Friday, January 18, 2019


Recently I was invited to a private tour of our local Orange County, CA medical ophthalmic device  company Glaukos located in San Clemente, CA.  Here are the pearls of my visit that I would like to share with you.

As of 2012 Glaukos broke out into glaucoma research and clinical care field with a new and pioneering device Istent that changed the treatment of glaucoma forever.  For patients diagnosed with glaucoma, it is a life long struggle to keep the intraocular pressure as low as possible.  That commitment requires constant discipline to take pressure lowering drops, sometimes up to three times a day.  Imagine your elderly relative or busy colleague that runs at the pace of our modern life who has to stop three times a day for 5 minutes at a time to put one drop into each eye and wait 5 minutes for absorption of these drops.  What if that patient is driving on a freeway and stuck in traffic, will he or she miss the drops? What if he or she forgot the drops at home?  Every time a patient misses the drops, glaucoma chips away at the optic nerve and leads to slow but permanent peripheral vision loss.

The breakthrough idea about the original Istent device back in 2012 was that the it lowered intraocular pressure in patients who have undergone cataract surgery and Istent implantation at the same time.  Istent was and is the smallest medical device that has been successfully implanted in human body to date.  The initial studies showed that patient had additional decline in intraocular pressure  by 15-20% in large populations in clinical trials compare to cataract surgery alone.  The original Istent required a bit of a steep learning curve for an ophthalmic surgeon.  Encouraged by the first five years of wide clinical implementation and receptive to surgeon user feedback, Glaukos developed a user friendly Istent Inject when two Istent devices with modified shape are implanted by a surgeon at the time of cataract surgery.

I have been implanting Istent since 2017 since have done over a 100 implantations at this point.  I was the first surgeon that implanted Istent Inject at out Newport Bay Surgery Center since it was introduced late in 2017.  I have seen excellent results where intraocular pressure decline in patients who have undergone combined cataract surgery and Istent implantation.  There are no side effect that we see with traditional glaucoma surgery that requires large implants in the eye.  There are no additional risks to the cataract surgery when Istent inject is added to the planned cataract removal.

If a patient can reduce dependence on glaucoma drops, not only is it a relief in time consumed placing the drops, it also leads to reduced risks of side effects associated with use of pharmaceutical agents, and the relief of financial burden placed by the costs of drops to the patient.

I am looking forward to offering that latest Minimally Invasive Glaucoma Surgery (MIGS) which includes Istent Inject implantation for all of my patients with glaucoma at Clarity Eye.  I feel strongly that Istent Inject is the safest medical device that I have placed in the eye since the advent of the intraocular implant.  Soon, we will have a decade of data from the pivotal studies on the original Istent implantation. With every new generation of Istent, just like every new generation of Iphone, the safety profile, and efficiency of the Istent device has increased manifold and now should be an attractive option to any patient who is looking to reduce or eliminate dependence on intraocular pressure lowering medication.  If you or your family member have glaucoma, ask your surgeon about Istent Inject!

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