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Chan L, Moster MR, Bicket AK, Sheybani A, Sarkisian SR, Samuelson TW, Ahmed IIK, Miller-Ellis E, Smith OU, Cui QN. New Devices in Glaucoma. Ophthalmol Ther 2023; 12:2381-2395. [PMID: 37558818 PMCID: PMC10441989 DOI: 10.1007/s40123-023-00780-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 07/20/2023] [Indexed: 08/11/2023] Open
Abstract
Glaucoma remains a leading cause of blindness globally. Minimally invasive treatment techniques are rapidly expanding the availability of therapeutic options for glaucoma. These include devices aimed at enhancing outflow through the subconjunctival space, Schlemm's canal, and suprachoroidal space, sustained-release drug delivery devices, and extraocular devices aiming to reduce glaucomatous progression through other novel means. In this review, we provide an overview of several novel devices either newly available or in development for the medical and surgical management of glaucoma. Further studies are required to determine the long-term efficacy of these devices and how they will integrate into the current landscape of glaucoma management.
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Affiliation(s)
- Lilian Chan
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, 51 North 39th St., Philadelphia, PA, 19104, USA
| | | | - Amanda K Bicket
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, Medical School, University of Michigan, 1000 Wall St, Ann Arbor, MI, 48105, USA
| | - Arsham Sheybani
- Washington University School of Medicine, 660 South Euclid Ave, Campus Box 8096, St Louis, MO, 63110, USA
| | - Steven R Sarkisian
- Oklahoma Eye Surgeons, 5600 N Portland Ave, Oklahoma City, OK, 73112, USA
| | - Thomas W Samuelson
- Minnesota Eye Consultants, University of Minnesota, 909 Fulton St SE, Minneapolis, MN, 55455, USA
| | - Iqbal Ike K Ahmed
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
- Prism Eye Institute, Mississauga, Canada
- John A. Moran Eye Center, University of Utah, 65 Mario Capecchi Drive, Salt Lake City, UT, 84132, USA
| | - Eydie Miller-Ellis
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, 51 North 39th St., Philadelphia, PA, 19104, USA
| | - Oluwatosin U Smith
- Glaucoma Associates of Texas, 10740 N. Central Expy, Suite 300, Dallas, TX, 75231, USA
| | - Qi N Cui
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, 51 North 39th St., Philadelphia, PA, 19104, USA.
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Samuelson TW, Ferguson TJ, Brubaker JW, Bacharach J, Gallardo MJ, Chaglasian M, Comer G, Yoo P. Negative Pressure Application via a Multi-Pressure Dial to Lower IOP in Patients with Suspected Glaucoma or Open Angle Glaucoma. J Glaucoma 2023; 32:708-720. [PMID: 37171994 DOI: 10.1097/ijg.0000000000002231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 04/16/2023] [Indexed: 05/14/2023]
Abstract
PRCIS The multi-pressure dial applies localized periocular negative pressure to safely and effectively lower IOP and represents the first non-invasive, non-pharmacologic device for IOP reduction. OBJECTIVE To evaluate the safety and effectiveness of the Multi-Pressure Dial (MPD) system, a device that applies periocular negative pressure to lower intraocular pressure (IOP). SETTING 6 investigational sites, United States. DESIGN Prospective, assessor-masked, randomized controlled trial. METHODS Subjects with suspected glaucoma, ocular hypertension (OHTN), and open angle glaucoma (OAG) with baseline IOP ≥13 mmHg and ≤32 mmHg were enrolled. One eye of each subject was randomized to receive negative pressure application; the fellow eye served as a control. The study eye negative pressure setting was programmed for 60% of the baseline IOP. The primary effectiveness endpoint was the proportion of study eyes versus control eyes achieving an IOP reduction ≥20% at Day 90. Secondary endpoints included the proportion of eyes achieving an IOP reduction ≥25% at Day 90 as well as the proportion of eyes achieving an IOP reduction ≥20% at Days 30 and 60. RESULTS 116 eyes of 58 subjects completed the study. At the Day 90 visit, 89.7% ( n =52) of study eyes versus 3.4% ( n =2) of control eyes achieved an IOP reduction ≥20% ( P <0.001). At Day 90, 77.6% ( n =45) of study eyes achieved a ≥25% IOP reduction compared to 1.7% ( n =1) of control eyes ( P <0.001). The most commonly reported adverse events were lid (17.2% study eye, 7.8% control eye) and periorbital edema (14.1% study eye, 10.9% control eye). CONCLUSIONS This trial demonstrates that the MPD safely and effectively lowers IOP in a group of patients that included glaucoma suspects, OHTN, and patients with OAG.
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Affiliation(s)
| | | | | | | | - Mark J Gallardo
- El Paso Eye Surgeons, El Paso, TX, USA
- University of Texas Health Sciences Center, San Antonio, TX, USA
| | | | - George Comer
- Southern California College of Optometry, Fullerton, CA, USA
| | - Paul Yoo
- Equinox Ophthalmic, Inc., Newport Beach, CA, USA
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Safa BN, Bleeker A, Berdahl JP, Ethier CR. The Effects of Negative Periocular Pressure on Biomechanics of the Optic Nerve Head and Cornea: A Computational Modeling Study. Transl Vis Sci Technol 2023; 12:5. [PMID: 36745441 PMCID: PMC9910383 DOI: 10.1167/tvst.12.2.5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Purpose The purpose of this study was to evaluate the effects of negative periocular pressure (NPP), and concomitant intraocular pressure (IOP) lowering, on the biomechanics of the optic nerve head (ONH) and cornea. Methods We developed a validated finite element (FE) model of the eye to compute tissue biomechanical strains induced in response to NPP delivered using the Multi-Pressure Dial (MPD) system. The model was informed by clinical measurements of IOP lowering and was based on published tissue properties. We also conducted sensitivity analyses by changing pressure loads and tissue properties. Results Application of -7.9 mmHg NPP decreased strain magnitudes in the ONH by c. 50% whereas increasing corneal strain magnitudes by c. 25%. Comparatively, a similar increase in corneal strain was predicted to occur due to an increase in IOP of 4 mmHg. Sensitivity studies indicated that NPP lowers strain in the ONH by reducing IOP and that these effects persisted over a range of tissue stiffnesses and spatial distributions of NPP. Conclusions NPP is predicted to considerably decrease ONH strain magnitudes. It also increases corneal strain but to an extent expected to be clinically insignificant. Thus, using NPP to lower IOP and hence decrease ONH mechanical strain is likely biomechanically beneficial for patients with glaucoma. Translational Relevance This study provides the first description of how NPP affects ONH biomechanics and explains the underlying mechanism of ONH strain reduction. It complements current empirical knowledge about the MPD system and guides future studies of NPP as a treatment for glaucoma.
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Affiliation(s)
- Babak N. Safa
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University, Atlanta, GA, USA
| | - Adam Bleeker
- Dean McGee Eye Institute Department of Ophthalmology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - John P. Berdahl
- Equinox Ophthalmic, Newport Beach, CA, USA,Vance Thompson Vision, Sioux Falls, SD, USA
| | - C. Ross Ethier
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University, Atlanta, GA, USA
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Kamalipour A, Moghimi S, Inpirom VR, Mahmoudinezhad G, Weinreb RN. Multipressure Dial Goggle Effects on Circumpapillary Structure and Microvasculature in Glaucoma Patients. Ophthalmol Glaucoma 2022; 5:572-580. [PMID: 35605936 PMCID: PMC10566504 DOI: 10.1016/j.ogla.2022.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/25/2022] [Accepted: 05/16/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the effects of pressure changes induced by a multipressure dial (MPD) on circumpapillary retinal nerve fiber layer (RNFL) and capillary density (CD) measurements in patients with glaucoma using OCT angiography (OCTA). DESIGN Prospective interventional study. PARTICIPANTS Twenty-four patients with primary open-angle glaucoma. METHODS One eye of each patient underwent negative pressure application with the MPD. The MPD alters intraocular pressure (IOP) relative to atmospheric pressure by generating a negative pressure vacuum within a goggle chamber that is placed over the eye. Each participant underwent serial high density OCTA imaging (AngioVue) of the optic nerve head at different negative pressure increments of -5 mmHg, starting from 0 mmHg, ending at -20 mmHg, and then returning to baseline. Images were acquired after 2 minutes of sustained negative pressure at each target pressure to allow for stabilization of the retinal structures and microvasculature. The RNFL thickness and CD measurements were automatically calculated using the native AngioVue software, and then exported for analysis. MAIN OUTCOME MEASURES The influence of different levels of negative pressure on circumpapillary RNFL thickness and CD measurements, assessed by a linear mixed-effects model with repeated measures. RESULTS The mean (± SD) age was 71.0 years (± 7.8 years), the baseline IOP was 17.5 mmHg (± 3.6 mmHg), and there was a mean 24-2 mean deviation of -2.80 dB (± 2.55 dB). Serial circumpapillary CD measurements showed a statistically significant dose-dependent increase from baseline, without negative pressure application, to the maximum negative pressure application of -20 mmHg (difference, 2.27%; P = 0.010). Capillary density measurements then decreased symmetrically when lowering the negative pressure to baseline. Circumpapillary CD measurements at target negative pressures of -10 mmHg, -15 mmHg, and -20 mmHg were significantly higher than the baseline measurements (all P values < 0.05). Circumpapillary RNFL thickness remained the same throughout different levels of negative pressure. CONCLUSIONS Circumpapillary CD measurements showed a dose-dependent increase with the induction of negative pressure, while RNFL thickness measurements remained unchanged.
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Affiliation(s)
- Alireza Kamalipour
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, CA
| | - Sasan Moghimi
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, CA
| | - Veronica R Inpirom
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, CA
| | - Golnoush Mahmoudinezhad
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, CA
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, CA.
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Structural and Metabolic Imaging After Short-term Use of the Balance Goggles System in Glaucoma Patients: A Pilot Study. J Glaucoma 2022; 31:634-638. [PMID: 35696700 PMCID: PMC9378591 DOI: 10.1097/ijg.0000000000002066] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 06/01/2022] [Indexed: 02/04/2023]
Abstract
PRCIS Short-term use of the Balance Goggles System (BGS) in glaucoma patients was not associated with the observable changes in conventional ocular coherence tomography (OCT) imaging, but metabolic imaging using peripapillary flavoprotein fluorescence (FPF) may represent a useful adjuctive investigation. OBJECTIVE To determine whether the intraocular pressure (IOP)-lowering effects of the BGS are accompanied by changes in retinal thickness measured by OCT, retinal vascular density measured by ocular coherence tomography-angiography (OCTA), or novel peripapillary metabolic profiling using FPF measured by a fundus camera. DESIGN Prospective comparative case-series. SUBJECTS Eight eyes from 8 patients with open angle glaucoma ranging from mild to severe. METHODS In this prospective, single-center, open-label, nonrandomized, and single-arm study patients received a baseline evaluation including retinal imaging, then 1 hour of negative pressure application through the BGS, followed by repeat retinal imaging. Participants then used the BGS at home for 1 month and underwent a repeat evaluation at the conclusion of the trial. MAIN OUTCOME MEASURES Changes in nerve fiber layer thickness, OCTA vascular parameters, and FPF scores. RESULTS Mean baseline IOP was 18.0±3.1 mmHg and there was no significant change in IOP at follow-up. At 1 month compared with baseline, there was a statistically significant improvement in FPF optic nerve head rim scores (12.7±11.6 to 10.5±7.5; P =0.04). In addition, there was a trend toward an increase in retinal nerve fiber layer thickness after 1 month (69.5±14.2 to 72.0±13.7; P =0.1), but there were no statistically significant differences observable with any of the OCTA vascular parameters either at 1 hour or after 1 month. CONCLUSIONS There were no significant changes observable using conventional OCT imaging after short-term use of the BGS, although metabolic imaging using FPF may be a useful potential biomarker to complement existing investigations. Additional studies are warranted to further investigate these changes.
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Brambilla E, Ferguson TJ, Chu N, Ammar D, Yoo P. Intraocular Pressure Measurement with Pneumatonometry and a Tonometer Tip Cover During Negative Pressure Application. Clin Ophthalmol 2022; 16:1289-1300. [PMID: 35502158 PMCID: PMC9056074 DOI: 10.2147/opth.s359605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/13/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose This is a 2-part study to investigate the agreement between pneumatonometry and direct pressure transducer intraocular pressure (IOP) measurements in a perfusion organ culture (POC) model where (1) the perfusion fluid column is open to atmospheric pressure, holding IOP constant to permit evaluation of the impact of negative pressure (NP) on IOP measurements, and (2) the perfusion fluid column is a closed system, allowing IOP to vary with NP application. Methods The first part incorporated a fluid column open to atmospheric pressure, maintaining IOP constant to permit evaluation of the effect of applied NP on IOP measurement accuracy. In the second part, the POC column was closed, allowing IOP to vary with NP application and permit evaluation of agreement between pneumatonometry and pressure transducer measurements. In each part, four perfused tissues were used in thirteen paired pre-set IOP (10, 20, 25, 30 mmHg) and NP (0, 5, 10, 15, 20 mmHg) combinations, resulting in a total of 1040 paired measurements (520 per study). The difference in IOP measurements (Δ IOP = Excursion tonometry – pressure transducer) was calculated at each paired configuration. Results During the first part, the mean Δ IOP was −0.7 ± 1.6 mmHg across all measurements. During the second part, the mean Δ IOP across all measurements was +0.7 ± 1.4 mmHg. At NP settings of −5, −10, −15, and −20 mmHg, across all pre-set IOPs, the mean IOP reduction via Excursion tonometry was 3.1 ± 0.3, 5.6 ± 1.3, 8.5 ± 1.7 and 11.2 ± 1.8 mmHg, respectively. Conclusion Measurement of IOP via Excursion tonometry yields results within the accuracy range of the pneumatonometry device (per manufacturer) and is minimally impacted by NP application. The IOP-lowering results are consistent with previous studies and further support the effectiveness of the Multi-Pressure Dial in lowering IOP relative to atmospheric pressure.
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Affiliation(s)
| | - Tanner J Ferguson
- Vance Thompson Vision, Sioux Falls, SD, USA
- Correspondence: Tanner J Ferguson, Vance Thompson Vision, 3101 W. 57th St, Sioux Falls, SD, USA, Email
| | - Nathan Chu
- Equinox Ophthalmic, Inc., Newport Beach, CA, USA
| | - David Ammar
- Lions Eye Institute for Transplant & Research, Tampa, FL, USA
| | - Paul Yoo
- Equinox Ophthalmic, Inc., Newport Beach, CA, USA
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Shafer B, Ferguson TJ, Chu N, Brambilla E, Yoo P. The Effect of Periocular Negative Pressure Application on Intraocular and Retrobulbar Pressure in Human Cadaver Eyes. Ophthalmol Ther 2021; 11:365-376. [PMID: 34910290 PMCID: PMC8770790 DOI: 10.1007/s40123-021-00442-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/29/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction To investigate the effect of applying negative pressure (vacuum) to the periocular space on intraocular pressure (IOP) and retrobulbar pressure (RBP) by use of the Multi-Pressure Dial (MPD) system (Equinox Ophthalmic, Inc.). Methods Two eyes of two full body cadavers were studied. In each subject, the retrobulbar space, posterior segment and intra-goggle space were cannulated to provide direct IOP, RBP and intra-goggle pressure measurements via a pressure transducer data acquisition system. The goggles of the MPD system were placed over the eyes of each subject, and multiple test runs were performed, with negative pressure settings programmed to 5, 10 and 20 mmHg. IOP and RBP measurements were continuously obtained during each run and plotted against time for analysis. Results For both subjects, the mean reduction (± standard deviation) in IOP was 1.6 ± 0.9 (10%), 3.5 ± 1.8 (23%) and 5.6 ± 2.0 (37%) mmHg at programmed negative pressure levels of − 5, − 10 and − 20 mmHg, respectively. The overall mean change in RBP (mmHg) during negative pressure application was 0.02 ± 0.14 at − 5 mmHg, 0.03 ± 0.19 at − 10 mmHg and − 0.01 ± 0.18 at − 20 mmHg. In both subjects, the magnitude of RBP change during application of negative pressure fell below the uncertainty of the measurement system. Conclusions The application of negative pressure to the periocular space with the MPD decreases IOP but does not affect RBP. Supplementary Information The online version contains supplementary material available at 10.1007/s40123-021-00442-2.
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Affiliation(s)
| | | | - Nathan Chu
- Equinox Ophthalmic, Inc., Newport Beach, CA, USA
| | | | - Paul Yoo
- Equinox Ophthalmic, Inc., Newport Beach, CA, USA
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Short-term Evaluation of Negative Pressure Applied by the Multi-Pressure Dial System to Lower Nocturnal IOP: A Prospective, Controlled, Intra-subject Study. Ophthalmol Ther 2021; 10:349-358. [PMID: 33871812 PMCID: PMC8079468 DOI: 10.1007/s40123-021-00343-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/26/2021] [Indexed: 12/19/2022] Open
Abstract
Introduction The purpose of this study was to investigate the short-term safety and feasibility of negative pressure application by the Multi-Pressure Dial (MPD) System to lower nocturnal intraocular pressure (IOP) in subjects with open-angle glaucoma (OAG). Methods A prospective, controlled, intra-subject study of 22 eyes from 11 subjects at a single site was performed. All subjects had a history of OAG and were currently using a topical prostaglandin. For each subject, the eye with the highest IOP in the supine position was selected as the treatment eye (TE) and the contralateral eye served as the control eye (CE). The negative pressure for the TE was set to 60% of the baseline IOP value with no negative pressure in the CE. IOP measurements were collected at three prespecified time points overnight in the supine position with active negative pressure. The primary outcome measure was mean IOP with the application of negative pressure. Results At the three overnight time points, the mean (± standard deviation) baseline IOP prior to negative pressure application was 22.2 ± 2.5 mmHg in the TE and 21.8 ± 2.5 mmHg in the CE. With the application of 60% negative pressure to the TE and no active negative pressure to the CE, the mean IOP was 14.2 ± 2.2 and 19.5 ± 2.4 mmHg, respectively. The mean percentage IOP reduction in the TE was 35% (p < 0.001). There were two minor adverse events, both unrelated to device wear, and there were no IOP spikes ≥ 10 mmHg. Conclusion The MPD can safely and effectively lower nocturnal IOP in the supine position. The MPD holds promise as a potential new, non-invasive treatment option for the control of nocturnal IOP.
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