First-in-human technology enables real-time outflow measurement during glaucoma surgery

Sean Ianchulev, MD, MPH, will unveil a new technology called micro-interventional Dynamic Outflow Curve (miDOC) during the Charles D. Kelman Innovator’s Lecture at the American Society of Cataract and Refractive Surgery annual meeting in Washington, DC, April 10-13, according to a press release from Mt. Sinai. Ianchulev is Professor of Ophthalmology at the Icahn School of Medicine at Mount Sinai and Director of Ophthalmic Innovation and Technology at New York Eye and Ear Infirmary of Mount Sinai (NYEE).

He and Gautam Kamthan, MD, Assistant Clinical Professor of Ophthalmology at the Icahn School of Medicine, Assistant Director of Ophthalmic Innovation and Technology at NYEE, and Principal Investigator of the first-in-human study of miDOC, are the co-inventors of this technology.

The press release explained that miDOC was designed to provide continuous intraoperative measurement of ocular flow and pressure, all of which historically have been difficult to assess during the surgical course. The system enables surgeons to monitor changes in real time and adjust procedures accordingly for individual patients.

“This is the equivalent of what optical biometry did for cataract surgery. miDOC brings precision to glaucoma surgery that simply has not existed before. We are certainly on the verge of something very exciting: bringing glaucoma surgery into the age of digital-guided precision, high fidelity, and biometric feedback. This will allow glaucoma surgeons to one day achieve similar outcomes as we see in cataract surgical interventions,” Ianchulev said.

Upgrading glaucoma surgery

During those surgeries, the ocular flow and intraocular pressure (IOP) cannot be determined precisely. The IOP can only be measured before and after the procedure, making the surgical outcomes unpredictable, according to the surgeons.

As cited in the press release, over 50% of patients undergoing trabeculectomy and drainage device implants do not achieve complete postoperative success and medication independence, and this in some cases is not recognized until the follow-up appointment. miDOC can change this.

“Intraoperative measurement of aqueous outflow has not previously been possible during ophthalmic surgery. This capability has the potential to transform outflow-based surgical interventions by advancing the field toward high-precision biometry and improved clinical outcomes,” Kamthan said.

Early clinical experience with miDOC

The technology was first used in patients in July 2025, and to date, 20 cases have been completed. The investigators reported that all procedures were completed successfully with intraoperative biometric guidance.

miDOC enabled continuous measurement of key parameters intraoperatively that included the IOP, flow, outflow facility, and ocular rigidity/compliance. Ianchulev and Kamthan pointed out that these measurements provide new insight into how surgical interventions affect the eye in real time.

Potential applications in ophthalmology

In addition to its usefulness in glaucoma surgery, miDOC may be extended into other ophthalmic procedures, such as cataract surgery, to identify patients who may have a significant spike in IOP during the immediate recovery period to prevent irreversible visual damage.

The investigators also explained that miDOC may detect the choroidal blood flow, which provides essential oxygen and nutrients to the outer retina, particularly the macula, which is responsible for the central vision. Understanding the health of the choroid could inform retinal surgeons about potential chorioretinal diseases, they explained.

Other areas that may benefit from the insights provided by miDOC are the cerebrovascular, cardiac, and lymphatic physiologies, which could have implications for the rest of the body.

Future development

The press release also noted that the investigators are planning to further refine miDOC and pursue regulatory pathways for its broader clinical use. The device is currently investigational and has not yet received clearance from the US FDA.

A patent for this technology was filed through Mount Sinai, and the technology is currently unlicensed. The inventors and Mount Sinai would financially benefit if this technology is approved and commercialized. miDOC was developed with funding from Mount Sinai Innovation Partners.