Quad Cities, IL/IA

Working with the community... for a healthier community.

New Era Of Cataract Surgery Plus iStent® for Glaucoma


By Lisa Brothers Arbisser, MD, Eye Surgeons Associates

cataract, which is a clouding of the normal human lens of the eye, will
develop in everyone who lives to be old enough. It is seen at every age
due to genetics, trauma, lifestyle, and exposure to certain medications
and to sunlight. The average age of cataract surgery is 72. Many factors
play a role in how quickly this clouding can interfere with activities
of daily living. When it does, cataract surgery, with our many choices
of intraocular lenses and methods, is an opportunity to restore vision,
which without glasses, can be even better than youthful eyes.

not as common as cataracts alone, open angle glaucoma is predicted to
afflict 80 million patients worldwide by 2020. Open angle glaucoma is a
condition where fluid builds up in the eye raising the pressure and
causing gradual loss of vision due to nerve damage not noticeable in its
early stages. It is often seen in older cataract patients seeking
vision improvement. Vision lost due to cataract can almost always be
regained at any stage because the cataract blurs the view but does not
harm the eye structures. While glaucoma moves slowly, vision loss is
irreparable due to the actual and painless loss of seeing nerves.

glaucoma patients are placed on eye drops to reduce the pressure and
control their glaucoma, halting vision loss. Up to three different types
of eye drop medications are required. These are used up to three times a
day for the rest of the patient’s life. They are expensive, hard to
reliably remember and can cause irritation and permanent changes of the
eyes, eyelids, and eye socket. Although cataract surgery alone may cause
some decrease in pressure, in 50 percent of cases, it rarely allows
patients to stop their drops. Until now, methods of combining cataract
and glaucoma surgery substantially increased the risk of complications
and are rarely performed.
The FDA has recently approved a brand new
way to manage mild to moderate open angle glaucoma at the same time
cataract surgery is performed. This new technology is known as the
iStent. It’s been in use outside the country for six years.

iStent is the world’s smallest medical device at 20,000 times smaller
than the intraocular lens that is normally implanted during cataract
surgery to restore vision after the cloudy lens is removed. When in
place one cannot see it or feel it. This snorkel-like device adds a step
to the cataract surgery, increasing the time by 5 or 10 minutes, but
requires no added incision, no stitches, and no change in the
postoperative recovery for the patient. The iStent bypasses the drain
(trabecular meshwork) and is placed into the internal drainage channel
of the eye (Schlemm’s canal) allowing the fluid, which has built up
inside the eye, to flow naturally as if there was no disease. The main
U.S. clinical trial showed that 68 percent of people implanted with one
iStent had a reduction of eye pressure to normal or below by increasing
the flow up to 85 percent, and many were able to eliminate a glaucoma
eye drop for two years or more. Unlike most of the technology in play
today, the iStent procedure adds no risk above that of cataract surgery
alone. Implantation of the device allows for future treatment options,
if needed, as it does not interrupt the natural structure of the eye.

countries with socialized medicine where both drugs and devices are
paid for out of one government pocket, surgeons are routinely placing
one or more iStents in virtually all cataract patients with mild to
moderate open angle glaucoma, as well as those without cataract. In the
U.S., one iStent is covered by insurance if placed during cataract
surgery. Two surgeons, at ESA, are the first certified to deliver this
new era of glaucoma care to patients in the region. Given the
risk-benefit profile of this miraculous new technology, we are fortunate
to have this opportunity to better manage glaucoma for appropriate
cataract patients, while restoring optimal vision.

Brothers Arbisser, MD, is certified by the American Board of
Ophthalmology and the American Board of Eye Surgery in cataract/implant
surgery. She teaches cataract and anterior segment surgery worldwide.
Dr. Lisa sees patients at Eye Surgeons Associates Rock Island and
Bettendorf offices. For more information, please see our website: