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Dickerson JE, Harvey AE, Brown RH. Ab Interno Canaloplasty and Trabeculotomy Outcomes for Mild, Moderate, and Advanced Open-Angle Glaucoma: A ROMEO Analysis. Clin Ophthalmol 2024; 18:1433-1440. [PMID: 38803557 PMCID: PMC11129760 DOI: 10.2147/opth.s464233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 05/16/2024] [Indexed: 05/29/2024] Open
Abstract
Purpose To determine if there was an association between severity of glaucoma and intraocular pressure (IOP) and medication (med) outcomes for patients in the ROMEO (Retrospective, Observational, Multicenter Evaluation of OMNI) study. Setting Eleven ophthalmology practices in 8 US states. Design Post-hoc analysis of all eyes enrolled and treated with ab interno canaloplasty and trabeculotomy in the retrospective, multicenter ROMEO study. Methods Eyes were grouped according to visual field mean deviation (MD): mild (MD better than -6 dB), moderate (MD between -6 and -12 dB), advanced (-12 dB or worse). IOP and med outcomes at 12 months were compared across groups. Least squares regression was used to assess the relationship of MD with month 12 IOP. Outcomes for 1st and last MD deciles were compared as a sensitivity analysis. Results One hundred and twenty-seven eyes were available for analysis including 79 mild, 42 moderate, 6 advanced. Most eyes had a reduction in IOP at Month 12 (70%) with most at 18 mmHg or less. Percentage IOP reduction was similar across the groups (mild 16.9%, moderate 18.6%, advanced 18.0%) with mean month 12 IOP between 14 and 16 mmHg. Medications were also reduced in all three groups; -0.8 (mild, P < 0.001), -0.55 (moderate, P < 0.05), and -1.0 (advanced, P = 0.139, ns). Regression analysis revealed no relationship between month 12 IOP and MD. Med reductions were observed for all groups with a reduction of 1 or more medications seen in (%, 95% CI) 69%, 59-79 (mild), 50%, 35-65 (moderate), and 60%, 21-99 (advanced). Secondary interventions tended to have greater incidence with worse MD likely reflecting lower desired IOP targets. Conclusion Analysis of data from the ROMEO study suggests that similar meaningful IOP and med reductions can be expected across the range of disease severity studied.
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Affiliation(s)
- Jaime E Dickerson
- Sight Sciences, Inc., Menlo Park, CA, USA
- North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX, USA
| | | | - Reay H Brown
- Sight Sciences, Inc., Menlo Park, CA, USA
- Atlanta Ophthalmology Associates, Atlanta, GA, USA
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Smith AK, Kwan CC, Fox A, Noh S, Gustafson K, Lin KY, Mosaed S. Prospective Study of Canaloplasty and Trabeculotomy Performed by Trainees. Clin Ophthalmol 2024; 18:17-26. [PMID: 38192581 PMCID: PMC10771790 DOI: 10.2147/opth.s441834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/20/2023] [Indexed: 01/10/2024] Open
Abstract
Purpose To evaluate outcomes of new adopters of the OMNI® Surgical System (Sight Sciences, Inc.) by prospectively evaluating intermediate-term outcomes of patients operated by trainees. Patients and Methods This was a prospective study of surgeries performed by trainees on patients with open angle glaucoma undergoing simultaneous cataract surgery and ab interno canaloplasty and trabeculotomy using the OMNI Surgical System. Pre-operative intraocular pressure (IOP) and number of glaucoma medications were recorded. Only patients with a minimum of 6-month follow up were included. Baseline IOP was used to separate subjects into two groups: Group 1 (IOP ≥18 mmHg) and Group 2 (IOP <18 mmHg). Mean decrease in IOP and medications was calculated and compared with paired t-tests for the overall sample as well as the subgroups. Success was defined as those with a ≥20% reduction from pre-operative IOP or with an IOP ≤18 mmHg and ≥6 mmHg and on the same or fewer number of medications while not requiring additional surgery. Adverse events were also recorded. Results Forty-two eyes of 31 patients were included. Mean pre-operative IOP was 17.2 ± 4.8 mmHg and mean number of medications was 2.4 ± 1.2. The primary endpoint was reached in 83.3% of patients at 12 months. IOP was reduced by 22.3% to 13.4 ± 2.4 (p<0.001). Mean number of medications decreased to 1.7 ± 1.6 (p<0.001). Group 1 mean IOP decreased 35.4% from 22.2 ± 4.6 mmHg to 14.3 ± 2.8 mmHg (p<0.001). Group 2 mean number of medications decreased from 2.3 ± 1.1 to 1.6 ± 1.5 (p<0.001). Conclusion When operated on by the novice MIGS surgeon, the OMNI device provides effective IOP and glaucoma medication reduction with minimal adverse events. Efficacy and safety of the device in the hands of trainees was comparable to experienced glaucoma surgeons suggesting its ease of adoption.
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Affiliation(s)
- Andrew K Smith
- School of Medicine, University of California, Irvine, CA, USA
- Department of Ophthalmology, Gavin Herbert Eye Institute, Irvine, CA, USA
- Department of Ophthalmology, Tibor Rubin Veteran Affairs Medical Center, Long Beach, CA, USA
| | - Changyow C Kwan
- School of Medicine, University of California, Irvine, CA, USA
- Department of Ophthalmology, Gavin Herbert Eye Institute, Irvine, CA, USA
- Department of Ophthalmology, Tibor Rubin Veteran Affairs Medical Center, Long Beach, CA, USA
| | - Austin Fox
- School of Medicine, University of California, Irvine, CA, USA
- Department of Ophthalmology, Gavin Herbert Eye Institute, Irvine, CA, USA
- Department of Ophthalmology, Tibor Rubin Veteran Affairs Medical Center, Long Beach, CA, USA
| | - Stephanie Noh
- School of Medicine, University of California, Irvine, CA, USA
- Department of Ophthalmology, Gavin Herbert Eye Institute, Irvine, CA, USA
- Department of Ophthalmology, Tibor Rubin Veteran Affairs Medical Center, Long Beach, CA, USA
| | - Kevin Gustafson
- School of Medicine, University of California, Irvine, CA, USA
- Department of Ophthalmology, Gavin Herbert Eye Institute, Irvine, CA, USA
- Department of Ophthalmology, Tibor Rubin Veteran Affairs Medical Center, Long Beach, CA, USA
| | - Ken Y Lin
- School of Medicine, University of California, Irvine, CA, USA
- Department of Ophthalmology, Gavin Herbert Eye Institute, Irvine, CA, USA
- Department of Biomedical Engineering, University of California, Irvine, CA, USA
| | - Sameh Mosaed
- School of Medicine, University of California, Irvine, CA, USA
- Department of Ophthalmology, Gavin Herbert Eye Institute, Irvine, CA, USA
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Greenwood MD, Yadgarov A, Flowers BE, Sarkisian SR, Ohene-Nyako A, Dickerson JE. 36-Month Outcomes from the Prospective GEMINI Study: Canaloplasty and Trabeculotomy Combined with Cataract Surgery for Patients with Primary Open-Angle Glaucoma. Clin Ophthalmol 2023; 17:3817-3824. [PMID: 38105915 PMCID: PMC10725746 DOI: 10.2147/opth.s446486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/08/2023] [Indexed: 12/19/2023] Open
Abstract
Purpose To provide long-term intraocular pressure (IOP) and ocular hypotensive medication usage outcomes through 36 months for patients treated with canaloplasty and trabeculotomy (OMNI Surgical System) combined with cataract surgery as participants in the GEMINI study. Setting Eleven ophthalmology practices in 10 US states. Design Non-interventional 36-month extension of the 12-month, prospective, multicenter, GEMINI study. Methods GEMINI patients had visually significant cataract, mild-to-moderate glaucoma (ICD-10 guidelines), medicated IOP <33 mmHg, and unmedicated mean diurnal IOP (DIOP) (after washout) 21-36 mmHg. Patients from GEMINI were eligible for inclusion. Outcome measures were reduction in mean unmedicated DIOP, reduction in mean IOP-lowering medications, percent of eyes with ≥20% reduction in unmedicated DIOP, and percent of eyes with unmedicated DIOP ≥6 and ≤18 mmHg. Results A total of 66 patients provided consent and were enrolled. Mean (SD) unmedicated DIOP was 23.1 (2.7) mmHg at baseline, 16.7 (4.1), 16.3 (3.3) at 24 and 36 months; mean reductions of 6.2 (4.1) and 6.9 (3.4) mmHg. Twelve-month IOP at the end of GEMINI was 15.6 mmHg. The proportion of eyes with ≥20% reduction in IOP was 77% and 78% (months 24 and 36) compared to 87% at month 12 from GEMINI. About 68% of patients had an IOP between 6 and 18 mmHg at 24 months and 71% at 36 months. Mean IOP-lowering medications was 1.7 at baseline, which was reduced to 0.4 (24 months, -1.3) and 0.3 (36 months, -1.4). About 74% of patients (46 of 62) were medication free at 36 months. Conclusion GEMINI demonstrated 12-month effectiveness of canaloplasty and trabeculotomy with OMNI combined with cataract surgery for IOP and medication reduction in mild-to-moderate glaucoma. However, longer-term data is key to the decision making in the selection of a surgical treatment. This GEMINI extension demonstrates that the 12-month outcomes from GEMINI were sustained through 36 months.
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Affiliation(s)
| | | | | | | | | | - Jaime E Dickerson
- Sight Sciences, Menlo Park, CA, USA
- North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - On behalf of the GEMINI 2 STUDY GROUP
- Vance Thompson Vision, West Fargo, ND, USA
- Omni Eye Services, Atlanta, GA, USA
- Ophthalmology Associates, Fort Worth, TX, USA
- Oklahoma Eye Surgeons, Oklahoma City, OK, USA
- Sight Sciences, Menlo Park, CA, USA
- North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX, USA
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Chan PPM, Larson MD, Dickerson JE, Mercieca K, Koh VTC, Lim R, Leung EHY, Samuelson TW, Larsen CL, Harvey A, Töteberg-Harms M, Meier-Gibbons F, Shu-Wen Chan N, Sy JB, Mansouri K, Zhang X, Lam DSC. Minimally Invasive Glaucoma Surgery: Latest Developments and Future Challenges. Asia Pac J Ophthalmol (Phila) 2023; 12:537-564. [PMID: 38079242 DOI: 10.1097/apo.0000000000000646] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/12/2023] [Indexed: 12/21/2023] Open
Abstract
The development of minimally invasive glaucoma surgeries (MIGSs) was intended to provide safe and modestly efficacious modalities for early intervention of mild-to-moderate glaucoma, with minimal trauma and rapid recovery. They were mainly ab interno procedures that reduce intraocular pressure by facilitating the aqueous outflow by bypassing the trabecular meshwork resistance, reinforcing the uveoscleral flow via the supraciliary space, and reducing aqueous production by the ciliary body. While the cumulating evidence helps shape the role of the available MIGS, the exponential new development and advancement in this field has expanded the territory of MIGS. Apart from developing subconjunctival MIGS filtration devices (Xen gel stent and PRESERFLO MicroShunt), there is a tendency to revisit the "traditional" MIGS for alternative use and to modify the procedures with consideration of the fundamental aqueous outflow physiology. Combined MIGS has also been suggested, based on the theory that their different mechanisms may provide additive or synergistic effects. The advancement of laser procedures is also promising and could supplement unmet needs along the glaucoma treatment algorithm. This review examines the broad array of MIGS, updates the recent findings, discusses their potential alternative applications, and explores future challenges.
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Affiliation(s)
- Poemen P M Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Department of Ophthalmology and Visual Sciences, Lam Kin Chung. Jet King-Shing Ho Glaucoma Treatment and Research Centre, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Jaime E Dickerson
- Sight Sciences, Menlo Park, CA, USA
- University of North Texas Health Science Center, North Texas Eye Research Institute, Fort Worth, TX, USA
| | | | - Victor Teck Chang Koh
- Department of Ophthalmology, National University Health System, Singapore
- Centre for Innovation and Precision Eye Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ridia Lim
- Department of Ophthalmology, Sydney Eye Hospital, Sydney, Australia
- Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Enne Hiu Ying Leung
- The C-MER Dennis Lam & Partners Eye Center, C-MER International Eye Care Group, Hong Kong, China
| | - Thomas W Samuelson
- Minnesota Eye Consultants, Bloomington, MN, US
- Department of Ophthalmology, University of Minnesota, MN, US
| | - Christine L Larsen
- Minnesota Eye Consultants, Bloomington, MN, US
- Department of Ophthalmology, University of Minnesota, MN, US
| | | | - Marc Töteberg-Harms
- Department of Ophthalmology, Augusta University, Medical College of Georgia, Augusta, GA, USA
| | | | | | - Jessica Belle Sy
- Department of Ophthalmology, Sydney Eye Hospital, Sydney, Australia
- Baguio General Hospital and Medical Center, Baguil City, Benguet, Philippines
| | - Kaweh Mansouri
- Glaucoma Center, Swiss Visio, Clinique de Montchoisi, Lausanne, Switzerland
| | - Xiulan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Dennis S C Lam
- The C-MER Dennis Lam & Partners Eye Center, C-MER International Eye Care Group, Hong Kong, China
- The International Eye Research Institute of The Chinese University of Hong Kong (Shenzhen), Shenzhen, China
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