The decision to proceed with any surgical procedure is, for a patient, no small decision. A great deal of thought and research is required to make the correct choice. Dr. Sinskey explains why, for him, that choice was canaloplasty.
In the year 2000, I was on a cruise to Alaska with my family when I noticed that my contrast sensitivity was different between my two eyes. Upon returning home, I had my eyes checked in my practice. My IOP measured 26 mm Hg in my left eye and 17 mm Hg in my right. A slit-lamp examination showed that I had an exfoliation type of glaucoma. I started treatment with a single topical medication. Shortly thereafter, I underwent selective laser trabeculoplasty in my left eye.
After several years of selective laser trabeculoplasty efficacy, my IOP gradually increased, and I was placed on latanoprost (Xalatan; Pfizer Inc). At that point, I underwent argon laser trabeculoplasty in my left eye that decreased my IOP into the midteens. After about a year, my IOP began increasing again. I was treated with almost every class of glaucoma medication without much success. After consulting multiple glaucomatologists, it became clear to me that surgical intervention would be required to control my glaucoma.
During my surgical career, I performed and managed a large number of filtration procedures. After witnessing the numerous complications and often long, difficult postoperative courses involved with trabeculectomy, I wanted to avoid a bleb at all costs. After thoroughly exploring my options, I finally decided to proceed with canaloplasty.
I selected Richard Lewis, MD, to perform my surgery. After discussing the risks and benefits of canaloplasty with him, I underwent the procedure on July 28, 2010. On postoperative day 1, I had almost completely regained all of my vision and was able to conduct my normal activities of daily living; my IOP was 8 mm Hg but increased to 26 mm Hg over a 2-month period. At my 2-month postoperative visit, Dr. Lewis used a laser to open a hole in my Descemet's window. My IOP dropped to 10 mm Hg and has been stable off all topical medication since that time. Patients should be reassured constantly that it may take 2 to 3 months for the pressure to stabilize at a lower point after canaloplasty. Looking back, I cannot tell you how pleased I am with my postoperative outcome. Prior to canaloplasty, I was taking seven drops a day in my left eye. Eye drops were extremely irritating to my eye and completely occupied my life. Canaloplasty has significantly improved my quality of life.
After taking care of glaucoma patients for 45 years before I retired, experiencing glaucoma from a patient's perspective, doing the research on canaloplasty, and finally undergoing the procedure, I am certain that canaloplasty represents a major advance in glaucoma surgery. I think it behooves all ophthalmologists who treat glaucoma to add canaloplasty to their surgical armamentarium.
Robert M. Sinskey, MD, is medical director emeritus of the Southern California Lion's Eye Institute and clinical professor of ophthalmology at the Jules Stein Eye Institute at the University of California, Los Angeles. Dr. Sinskey is also a past president of the American Society of Cataract and Refractive Surgery and the founder of The Sinskey Eye Institute in Santa Monica, California, and the Robert M. Sinskey Pediatric Eye Care Clinic in Addis Ababa, Ethiopia. He acknowledged no financial interest in the product or company mentioned herein. Dr. Sinskey may be reached at (310) 393-0206; rsinsk@robertsinskey.com.
