Hello. I'm Dr. David Richardson.If you have glaucoma, you may be considering one of the many glaucoma surge...
Hello. I'm Dr. David Richardson.If you have glaucoma, you may be considering one of the many glaucoma surgeries available for this condition. Or, you may just be frustrated by the hassle, cost, and side effects of the glaucoma drops required to keep this disease under control.
As one of the leading causes of blindness, your glaucoma needs to be effectively treated. The fear of blindness from this eye disease is real. However, if you are considering the standard glaucoma surgery, called trabeculectomy, you may also fear the potential side effects of this surgery, which include worsening dry eye, blurred vision, long-term risk of infection, and even blindness. So, what do you do?
Fortunately, there is now an advanced glaucoma procedure which works as well as trabeculectomy for most glaucoma patients and has significantly fewer risks. It's called canaloplasty.
This minimally invasive procedure can be done on its own or at the same time as cataract surgery. Similar to the angioplasty procedure used by cardiac surgeons, canaloplasty uses a very small catheter to open the eye's natural drainage system. A special gel, called a viscoelastic, is used to expand the canal. This natural drainage duct is then held open by a suture. By increasing the size of the drainage tube, fluid can better exit the eye, reducing the pressure. Unlike traditional glaucoma surgery, once your eye has healed from canaloplasty there are no lifestyle restrictions. It is OK to swim or participate in water sports (something that is severely limited with trabeculectomy). Because the surgical incision is made underneath the upper lid, there is no visible scar or unsightly bleb.
Also unlike trabeculectomy, canaloplasty does not make dry eye syndrome worse. Some patients even notice an improvement in their dry eye symptoms as they are able to use fewer glaucoma drops after canaloplasty surgery. If you are considering glaucoma surgery, no doubt you are looking for some peace of mind that you will retain vision for many years. But, trabeculectomy comes with the unlikely, and devastating risk, of infection even years after surgery. This risk is not present with canaloplasty.
Yet another advantage of canaloplasty is that it is even more effective when done with cataract surgery. This means that if you have both a cataract and glaucoma, one trip to the operating room could potentially improve your vision and your eye pressure.
With so many advantages to canaloplasty, why, then, do so many surgeons recommend trabeculectomy? Following are a few of the reasons I've heard from other surgeons:
One. There is the perception that canaloplasty does not work as well as trabeculectomy. However, in a recent study that compared trabeculectomy to canaloplasty, there was no difference between surgeries in either the intraocular pressure or the number of drops used one year out from surgery. What was different? The vision. Vision recovered faster with canaloplasty than with trabeculectomy and the final vision was better with canaloplasty than with trabeculectomy. So, it seems that the general perception that many surgeons have about trabeculectomy is just not supported.
Two. Canaloplasty is a technically difficult procedure. This is true and not every surgeon will be capable of performing this delicate surgery. If your surgeon is not comfortable with performing canaloplasty, I would encourage you to consult with a certified canaloplasty surgeon prior to deciding on trabeculectomy. Just as you would not purchase a car without comparing at least a few different models, you should not schedule a trabeculectomy without at least considering your other available options. Although it is possible that you may not be a candidate for canaloplasty, most patients with open angle glaucoma who have not already had glaucoma surgery can have canaloplasty.
Three. The surgery takes longer than trabeculectomy. This is also true. Canaloplasty can take anywhere from forty minutes to over an hour to perform (twice as long as trabeculectomy). But, this is a matter of cost to the surgery center, not you. You and your surgeon should not be concerned about how long the surgery takes if the final outcome is lower pressure, fewer risks, and longterm peace of mind.
In summary, canaloplasty is an exciting development in the surgical treatment of glaucoma. If you have glaucoma and are having difficulty with your eyedrops, considering cataract surgery, or have been told that you may need glaucoma surgery, you should consider this lower-risk option to traditional trabeculoplasty. I hope this video has been helpful to you as you make this very important decision.
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