iStent inject W amplifies patient satisfaction, quality of life
Click Here to Manage Email Alerts
When a patient has a cataract and glaucoma, my mindset is not “this is a cataract patient who happens to have glaucoma.” Rather, I approach it as “this is a glaucoma patient who happens to have a cataract.”
This mindset is what demands I address their glaucoma at the same time as the cataract surgery. The ability to simultaneously produce drop- and spectacle-free outcomes in a safe procedure is a golden opportunity to improve patient quality of life.
Reducing medications for better outcomes
As doctors, we are all aware of the multiple issues that topical glaucoma medications present. From poor compliance to red, irritated eyes and exacerbation of ocular surface disease, the trade-off between controlling pressure and burdening the patient is significant. With our advancing understanding of the correlation between optimizing the ocular surface and successful cataract surgery results, it becomes even more imperative that we do everything we can to reduce topical medications when possible.
Phacoemulsification combined with microinvasive glaucoma surgery is my standard of care for cataract patients with mild to moderate glaucoma who also use topical glaucoma treatments. One MIGS device, the iStent inject W (Glaukos), optimizes the natural physiological outflow of aqueous humor while maintaining a micro-scale footprint. The iStent inject W includes two heparin-coated titanium stents loaded into a single-use sterile inserter to create two patent bypasses through the trabecular meshwork, the main source of resistance in glaucomatous eyes. The stents are designed to optimize visualization and deliver procedural predictability with a 360 µm diameter flange and four side ports in addition to the central outlet. The specially designed inserter helps to maneuver the implant for accurate, micro-targeted placement. The efficacy and safety profile of the device make it an excellent tool to create a meaningful improvement in both patient outcomes and satisfaction.
Proven efficacy
Two-stent trabecular micro-bypass has shown significant IOP reduction across a range of clinical studies. Patients in the iStent inject pivotal trial had a mean unmedicated IOP at baseline (following washout) of 24.8 ± 3.3 mm Hg. Twenty-four months after placement of two stents, the mean IOP was reduced by 7 mm Hg, representing a 31% reduction in IOP. That was accompanied by a 75% reduction in medication requirements. Overall, 63.2% of the iStent arm achieved unmedicated mean IOP at or below 18 mm Hg compared with 50% in the control arm that underwent cataract surgery only.
This trial was followed by a 36-month prospective, nonrandomized, consecutive cohort study of eyes with various types of glaucoma and considerable disease burden. All eyes underwent iStent inject implantation in addition to cataract surgery. At 36 months postoperatively, mean IOP was reduced by 37% to 14.3 ± 1.7 mm Hg, and mean medication burden decreased by 68% to 0.8 ± 0.9 medications. The iStent inject W reliably and consistently lowers IOP without the risk for hypotony, hyphema, choroidal hemorrhage or other issues associated with more invasive glaucoma procedures. There is minimal tissue disruption, which allows for potential future work in the angle if necessary. In addition, it does not affect the refractive outcomes of cataract surgery in any way, providing confidence when implanting toric or other premium IOLs.
iStent inject improves quality of life
The iStent inject pivotal studies not only showed a reduction in IOP and topical medications, but patient-reported outcomes were also collected to evaluate the impact of reduced topical medications on ocular symptoms and vision-related activities. A higher percentage of patients who received the iStent inject showed meaningful improvements in quality of life scores, including OSDI and VFQ-25, when compared with patients who received cataract surgery alone. Patients who received the iStent inject showed particular advantage in general health, ocular pain and driving vision. This is the first time that a MIGS procedure has been shown to positively affect patient quality of life compared with cataract surgery alone.
Better outcomes mean higher satisfaction
Undoubtedly, patients who have endured years of administering glaucoma medications and the subsequent side effects are excited about the possibility of reducing or eliminating their medication burden. As eye care providers, we have the satisfaction of not only knowing their disease is being controlled at all times, no longer subject to the inconsistencies of patient compliance, but also that we are making a meaningful difference in their quality of life.
- References:
- Friedman DS, et al. Invest Ophthalmol Vis Sci. 2007;doi:10.1167/iovs.07-0290.
- Hengerer FH, et al. Ophthalmol Ther. 2018;doi:10.1007/s40123-018-0152-8.
- Rossi GC, et al. Eur J Ophthalmol. 2009;doi:10.1177/112067210901900409.
- Samuelson TW, et al. Ophthalmology. 2019;doi:10.1016/j.ophtha.2019.03.006.
- Singh IP. Patient-reported outcomes with iStent inject trabecular micro-bypass. Presented at: European Glaucoma Society annual meeting; Dec. 12, 2020 (virtual meeting).
- Stone JL, et al. Arch Ophthalmol. 2009;doi:10.1001/archophthalmol.2009.96.
- Ung C, et al. Ophthalmology. 2013;doi:10.1016/j.ophtha.2012.11.026.
- For more information:
- I. Paul Singh, MD, can be reached at The Eye Centers of Racine and Kenosha, 3805B Spring St., Suite 140, Racine, WI 53405; email: ipsingh@amazingeye.com.
Collapse
Click Here to Manage Email Alerts