In my experience, the main benefit of canaloplasty is the IOP-lowering effect combined with the less-invasive approach. Patients have been so happy with it. All of my patients have done extremely well postoperatively. Additional benefits to the procedure are that there is no bleb or negligible ocular surface irritation, and postoperative recovery of vision is much more rapid than after standard trabeculectomy.
Canaloplasty's effect on IOP has been excellent in my patients. I have witnessed about a 30% to 40% reduction in IOP. All the patients I have referred to Steven Vold, MD, have had moderate-to-advanced glaucoma and were on at least two or three medications. Dr. Vold has combined most of the canaloplasties with a cataract extraction as well. As a result, my patients come back to me about 4 to 6 weeks postoperatively with the benefit of not only getting off their glaucoma medications but also seeing better.
I have seen no complications and no IOP spikes or hypotony with this procedure. For my patients that are 12 to 18 months out, there has been no long-term IOP drift, and IOP has been maintained off medication. I am more apt to refer people for canaloplasty more quickly, just because the results have been better than with standard incisional glaucoma surgery. In the past, I was always slightly hesitant to refer someone for trabeculectomy.
Most optometrists would be more comfortable observing patients with canaloplasty over a trabeculectomy, just because there are fewer complications. A key to my success with this procedure is that Dr. Vold and I work very closely together on the management of these patients. Communication is critical, as his practice is more than an hour's drive from my office. He manages the early postoperative care and returns my patients to me once their examination stabilizes. I have observed the surgery and understand how the surgery uses the natural anatomy of the eye to allow the drainage pathway to function more efficiently.
Michael R. McFarland, OD, is in practice at the Berryville Eye Clinic in Berryville, Arkansas. He earned the 2007 Norman E. Wallis Award for Excellence presented by the National Board of Examiners in Optometry for receiving the highest optometry board score in the United States. He acknowledged no financial interest in the products or companies mentioned herein. Dr. McFarland may be reached at mikemcfarlandopt@gmail.com.
