Eyeworld

61 EW FEATURE September 2018 • Products that could change how you practice "We have a dearth of new treat- ment mechanisms for glaucoma," said Dr. Kahook, a member of the Equinox Advisory Board. "I will be excited to see data from a longer- term treatment with the Balance Goggles, and I think the company is completing these studies in a sys- tematic and precise way. They have a top-notch engineering and clinical team who are all meticulous." EW Reference 1. Berdahl JP, et al. Cerebrospinal fluid pressure is decreased in primary open-angle glaucoma. Ophthalmology. 2008;115:763–8. Editors' note: The physicians have financial interests with Equinox. Contact information Berdahl: john.berdahl@vancethompsonvision.com Kahook: malik.kahook@gmail.com Swan: russell.swan@vancethompsonvision.com on-demand, titratable way to set the person's eye pressure right where we want it to be," Dr. Berdahl said. Dr. Swan thinks this technology could be especially useful in hard- to-treat glaucoma. "I think it has broad utilization and opportunity in all areas of glau- coma. … For patients with normal tension glaucoma, who we have struggled to find reasonable options for and some of the surgical options like a trabeculectomy or a tube put them at significant risk, it's nice to have something in the pipeline that decreases patients' risk but still al- lows them to get to their IOP goal," Dr. Swan said. "My message to people would be to keep an open mind in terms of the opportunity. Having seen the clinical results and having worn them myself, knowing what the tolerability of them is, I think it's a unique opportunity for patients that has a high safety profile but also a high level of comfort," Dr. Swan said. Could the goggles eliminate the need for pharmacologic therapy? Dr. Berdahl said he thinks there is the potential but "I wouldn't hang my hat on it yet." "It's easy to put in a drop, and drops work well when they're used properly," he said. "[The goggles] give doctors one more tool in the toolkit to treat glaucoma, and I think the goggles will help us treat some of the toughest forms of glau- coma." He envisions that the goggles would be worn primarily at night when patients are sleeping and most vulnerable to nocturnal pressure spikes. "We think that is a time when patients are quite vulnerable to their eye pressure, so we can help during that difficult-to-treat time, and perhaps those with the most severe forms of glaucoma would wear them longer," he said. If born out in clinical trials, the Balance Goggles would provide a "nonsurgical, nonpharmacologic, to counteract higher CSF pressure that may occur, for example, during space flight when optic nerve swell- ing can lead to loss of vision." In December 2015, Dr. Berdahl founded Equinox, the company de- veloping the goggles, which he said should enter clinical multicenter trials within the next year. The trials will first test the goggles on a low- risk patient population that could be helped the most, Dr. Berdahl said. But because the concept of the goggles is physics, he and others in- volved with the company think the treatment could apply to any type of glaucoma. Dr. Berdahl thinks that treat- ment with the goggles, which would be set to a specific IOP-lowering lev- el by the ophthalmologist, custom- ized to patient needs, will be used as adjunctive therapy. "Drops and prior surgical procedures are effective at lowering IOP to a certain level, then for those who need additional IOP lowering, I think the goggles would be a great option," he said. Balance Goggles are based on the concept that both intraocular pressure and intracranial pressure can play a role in the development of sight-threatening glaucoma—and thus also play a role in its treatment. Source: John Berdahl, MD Vision 4 Mars D r. Berdahl and Equinox were included in the Vision 4 Mars Challenge, sponsored by the National Space Biomedical Research Institute, which awarded grants in 2015. Dr. Berdahl said he thinks travel to Mars will be "the most unifying moment in human history during our lives, but it won't happen if astro- nauts can't see." Projects spearheaded by Dr. Berdahl and others are play- ing a role in better understand- ing the pathologic process and developing countermeasures to protect astronauts' eyesight. In doing so, Dr. Berdahl said, he thinks "we played a small role in one of the most momentous moments in human history."

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