Glaucoma Surgery: Canaloplasty

Canaloplasty is a new type of glaucoma treatment that many hope will be safer and have fewer complications than current surgical options like trabeculotomy or other glaucoma surgeries. The goal of canaloplasty is to treat primary open angle glaucoma by reopening the body's natural drainage routes and keeping them open to keep intraocular pressure (IOP) low and prevent optic nerve damage that often results.

The Problem: Primary Open Angle Glaucoma

Primary open angle glaucoma results when the body's natural drainage route (known as Schlemm's canal) becomes clogged with detritus over time. The spongy angle remains open, unlike in angle closure glaucoma, but it loses its ability to drain sufficient aqueous humor, which leads to an increase in intraocular pressure as the new humor produced by the eye is unable to drain.

The Canaloplasty Solution

The goal of traditional trabeculotomy is to open new drainage routes through the sclera, tissue under the white of the eye. Canaloplasty strives to correct primary open angle glaucoma by reopening the natural drainage routes. A flap is created in the sclera, which allows the surgeon to identify and access Schlemm's canal. A cannula (small, flexible tube) is passed through Schlemm's canal. The cannula is followed by a suture (surgical thread). The surgical thread cinches and holds open the Schlemm's canal. This allows the eye to drain normally, and thus reduces the intraocular pressure to safe levels.

Canaloplasty Limitations

Canaloplasty is still a very new procedure. First described in 2006, it has not been widely adopted by glaucoma surgeons because many believe that a procedure which does not create a new drainage route cannot sufficiently reduce intraocular pressure. It also has a steep learning curve, so surgeons who have had good results with trabulectomy or other procedures are reluctant to learn a new method. These two factors have combined to slow the rate at which studies to prove the safety and effectiveness of this procedure can go forward.

Currently, canaloplasty is still considered an experimental procedure, and many insurance companies will not pay for it. But it is a promising glaucoma treatment that may some day contribute to the relief of many glaucoma sufferers.

The first step in glaucoma treatment is glaucoma diagnosis. If you have not been screened for glaucoma, find a local ophthalmologist who can prevent vision loss from this silent thief of sight.