glaucoma Surgeries Categories

So let’s get to the talk: Glaucoma Surgery. Now, it used to be there only couple of glaucoma surgeries to think about so we could handle this whole talk in 15 minutes we didn’t have to parse things into categories but now we’re going to actually talk about a number of different types of surgeries and techniques and I find it helpful, just personally, to categorize things it helps me think about what surgery fits for what type of patient and so we can split glaucoma surgery into roughly three categories using this categorical criteria. One is non-invasive so a laser would be non-invasive. Minimally invasive this is really a whole new type of glaucoma surgery that we’ll be talking about in more detail, and then the penetrating or the standard glaucoma surgery- what we think of as Trabeculectomy and glaucoma drainage devices. And clearly of those three most people would prefer to avoid that last one.

We can also think of glaucoma surgery in terms if a mnemonic that I use – SEA: Shunts, which is essentially creating a non-physiologic pathway from the anterior chamber into usually subconjuctival space but it could be something else too. Enhance, which is to take the natural pathway of anterior chamber through the trabecular meshwork into Schlemm’s canal and then out the collector channel system into the venous system. That would be Enhance and the final one is Ablate. Destroy.

Currently Available Glaucoma Surgical Treatments

Now, what are the currently available surgical treatments here in the US and, kind of like with cataract surgery where you talk about the currently available lenses (you have a small little list) And then you compare that to what’s available in Europe and you get a list that goes on and on and on for pages and pages the same kind of thing is true with glaucoma surgery. We have a pretty limited list of what we have available here in the US and you know that’s because the FDA is really restrictive they do have a job of protecting us and our patients there’s a lot of controversy – whether or not they’re a little overly protective here in the US because there are a number of things the Europeans have access to that seem to be quite safe and effective that we don’t have and probably won’t have for years and will get to those.

So what are the currently available surgical treatments in terms of the non-invasive- the ones that enhance the outflow? We have Laser Trabeculoplasty. We’ll talk about that in a little bit more detail. And then we got penetrating which is, we’ve had since I was born- 1968, Trabeculectomy was developed. Glaucoma drainage devices were developed around the same time. Lately, just in the last few years this is really over the last, maybe, five to seven years. We’ve got a new class of glaucoma surgery, which we call them, “minimally invasive glaucoma surgeries” which include Cyclophotocoagulation, which is ablating the ciliary body. Trabectome, which is ablating the trabecular meshwork,  iStents, which, we’ll argue whether it enhances anything but in theory it enhances the outflow through the Schlemm’s canal and then Canaloplasty, which is there to enhance the natural drainage flow from the anterior chamber into the canal out through collectors channel system.

Laser Trabeculoplasty ALT, SLT, MLT for Glaucoma →

What’s New In Glaucoma Surgery Series:

1. What’s New In Glaucoma Surgery
2. Laser Trabeculoplasty ALT, SLT, MLT for Glaucoma
3. Trabeculectomy Glaucoma Surgery
4. Glaucoma Drainage Devices
5. Cyclophotocoagulation and Trabectome for Glaucoma
6. Glaukos iStent: A Quick Review and Commentary
7. Canaloplasty Minimally Invasive Glaucoma Surgery
8. Promising, Pending FDA Glaucoma Surgical Treatments
9. Trabecular Microbypass, Hydrus™ Microstent
10. Suprachoroidal Implants [SOLX®, STARflo™, iStent Supra®, CyPass®
11. Subconjunctival Implants [InnFocus MicroShunt® & Xen 45 Gel Stent]
12. Ab-Interno Canaloplasty: The Most Promising, FDA-Approved, Glaucoma Surgical Treatment?

SLT: The Gentler Glaucoma Laser Surgery

Dr. David Richardson offers Selective Laser Trabeculoplasty (SLT) as an outpatient procedure in his San Marino Eye office. SLT can be performed on the same day as most examinations and the whole procedure takes 5 minutes of less. SLT is a gentler glaucoma laser surgery. Contact Dr. David Richardson immediately to see if SLT is for you.  Call today to schedule an appointment with Dr. Richardson at 626.289.7856.