canaloplasty surgery faq

7/28/2019 Canaloplasty Surgery FAQ

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surgeryCANALOPLASTY

FAQ
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2013 New-Glaucoma-Treatments.com

Canaloplasty (pronounced Kah-NAL-oh-plas-tee)is a new glaucoma treatment that gives many peoplewith this potentially bl inding condition the hope ofsaving the vision they have. Canaloplasty can re-duce pressure in the eye (IOP) by nearly 40%, andmany glaucoma patients who have had Canaloplastyno longer need medications. This minimally inva-sive procedure is available alone or can be donewith cataract extraction (phacocanaloplasty). It is a

non-penetrating surgical procedure that does notrequire creation of a stula nor result in a bleb

such as with traditional trabeculectomy surgery. In-sertion of a micro-catheter into Schlemms canal(the eyes internal drainage duct) facilitates exit ofeye uid through the natural outow. The canal is

then dilated by injecting a sterile, gel-like materialcalled a viscoelastic. After the drainage channel is

made larger the micro-catheter is removed and a

Canaloplasty SurgeryFAQ

suture is placed within the canal system. Suture ten-sion within this system keeps it open for years re-

sulting in a controlled eye pressure.

What is Canaloplasty?

CANALOPLASTYNew Glaucoma Treatment

Go to http://new-glaucoma-treatments.com/canaloplasty/

See how Canaloplasty is done.

Watch Dr. Richardsons video online
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Saety. Canaloplasty is safer than traditional glau-coma surgery (trabeculectomy). If you are consid-ering glaucoma surgery to prevent further vision

loss then choosing a surgery that has fewer risksmakes sense.

Age. Younger patients need a better option thantraditional glaucoma surgery. Traditional glaucomasurgery is less likely to succeed in younger patientsand carries a lifetime risk of infection. Successwith Canaloplasty is not age dependent and there isno lifetime risk of infection.

Active Liestyle. If you are an energetic personwho enjoys such activities as watersports, it is im-portant for you to know that having traditional

Why Canaloplasty?
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glaucoma surgery will severely limit your ability toparticipate in certain sports. No such limitation ex-ists with Canaloplasty. Once healed, patients whohave had Canaloplasty are able to return to theirprevious active lifestyles without restriction or lim-itation.

Nearsighted. People who are very nearsighted

(highly myopic) are at a much higher risk of vision-threatening complications from traditional glauco-ma surgeries. This is not true with Canaloplasty.

Ethnicity. Traditional glaucoma surgery has a highfailure rate among African American patients. Incontrast, Canaloplasty has a well-established trackrecord of success among many races.

Fear o Cataract. If you do not currently have acataract, you should know that the risk of devel-oping one increases substantially after traditionalglaucoma surgery. This risk is much lower withCanaloplasty.

Diiculty with Glaucoma Medications. Ifyou are having trouble tolerating or affording yourglaucoma medications, then Canaloplasty maybe an option for you. With traditional glaucomasurgeries, the risk is just too high to consider forreasons of nancial hardship or side effects of

medicines alone.

These are just some of the many reasons to con-sider Canaloplasty. If you have open angle glau-coma (the most common type) and are consideringglaucoma surgery, then you should explore youravailable options before making a decision. Al-though there are certainly instances where tradi-tional glaucoma surgery is the best (or even only )option available, most patients with glaucoma are

candidates for Canaloplasty and should considerthis safer option.
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How long has Canaloplasty been

around?The answer to this question is

not as straightforward as it might seem. Al-though the iTrack catheter (required to performcanaloplasty) has only been FDA approved since2008, the surgical technique used to perform Ca-naloplasty has been around for decades*. The mod-ern procedure is essentially a modication of vis-cocanalostomy, which was rst described by Dr.

Stegmann in 1991. Because viscocanalostomy is a

technically difcult surgery to perform, it was notvery popular among most eye surgeons. Howev-er, with the invention (and FDA approval) of theiTrack, the impressive results and superior safetyprole of Canaloplasty have convinced a number

of surgeons (myself included) to become adept atthis procedure.

What does Minimally Invasive re-ally mean?Traditional glaucoma surger-ies (trabeculectomy or shunt surgery) re-

quire the creation of a full-thicknes hole (or stula)

through the wall of the eye (sclera). This allows

* Fyodorov SN, Ioffe DI, Ronkina TI: [Glaucoma sur-

gery- deep sclerectomy]. Vestn Oftalmol 4:6--10, 1982

uid to ow from the inside of the front of the

eye (anterior chamber) through the scleral hole to

a bleb (cyst, or blister-like elevation of the con-junctiva). From here the uid somehow nds itsway back into the venous system. These surgeriesare called penetrating. Canaloplasty, on the oth-er hand, is a non-penetrating (or minimally inva-sive) surgery because only a partial thickness ap

is created in the sclera. This ap is then sewn back

in place after Schlemms canal is opened so there isno stula created between the inside and outside of

the eye. Instead, uid in the eye drains out through

the (newly opened) natural drainage system of theeye.

How long does Canaloplasty take?Canaloplasty is not a quick surgery (at leastby eye surgery standards). In order for the

surgery to work properly, your surgeon must make

a ap in the sclera (the white part of the eye) and

extend this all the way to a very thin and fragilemembrane called Descements membrane withouttearing it. This ap is created just above a vascu-lar tissue (which easily bleeds) called the choroid.All of this happens in a space no larger than thengernail on your pinky nger. It can be tedi-

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ous and requires both skill and patience from yoursurgeon. Thus, it can take anywhere between 45

minutes and two hours. The benets, however, canlast a lifetime.

What i my natural drainage

canal cannot be ully

catheterized?To get the full benet ofCanaloplasty, it is important for your surgeon tocanulate the full 360 degrees of Schlemms canal,

dilate the canal with viscoelastic, and stent it openwith a suture. The inabil ity to complete any one ofthese elements (say, from prior scarring of the ca-nal) can limit the effectiveness of the surgery. How-ever, even if a full Canaloplasty procedure cannotbe completed, your surgeon can most likely convertto either a traditional trabeculectomy or viscocana-lostomy. A recent study** conrmed that, while not

as effective as Canaloplasty, viscocanalostomy cansignicantly reduce the pressure in the eye provid-ing for some protection from glaucoma.

** Canaloplasty in One Eye Compared With Viscoca-

nalostomy in the Contralateral Eye in Patients With Bilateral

Open-angle Glaucoma. Koerber, N. Journal of Glaucoma.

Online ahead of print, January 26, 2011.

Is Canaloplasty surgery painul?No. During surgery your eye will be anes-

thetized (numbed). After surgery you willbe given drops to reduce inammation and prevent

pain. Generally, people do notice a foreign bodysensation (scratchy sensation) under the uppereyelid for up to a few weeks after surgery. This iscaused by the slowly dissolving sutures and resolveson its own. If you have Canaloplasty surgery andhave more severe pain than what is described here,

you should immediately contact your surgeon.

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If something doesnt work, thentry something else. Because thisnew procedure is un-

believable. I cant sayenough about it. Imjust thrilled. Its likegiving me a new life!

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CanaloplastyELIGIBILITYIve had glaucoma laser surgery.

Can I have Canaloplasty? If you havehad either of the laser surgeries for openangle glaucoma (Argon Laser Trabeculoplasty orSelective Laser Trabeculoplasty), you may still bea candidate for Canaloplasty. It depends, however,on how much scarring there is from the laser sur-gery. Although your surgeon can visually inspectthe area around Schelmms canal using a specialcontact lens (a technique called gonioscopy), s/hecannot tell if there has been permanent scarringof the canal itself. It may not be possible to fullycatheterize the canal if there is dense scarring ofthe canal (called stenosis). In that case, your sur-geon would not be able to stent the canal open witha suture, but would still inject a special gel (called aviscoelastic) into the partially opened canal. Whenthe canal cannot be fully canulated and the stent

is not placed, this is called viscocanalostomy. Al-though not as effective as canalopasty, it can stilllower the IOP.

Ive already had traditional glau-

coma surgery (trabeculectomy).

Can I have Canaloplasty?The stand-ard answer would be no. However, it is possible(though technically quite challenging) for Canalo-plasty to be done in an eye that has already had atrabeculectomy that is no longer functioning. Ifyou and your surgeon are considering this option itis important for you to have realistic (guarded) ex-pectations of success. Many patients are interestedin the option of Canaloplasty because (comparedto other glaucoma surgeries) there are fewer risks.But, if you are not the ideal candidate, there mayalso be less of a potential benet.

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Ive used glaucoma drops or a very

long time. Will that aect the suc-

cess o Canaloplasty? Possibly*. Thereis growing evidence that Schelmms canal (the eyesnatural drainage duct) decreases in size with long-term use of glaucoma medications. If there issignicant stenosis (scarring down) of the canal,

then it may not be possible to thread the catheterall of the way around the canal. However, evenif a stent cannot be left in the canal it is generallypossible to dilate a signicant portion of the canal

with viscoelastic. When the cathether cannot befully threaded and a stent is not placed, this proce-dure is called viscocanalostomy. Viscocanalostomyhas been around since 1991 and is also an effectivetreatment for glaucoma (though less so than Cana-

loplasty).

* Dahan E, Drusedau MU: Nonpenetrating ltration

surgery for glaucoma: control by surgery only. J Cataract

Refract Surg 26:695--701, 2000

8 Fill out our brief onlineevaluation form to see ifyou or your loved one is

a candidate for this

exciting new surgery.

Go to http://new-glaucoma-treatments.com/canaloplasty-evaluation/

Visit Online

Evaluation Form
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Will my vision change ater

Canaloplasty? If you are hoping for bet-ter vision after canaloplasty, it is importantto point out that the purpose of any glaucoma treat-ment (incuding Canaloplasty) is to preserve vision,not improve it. That being said, your vision willchange in the following ways after surgery. First,your vision will likely be worse the rst few days (or

even weeks) after surgery. This is expected. WhenSchlemms canal is dilated some blood reuxes

back through the newly dilated canal into the eye.Some even consider this a sign of successful sur-gery. This blood eventually is cleared out the sameway it got into the eye. Another cause of (gener-ally temporary) uctuations in vision is surgically

induced astigmatism from the suture used to closethe surgical incision. This almost always resolvesby a month or so after surgery Once the eye is fully

CanaloplastyBENEFITS

9healed (about three months after surgery) an inter-esting thing happens: some patients note that theirvision does seem better than it was prior to surgery.This is likely because glaucoma drops worsen a con-dition called Tear Dysfunctional Syndrome that cancause blurred vision. After successful Canaloplastysurgery the need for glaucoma drops is reduced (oreven eliminated). Without these drops, Tear Dys-functional Syn-drome improves

which canresult inclearervisionfor somepatients.


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Will Canaloplasty cure my

glaucoma? No. To date there is no

cure for glaucoma. The best any treat-ment can do is to halt (or slow) the progression ofthis disease. The closer the IOP to 8mmHg, thebetter (below that and the eye can lose vision fromthe pressure being too low). Studies have shownthat for most glaucoma patients an IOP of less than15mmHg can be protective (a goal often achievedwith Canaloplasty). Some forms of glaucoma (such

as advanced, low tension, or normal tension glau-coma) require IOPs of less than 12mmHg in orderto avoid loss of vision. Only your eye surgeon candetermine what your eyes goal should be.

Will I be able to stop using glau-

coma drops ater Canaloplasty?Possibly. Remember that the primary

objective of any glaucoma surgery (including Ca-naloplasty) is to lower your IOP into a safer rangeand protect you from further loss of vision. A sec-ondary goal would be to reduce (or even eliminate)the use of glaucoma drops. Studies have shownCanaloplasty to be effective at achieving both ofthese goals. Not only do most people who undergoCanaloplasty have lower IOPs after surgery, but onaverage, they are able to stop just under two medi-cations. What does just under two mean? Well,

some people are able to stop one drop, some two,others none and some are even able to stop all of

their drops. How many you will be able to stop ifyou have Canaloplasty cannot be predicted, thoughits likely that you will be able to stop at least one ofthem if you are on multiple drops.

How long will my IOP stay con-

trolled with Canaloplasty? Be-cause Canaloplasty has only been FDA

approved since 2008, we only have three-year re-sults**. There is no reason, however, to believe thatthe surgery will stop working. In a study thatlooked at the long-term (7 year) results of com-bined cataract surgery and viscocanalostomy(theless effective precursor to Canaloplasty), IOP wasreduced by over 33% (on average) at the last docu-

** Three-year results of circumferential viscodilation

and tensioning of Schlemm canal using a microcatheter to

treat open-angle glaucoma. Richard A. Lewis, Kurt von

Wolff, Manfred Tetz, Norbert Koerber, John R. Kearney,

Bradford J. Shingleton, Thomas W. Samuelson. Journal of

Cataract & Refractive Surgery - April 2011 (Vol. 37, Issue

4, Pages 682-690, DOI: 10.1016/j.jcrs.2010.10.055)

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mented visit.*** We can reasonably expect the long-term results of Canaloplasty and Phacocanaloplasty

to be even better than those published for viscoca-nalostomy and Phacoviscocanalostomy.

What i Canaloplasty doesnt

work? Can I still have tradi-

tional glaucoma surgery ater

Canaloplasty?Yes. Having Canaloplasty doesnot affect your ability to have other types of glau-

coma surgery at a later date as long as your Cana-loplasty surgeon operates in one of the superiorquadrants of the eye. Some Canaloplasty sur-geons, however, operate at what is called the 12:00position. This approach can make it difcult (but

not impossible) for a surgeon to perform tradition-al glaucoma surgery at a later date.

Im a very active person.Will having Canaloplasty orce

me to limit my activities?

*** Seven-year follow-up of combined cataract extrac-

tion and viscocanalostomy. Manijeh S. Wishart, Evgenios

Dagres. Journal of Cataract & Refractive Surgery - De-

cember 2006 (Vol. 32, Issue 12, Pages 2043-2049, DOI:

10.1016/j.jcrs.2006.08.035)

The answer to this question depends on what time,after surgery, you are referring. Immediately after

surgery (and at least for a few days, but sometimesup to weeks after) your vision will be blurry in theeye that had canaloplasty. Therefore, any activitiesthat require good binocular vision (such as work-ing with heavy machinery) should be avoided untilthe vision improves. Additionally, it is generally agood idea to keep the eye clean and dry (no garden-ing or swimming) for at least a few weeks. Oncethe incision has healed over (about a month aftersurgery) it is generally OK to resume all of yourusual activities.

Contrast this with traditional glacuoma surgery(trabeculectomy) which does limit your activitiesfor the rest of your life. Because of the fragile na-ture of a bleb after trabeculectomy (and the risk of

rupture and/or infec-

tion), once someonehas had trabeculec-tomy surgery s/hecannot participatein most water sportswithout high-qualityprotective eyewear.

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I wear sot contact lenses. Can I

continue to wear them ater

Canaloplasty? Yes, but you mayhave to wait until the eye is healed from surgery.How soon you may restart use of contact lenseswill be up to your surgeon. Additionally, it may benecessary to get tted for new contact lenses after

Canaloplasty as the surgery can sometimes changeyour refractive error.

Contrast this with traditional glacuoma surgery

(trabeculectomy). Because of the fragile nature ofa bleb after trabeculectomy (and the risk of rup-ture and/or infection), once someone has had trab-eculectomy surgery s/he cannot wear soft contactlenses after surgery for as long as the bleb is func-tioning. Hard contact lenses, however, are gener-ally OK to wear even with trabeculectomy (thougha retting may be needed after surgery).

Ive heard that Canaloplasty is

not as eective as more tradi-

tional glaucoma surgery

(trabeculectomy). Is this true? No, althoughthis is widely believed by many surgeons who donot perform Canaloplasty. It has generally beenthought that trabeculectomy is the only way to

get intraocular pressures (IOPs) under 12mmHg.

However, a recent head-to-head study**** comparingone year results of Canaloplasty vs. trabeculectomyshowed no signicant difference in average IOP

between the two surgeries. Granted, average IOPdoes not address the issue of the lowest IOP achiev-able. Nevertheless, some of my own patients whohave had Canaloplasty now have pressures between8-10mmHg. This is by no means the average result,but does speak to the issue of whether it is possiblefor Canaloplasty to lower the IOP below 10mmHg.

Is Canaloplasty really saer thantraditional glaucoma surgery

(trabeculectomy)? Yes. A recentstudy***** compared one year results of Canaloplastyvs. trabeculectomy. Although there was no signicant

difference in the nal intraocular pressures (IOPs)

between the two surgeries (meaning both surgerieswere equally good at lowering IOP), two differences

were noted: (1) Canaloplasty patients experiencedfewer side effects and complications compared tothose who had trabeculectomy; and (2) the patientswho had Canaloplasty had better vision than thosepatients who had trabeculectomy.

**** Non-Penetrating Schlemms Canaloplasty versus Trab-

eculectomy: A Head-to-Head Comparison. Tam D, Calafati J,

Ahmed I. [Submitted for publication, December 2010].

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RISKSCanaloplasty

What arethe Risks o

Canaloplasty?Although it is true that there arefewer risks with Canaloplasty thanthere are with traditional glaucomasurgery (trabeculectomy), it is notwithout risk. All surgeries (there

are no exceptions) have risks associated with them.The important thing to consider when faced withthe need for surgery is the relative risk of the pro-cedure compared to going without the procedure.If your glaucoma is not under control then (givenenough time) you will lose vision. Glaucoma sur-geries offer a method of preventing that loss ofvision. The most commonly encountered risks of

Canaloplasty are:

1. Bleeding in the eye. Almost 30% of peoplewho have Canaloplasty have some bleeding in thefront of the eye. However, as mentioned earlier,this bleeding (called a hyphema or microhyphema)is pretty much to be expected (and may actually bedesired *). This resolves with time and rarely causesany permanent reduction in vision.

2. Intraocular pressure spikesduring the heal-ing period after surgery. About 5% (one in twenty)people will have a short period after surgery when

* Canaloplasty and Transient Anterior Chamber

Haemorrhage: a Prognostic Factor? Koch J, Heiligenhaus

A, Heinz C. Klinische Monatsbltter fr Augenheilkunde

(Clinical Journal of Ophthalmology) 2010 Nov 16. (online

ahead of print).

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the IOP is actually higher than it was before sur-gery. This almost always resolves.

3. The ormation o a bleb (blister) on the sur-face of the eye in the area of the incision (6%). Itis worth noting that with trabeculectomy, the for-mation of a stable bleb is necessary for success,while with Canaloplasty, it is considered to be anundesireable outcome, or risk. These blebs rare-ly limit the effectiveness of Canaloplasty. Howev-er, blebs can be associated with Tear DysfunctionalSyndrome (Dry Eye Syndrome) and could limityour ability to participate in cer tain activities (suchas certain water sports).

4. Descemets Membrane Separation, or De-tachment (3%). In order to open Schlemms canal,a gel-like substance (called a viscoelastic) is injectedinto the canal. If the canal is particularly tight

it is possible for the gel to follow the path of leastresistance and dissect beneath Descements Mem-brane (the thin lm on the back of the cornea). If

this happens, the vision could be affected. How-ever, with time (weeks to months) these almost al-

ways resolve on their own. If it is not spontane-ously improving, it is generally possible for your

surgeon to inject a gas bubble in your eye to pressthis membrane back against the cornea.

5. The need to perorm traditional glaucoma

surgery (4%). Less than one in twenty Canalo-plasty surgeries fail and must be converted toeither trabeculectomy or a shunt. This may bedone either at the time of initial surgery or at alater date. Your surgeon would make this decisionas clinically appropriate.

6. Hypotony (IOP too low). Too low? you maybe wondering, I thought the problem was thatthe pressure was too high? Well, if the IOP dropsbelow 5mmHg (millimeters of Mercury) and staysthere, vision can be lost from a condition known ashypotony maculopathy. Fortunately, this condi-

tion is pretty rare with Canaloplasty (only one per-son in 200 would be expected to have prolongedhypotony). Compare this to trabeculectomy inwhich at least 1 out of every 10 people is likely toexperience hypotony.
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7. Inection. To date, vision-threatening infec-tion of the eye (called endophthalmitis) has not

been documented with Canaloplasty. In theory,however, anytime an incision is made in the eye, aninfection could be possible. So, although the riskseems to be less than 1 in 1,000, its probably notzero. Compare this to trabeculectomy which car-ries up to a 5% chance per year of developing aninfection called blebitis that (if not caught earlyand treated) can result in endophthalmitis and lossof vision.

In summary, although not without risk, Canalo-plasty is associated with signicantly fewer risks

(both in number and severity) than traditional glau-coma surgeries such as trabeculectomy

Im araid o having something

placed in my eye. What are the

risks o the stent?Although this isan understandable concern, the only thing left inthe eye after Canaloplasty is a suture. The materialused in this suture (polypropylene) has been usedin eye surgery for decades and has a very good safe-ty record. In fact, this material has been used inthe eye far longer than most of the materials used

to make the intraocular lenses (IOLs) in moderncataract surgery. It is very unlikely that this suture

would ever erode into or through the eye wall as itis securely threaded through Schlemms canal. Inthe few reported cases where the suture has erod-ed into the anterior chamber it seldom causes anyproblem.

What is the big

deal about a

bleb, anyway?With traditional glaucoma surgery(trabeculectomy), a blister-likeuid collection (called a bleb)

must be present on the surface ofthe eye for the surgery to work.Aqueous uid (the uid inside the

eye) ows through the stula into this bleb where it

then nds its way out of the eye. If this bleb scars

down, the the surgery fails and the intraocular pres-sure (IOP) goes back up potentially causing a fur-ther loss of vision from glaucoma. Unfortunately,the body wants to scar down the bleb as part ofthe natural healing response. In order to preventthis from happening most modern trabeculectomysurgeons use a chemical called an antimetabolite

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to preserve the bleb. The most commonly usedantimetabolite (Mitomycin-C, or MMC) causes per-manent damage to the eye tissue in the area of thesurgery.

The tissue exposed to MMC is very fragile and doesnot heal well. Fluid in the bleb exerts pressurewhich can result in what is called a high bleb.

This is essentially a thin bubble-shaped bleb. Thesecan cause (or may exacerbate) Tear DysfunctionalSyndrome resulting in chronic irritation, tearing,and blurred vision. Because the wall of the bleb isso thin any trauma to the eye can rupture it. Sinceit does not heal well any damage to the bleb mayrequire surgical revision.

Finally, and most concerning, is that when MMCis used during trabeculectomy, there is up to a 5%risk per year of bleb leak** which can progress to

** Greeneld DS, Suer IJ, Miller MP, Kangas TA,

Palmberg PF, Flynn HW Jr. Endophthalmitis after ltering

surgery with mitomycin. Arch Ophthalmol 1996;114:943-

949.

infection of the inside of the eye (endophthalmitis,up to 1% per year) if not successfully treated. En-dophthalmitis often leads to severe loss of visionor blindness. This risk continues for the life of thepatient unless the bleb scars down (fails).

Canaloplasty is a blebless (or bleb-free) pro-

cedure. With Canaloplasty no stuas are created

and there is no need to modify the natural healingof the eye. Without a bleb, there is no worseningof Tear Dysfunctional Syndrome or risk of blebi-tis. Occasionally (about 6% of the time), a bleb willspontaneously form with Canaloplasty. However,because most Canaloplasty surgeons do not useMMC, the bleb is usually shallow and unlikely toresult in Tear Dysfunctional Syndrom or blebitis.
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Surgeons & ReerencesCanaloplasty

Are all Canaloplasty surgeons Glaucoma

Specialists?No. For example, Dr. Richardson isnot fellowship trained but does specialize in treat-

ing glaucoma with advanced procedures such as Canaloplasty. Afellowship trained glaucoma specialist is someone who spendsone to two additional years after residency learning how to dealwith advanced and unusual forms of glaucoma. Because Canalo-plasty can most effectively treat earlier (less advanced) forms ofthe more common types of open angle glaucoma, it is often per-formed by general ophthalmologists and/or cataract surgeons.Indeed, it is particularly effective when done at the same time ascataract surgery - in which case it is called phacocanaloplasty.

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What training is required to

become an Interventional

Ophthalmologist(Canaloplasty Surgeon)? Interventional Oph-thalmologists must rst complete their training as

EyeMDs (completion of a bachelors degree fol-lowed by four years of medical school, one year ofinternship, and three years of residency training ineye diseases and surgery). Once procient as an

eye surgeon, an ophthalmologist can request to be

trained in the technique of Canaloplasty. Doctorsare required to complete a wet-lab (practice oncadaver eyes) prior to performing Canaloplasty sur-

gery on humans. Then, the rst 10

surgeries are conducted under thedirect monitoring of a Clinical Spe-cialist. Only a fraction of surgeons

who start the Canalo-

plasty training completethe monitoring require-ments and go on to be-come Canaloplasty sur-geons.

Where can I fnd a

Canaloplasty surgeon

near me?Visit the iScience web-site*. This site will provide a list of Canaloplastysurgeons near you.

How much does Canaloplasty

cost? The amount charged for cana-loplasty varies by surgeon and surgery

center. If you do not have insurance, the total cost

for canaloplasty can range from $4,000 to upwardsof $8,000 per eye. Fortunately, Medicare and manyinsurances pay for Canaloplasty when surgical treat-ment of glaucoma is indicated. Even if you do nothave insurance, however, Canaloplasty can pay foritself over time simply by saving you thousands ofdollars per year in the cost of glaucoma drops thatmay no longer be necessary after this surgery.

* http://canaloplasty.com/iscience/nd_a_physician.php

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Where can I learn more about Canaloplasty?Below are some additional resources that could help you to decide if Canaloplasty is right foryou:

1. Canaloplasty.com- Created by iScience, the manufacturer of the catheter used in Cana-loplasty. This is where you would go to nd a Canaloplasty surgeon near you.

2. YouTube.com - If you want to see what this surgery actually looks like (and arent toosqueamish).

3. New-Glaucoma-Treatments.com- This website was created by Dr. Richardson in order

to provide a one stop solution for those patients looking for the latest information about Ca-naloplasty. Dr. Richardson updates this site weekly with the latest news about this and otherglaucoma treatments.

4. Find a Canaloplasty sur-

geon and schedule a consul-

tation - There is no better way

to nd out if Canaloplasty isright for you than to have youreye evaluated by a surgeon cer-tied to perform Canaloplasty.

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Go to http://new-glaucoma-treatments.com/canaloplasty-evaluation/

Fill out our brief onlineevaluation form to see ifyou or your loved one is

a candidate for thisexciting new surgery.

Visit Online

Evaluation Form
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Dr. David Richardsonhas performed thousands of eye surgeries using the most advanced techniques. He is trusted not only

by thousands of patients, but also by other medical professionals. Dr. Richardson was named a Super Doctor by his peers in theLos Angeles Magazine in 2010, 2011, 2012 and 2013. In a similar survey conducted by Pasadena Magazine, Dr. Richardson wasalso voted as a Top Doc for the past 6 consecutive years (2008-2013). Actions, though, speak louder than words - Dr. Richard-son is the personal eye surgeon for many of the most respected doctors in the San Gabriel valley. Dr. David Richardson is amonga select group of ophthalmologists in Southern California offeringCanaloplasty as a treatment option for his glaucoma patients.

Do you want to receive other patient-focused materials regarding glaucoma or cataract? Visit -> drmd.me/newsletter-pd

experience the Dr. Richardson diference...

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