Eyeworld

78 | EYEWORLD | FALL 2024 G UCOMA Relevant disclosures Lewis: ViaLase Singh: Alcon, BELKIN Vision, ELIOS Vision Contact Lewis: rlewismd1@gmail.com Singh: ipsingh@amazingeye.com the long term because SLT wears out in a year or two. I hope these results will be replicated in the randomized controlled trial that has been fully enrolled," he said. The pivotal trial has 152 patients random- ized, comparing femto/FLigHT to SLT. It is an outside the U.S. study, with 76 patients in each arm. "We're extending that study out to 3 years, with the initial data analysis being submitted to the FDA, hopefully in the fall. We hope for clear- ance sometime in 2025," Dr. Lewis said. Dr. Singh called the ViaLase procedure "groundbreaking and paradigm shifting be- cause this is a non-invasive procedure." You're performing a trabeculotomy without having to open up the eye, he said, adding that there's no cutting and no risk of infection. What's even more impressive are the diag- nostic capabilities, he said. "It has a 360 gonio- scopic imaging system, and it also has intraoper- ative OCT. It can allow us to truly see the angle in high definition better than any gonioscopic view." Currently, it may be hard to do smaller trabeculotomies temporally by hand. With this, physicians can perform trabeculotomies any- where in the angle, and they can make a perfect incisional trabeculotomy without having to open up the eye. This can allow physicians to perform trabeculotomies earlier in the disease state. Dr. Singh said the FligHT procedure could be used as a first-line or second-line treatment. He thinks that this could open up options for physicians to have the same type of precision they're used to with femtosecond lasers. Dock- ing is similar to that with the femtosecond laser, he said, adding that a lot of cataract/refractive surgeons used to femto will be comfortable with this device. ELIOS Dr. Singh also mentioned the laser from ELIOS Vision (not yet approved in the U.S.). Recruit- ment has been completed for a cataract combi- nation study, and there is currently a standalone study. This laser produces an efficient, clean surgery, he said. It uses an excimer laser with a probe that allows the physician to create 210-micron channels. "You get 10 of these 'shots on goal'—10 micro channels through the trabec- ular meshwork into Schlemm's canal into the nasal angle," he said. There's no canal dilating or trying to fit something into the canal. Dr. Singh said it's very user friendly and efficient in terms of the adoption and learning curve. The efficacy is similar to what we'd expect with MIGS, he said. You can get the pressure down to the mid to upper teens, and it fits for the mild to moderate patient population at the time of cataract surgery. The laser has a small footprint, with a small tower that physicians can transport, and the probes are thin. "I've been talking to a lot of comprehen- sive and cataract and refractive surgeons. I love stenting, but some surgeons say they don't want to put a stent in and have the risk that it's not positioned correctly. There's a little bit of concern using devices that have to stay in the eye," Dr. Singh said. "With lasers like the ones from ELIOS Vision, ViaLase, and BELKIN Vision, we're not having to leave a foreign body in the eye. That's why lasers are beneficial to a lot of physicians who might not feel as comfortable in the angle." continued from page 77 Valerie Trubnik, MD, Glaucoma Editorial Board member, shared how she has knocked down clinical and surgical challenges: One of the biggest postoperative obstacles that I face post-cataract or glaucoma surgery is dry eye disease. A lot of cataract/glaucoma patients have previously undiagnosed ocular surface disease that, if not treated, contributes to patient dissatisfaction post-surgery despite a well-executed surgery. I have become very cognizant of recognizing and treating dry eye ahead of time with an algorithm and combination of drops and lid hygiene. I have also learned to be patient in waiting for those patients to get better before proceeding with surgery (if that's an option). Once the treatment takes effect, the surgery outcomes and patient satisfaction have drastically improved. S t r i k e !

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