Breakthrough with glaucoma

Eye surgeons at Trinity Regional EyeCare in Minot are among a select group of doctors nationwide approved to perform a new breakthrough treatment for glaucoma patients who also have cataracts.

Dr. Darrell Williams, medical director and ophthalmologist, said he and his colleagues are among just 150 eye surgeons nationwide authorized to use a device called the iStent Trabecular Micro-Bypass Stent, or iStent. Trinity Regional EyeCare is the only center in North Dakota to use the device, he added.

“This is a tremendous innovation,” Williams said. “It gives us a brand new tool unlike anything we have for glaucoma.”

The iStent device will help a substantial number of cases, he continued, because about 20 percent of the patients have or come in for glaucoma.

The iStent device is a microscopic titanium tube that is 1 millimeter in size, said Dr. Chad Wolsky, also an ophthalmologist. It is designed to be inserted into the eye during cataract surgery as a treatment for glaucoma. Glaucoma is a leading cause of vision loss and blindness and a disease associated with increased fluid pressure in the eye, Wolsky said.

Williams said the iStent device is a little like a heart stent.

“Fluid is made continuously and formed every two hours and circulated back into the blood stream every two hours,” he explained. “There’s a place in the eye where that happens and with time that clogs up like a sluggish drain in a sink. The fluid is formed faster in the eye than it can drain back out, so as the drain gets sluggish, we use a laser to help unclog the drain and eyedrops to lower the pressure.”

In a healthy eye, clear fluid flows continuously in and out of the eye through the trabecular meshwork and Schlemm’s canal, Wolsky said. In open-angle glaucoma, the most common form, the meshwork becomes blocked or drains too slowly, allowing pressure to build up inside the eye and potentially rise to a level that does damage to the optic nerve, he continued. The iStent is designed for people with mild to moderate cases of the most common form of glaucoma, Wolsky added.

The iStent device goes into the tissue of the eye, Wolsky said, and the tissue has a lot of memory. The device slips between the trabecular meshwork and that holds the stent in position, he also said. “It would be extremely hard to dislodge it once it’s in place. The natural tissue that drains fluid helps hold the stent in position.”

Glaucoma is a common cause of vision loss and many people are not aware they have it, Williams said. One of the first parts of the vision to be affected is side vision, he added. Treatment for glaucoma is all preventive in order to save whatever vision the person still has, Williams said, and it left untreated, the nerve eventually burns out. Glaucoma is kind of like high blood pressure, he noted, in that you don’t know you have it until you have a heart attack or a stroke.

“You may have high pressure in the eye and may not realize it until the vision is damaged,” he said. “That’s why routine eye exams with a family optometrist or ophthalmologist always includes measuring eye pressure.”

Traditional treatments of glaucoma have consisted of prescription eye drops that often have to be administered multiple times daily, Wolsky said, and can also be expensive and full of side effects

“Some patients are on two or three medications at a cost of $100 to $300 per month,” Wolsky said. “This can be a hurdle, especially for older patients. With the iStent, many of our patients will need less medicine to control their eye pressure and some may not need any drops at all.”

Trinity Regional EyeCare had been anticipating the iStent’s release for some time, Williams said, and were excited that the U.S. Food and Drug Administration approved it last year as a treatment to be performed in conjunction with cataract surgery.

“This is great news for people with both cataract and glaucoma,” he continued. “The iStent is the smallest medical device ever approved by the FDA. It’s so small that patients won’t even feel it or see it, but it will be working inside the eye to help reduce their eye pressure.”

The Glaukos Corp., the maker of the iStent device, is currently working on a second generation of the device that will be seven times smaller than the first or current device that is in use now, Wolsky said.

According to Williams, about one-third of glaucoma patients develop cataracts that have to be removed, which means a significant number of glaucoma patients stand to benefit from this treatment. Somewhere between 10 to 20 percent of cataract patients are candidates for this treatment, Wolsky added.

Both Williams and Wolsky have been seeing positive results from the new glaucoma treatment. Patients who have had the device implanted don’t even know it’s there, Wolsky said. “It’s a painless procedure and doesn’t add a lot of time to cataract surgery,” he added.

“We’re proud to be among a limited number of providers around the country able to offer this to our patients,” Williams said.