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    2015 brings big Medicare changes, small technology changes to glaucoma surgery


    Laser advances

    Laser surgery also took steps forward in 2015. In October, a small study showed that CO2 laser-assisted sclerectomy surgery was safe and effective for reducing elevated IOP and medication burden in both primary open-angle glaucoma and secondary capsulary glaucoma. For the procedure, the laser gradually ablates deep scleral layers within the scleral bed, continuing until percolating aqueous humor is visible.

    Selective laser trabeculoplasty also advanced in 2015 with the addition of computer guidance. In March, researchers reported that they had used pattern scanning to assure complete treatment without overlap or gaps. They found that the technique was equally effective in lowering IOP, but that patients found it more comfortable.

    The next few years look promising for these surgical techniques – as long as glaucoma surgeons can stay in business to provide them.

    On the horizon

    Many of the techniques surgeons now use look crude compared to the ones that researchers are dreaming up. In 2015, investigators reported promising experiments in mice using stem cells, said Joel Schuman, MD, chairman of ophthalmology at the University of Pittsburgh.

     “The findings are really positive,” he said. “You can take stem cells from a patient. You can transform them so they are trabecular meshwork cells and inject them into the eye, and in mice they home to the trabecular meshwork. They set up house, rebuild the trabecular meshwork and restore function.”

    Elsewhere, researchers reported exciting work in optic nerve regeneration, he said. “In mice they’re able to get a portion of the optic nerve to regrow.”

    What works in mice doesn’t always work in humans, he cautions. Still “it’s a big advance from where we were 5 years ago.”



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