Sclera

KOLOA, Hawaii — In this Healio Video Perspective from Hawaiian Eye 2025, I. Paul Singh, MD, discusses the AquaLumen, a subconjunctival bypass technology to lower IOP in patients with glaucoma.

SAN FRANCISCO — While small iris defects can be treated with sutures, patients with large iris defects who have poor cosmetics and light sensitivity can be successfully treated with artificial irises, according to a speaker here.

Among the many options for presbyopia, scleral approaches stand out for their unique attempt to tackle the roots of the problem, restoring physiological function rather than aiming for optical compensation. They had a slow takeoff and limited acceptance, but step by step, through a long path of research and technological upgrades, they continue to move forward. According to several surgeons, they might be the ideal solution for plano or near-plano presbyopia, when the lens is still clear. They are minimally invasive procedures that preserve the visual axis, and patients’ visual experiences can be outstandingly good, even beyond what measurements say.

There is a lot of excitement around the new eye drops for presbyopia, which should hopefully become available in the U.S. in the next 1 to 2 years. The beauty of this pharmacological option is that patients can try the drops and determine how effective they are and how well they tolerate them before committing to long-term use. It is the least invasive and easiest way to reverse the symptoms of presbyopia and reduce the need for reading glasses, with no known long-term downside or risk. Once available, patients will have the option to trial these medications. If not satisfied with the level of improvement in reading vision, or if the side effects are not well tolerated, patients can, of course, elect surgical options to improve their reading vision.

Implantation of a trabecular micro-bypass stent in patients with all types of glaucoma and moderate to severe glaucoma damage showed long-term efficacy and safety in a real-world, prospective, nonrandomized study at the University of Heidelberg, Germany.

In recent years, several IOL fixation techniques have been proposed. Nowadays the tendency is to evolve from time-consuming techniques that use knots and big incisions to easier, faster and sutureless techniques.