The loss of visual acuity associated with glaucoma may be an indirect result of increased IOP. But increased IOP is rarely the result of excessive aqueous production. It is usually an insufficiency in aqueous outflow.
“While the disease occurs at the back of the eye, virtually all of our treatments effect the front of the eye,” said Stephen Vold, MD, founder and CEO of Vold Vision, Fayetteville, AR. “All of our treatments for glaucoma deal with the aqueous in some manner.”
Dr. Vold introduced “New Horizons in Glaucoma Devices.” Glaucoma devices employ four broad outflow strategies: via Schlemm’s canal, into the supraciliary space, trans-scleral/subconjunctival outflow, or cilioablative. Nine companies presented their latest data and products.
Glaukos’ original iStent is the smallest medical device approved by the FDA, said Bruce Nogales, chief corporate development officer. The next generation, iStent Inject, is about one-third the size of the original and is a solo device. The iStent is used with cataract surgery.
“We saw dramatic reductions in IOP with iStent Inject,” Nogales said. “Two-thirds of patients had an IOP of 18 mm Hg or lower at 12 months with no medication and 84% had 18 mm Hg or lower with a single medication.”