New tool an eye-opening advancement in treating glaucoma

By Marissa Harshman, Columbian Health Reporter



A snorkel-shaped device no bigger than a flea is the latest technology offering relief to Clark County residents with glaucoma.

The titanium device is only 1 millimeter long and one-third millimeter tall, but it has the potential to make a big difference in the lives of people with mild to moderate glaucoma.

The device offers an alternative to traditional methods of treating glaucoma, an alternative more advanced than medicated eyedrops but less intensive than surgery, said Dr. Silvio Gurdian, an eye surgeon for 15 years.

Gurdian has implanted the device, called the iStent, in two area residents since beginning to offer the procedure earlier this summer at the Vancouver Eye Care ambulatory eye center. He hopes the procedure will help to prevent the riskier surgeries required for advanced glaucoma.

“Surgical advances in glaucoma have been challenging and slow to be adopted by eye surgeons due to complexity, cost and high risk of complications,” he said. “Therefore, many patients with glaucoma remain undertreated.”

Glaucoma affects millions of people and is one of the leading causes of blindness in the U.S., according to the Mayo Clinic.

Glaucoma is not a single eye disease but rather a group of eye conditions causing optic nerve damage that can result in vision loss. Most often, the damage is caused by abnormally high pressure in the eye, according to Mayo Clinic.

The pressure is due to a buildup of fluid that normally flows in and out of the eye through a drainage system where the iris (colored part of the eye) and the cornea (clear tissue on the eye’s surface) meet, according to Mayo Clinic.

Glaucoma can’t be cured and damage can’t be reversed, but treatment can reduce the pressure and prevent or slow vision loss.

Long-sought remedy?

Medicated eyedrops are the first method of treatment. Laser eye surgery to open clogged drainage canals is a more advanced treatment. And eye surgery is typically the last resort, Gurdian said.

People who are nearly blind or are facing impending blindness are treated with eye surgery, a procedure called trabeculectomy. The surgery has a high risk of complications, though, and is typically only performed by a few eye surgeons with extensive experience. The procedure is tough on patients, too, requiring about three months to recover from the blurred vision and discomfort associated with the surgery, Gurdian said.

“The world of ophthalmology has been looking for another procedure for a long time,” he said.

The iStent appears to be that long-sought procedure.

Gurdian compares the iStent to a heart stent. While a heart stent is used to open arteries, the iStent is used to pry open a clogged vein in the eye. The stent is placed in the vein at the root of the iris.

“We are catheterizing this microscopic blood vein,” he said.

Inserting an iStent is safer for the patient, less risky for the surgeon and more cost-effective than traditional eye surgery, Gurdian said.

The U.S. Food and Drug Administration approved the iStent device in June 2012. Gurdian underwent training with the company that manufactured the device, Glaukos Corp., and performed his first procedure in July.

The procedure is only approved in conjunction with cataract surgery, Gurdian said. While not every patient with cataracts has glaucoma, many do. That’s likely because both diseases progress with age, he said.

The device implantation takes less than 5 minutes, Gurdian said.

“It was a simple, fast procedure,” Gurdian said. “There’s very little, if any, risk.”

Gurdian hopes the simple procedure can prevent more severe glaucoma and advanced vision loss.

“I hope to see the end of end-stage glaucoma,” he said.

Marissa Harshman: 360-735-4546;;;