Fayetteville doctor leads breakthrough glaucoma surgery

A Fayetteville ophthalmologist has been a leader in the research and development of a minimally invasive surgical procedure to help prevent vision loss in glaucoma patients.

Dr. Steven Vold, owner of Vold Vision, was the first in the United States to implant the Cypass Micro-Stent after it received approval by the U.S. Food and Drug Administration on July 29.

The device, which is manufactured by Alcon, is a small tube that’s implanted in the eye to help drain fluid that builds up in glaucoma patients, according to the FDA.

The stent acts as a drain between the interior and exterior layers of the eye and can lower pressure that builds up in patients’ eyes.

If left untreated, the pressure can cause optic nerve damage, leading to blindness.

Glaucoma is the second leading cause of blindness in the world, according to the World Health Organization.

The most common form of glaucoma is primary open-angle glaucoma. This is the form in which the stent is used, and it is placed in the eye during cataract surgery.

In clinical trials, nearly 73% of those who received the stent during cataract surgery experienced significantly lower pressure levels in the eye, compared to 58% who only had cataract surgery.

Patients maintained the lower pressure levels over the two-year study.

A slight uptick in complications related to those who received the stent was attributed to bleeding, but the risk is “very comparable to cataract surgery,” Vold said.

The biggest concern would be surgeons misplacing the stent. Proper training is critical before implanting the stent, said Kevin LaMarche, executive director of Vold Vision.

Recently, Alcon medical experts were at Vold Vision receiving training on the device. A conference room at the Fayetteville office includes a smartboard, cameras and several large flat-screen TVs that can show a live feed of Vold performing procedures and allow for two-way communication between the surgery and conference rooms.

Vold, who specializes in glaucoma and cataracts management, is board certified by the American Board of Ophthalmology and completed an ophthalmology residency and glaucoma fellowship at Northwestern University Medical School in Chicago. He moved to Northwest Arkansas in 2007 and has owned Vold Vision since 2011.

 

Pressure Reducer
As of Nov. 1, Vold has performed the surgery 47 times since the Cypass Micro-Stent was approved by the FDA.

The surgery costs between $6,000 and $7,000 for both eyes, and can be covered by Medicare, Vold said.

On Sept. 27, Cheryl Harp became the first patient to receive the stent, and Vold said he has gotten nationwide interest, including from people in California, Florida and Massachusetts.

On Oct. 25, Carrie O’Brien of Bella Vista returned to Vold Vision to have the stent placed in her left eye. A week earlier, she had the stent placed in her other eye.

O’Brien, whose aunt lost her vision to glaucoma, found out she had the disease 15 years ago. Since then, she’s placed drops in her eyes daily to keep down the pressure.

“Everybody’s pressure is different,” she said. “You’ve got to keep that pressure down.”

Not only are the drops expensive, but they also cause her eyes to become dry, she said. But she recently stopped using the drops after receiving the stent in her eye. The day after the first procedure, she said, the pressure in her eye was cut in half.

“I’m so happy to get it done,” O’Brien said, before receiving the stent in her other eye. “It’s far and way above anything out there…I feel great.”

In the private conference room, O’Brien’s procedure was being broadcast live on one of the TV screens. Vold spent the majority of the nearly 10-minute procedure removing and replacing the lens as part of cataract surgery. The remainder of the procedure involved implanting the stent into the eye. The stent allows patients to not have to take medicine “almost immediately,” he said, and the overall procedure, corrects near sightedness because the stent is implanted along with cataract surgery.

 

Silent Thief
An estimated 3 million Americans have glaucoma, but only about half of them know it, according to American Academy of Ophthalmology. When the disease develops, people usually don’t have symptoms, and it progresses slowly.

“In this way, glaucoma can steal your sight very gradually,” according to the academy’s website. “Fortunately, early detection and treatment with glaucoma eye drops and glaucoma surgery or both can help preserve your vision.”

Dr. Andrew Iwach, AAO clinical spokesman and practicing ophthalmologist in San Francisco, said most patients can manage the disease with the drops, but minimally invasive surgical procedures such as the CyPass Micro-Stent are surgical techniques available to treat it.

Another minimally invasive surgical procedure includes the iStent, which was approved in 2012, and was designed to reduce eye pressure in glaucoma patients. Like the CyPass Micro-Stent, the iStent acts as a drain within the eye.

Iwach said he’s not used the CyPass Micro-Stent but is eager to do so. The procedures might eliminate the need for the patients to take one or two medications.

“It’s quite a ball and chain,” Iwach said. “These patients are treated for years.”

Some patients take eye drops up to four times daily, and the medicine is expensive. The cost of glaucoma medication has increased to $300-$400 per month, from $40-$50 monthly, Vold said. Half of patients who have been prescribed drops to treat glaucoma stop taking them by the end of the year. Treating glaucoma is like treating high blood pressure, he said. Between 40% and 50% of patients have nerve damage before it can even be detected.

As people age, they are at higher risk for glaucoma, but younger people can have it, too.

“I’ve operated on babies and newborns,” Vold said.

African-Americans and Hispanics are at higher risk to get glaucoma and should receive annual screenings for the disease, he said.

In the 1970s, after drops were developed to treat glaucoma, it started to become more of a medical disease, Vold said. Surgery was reserved only as a “last resort.”

Traditional glaucoma surgery involves cutting a hole in the eye, which causes a blister or bleb, leading to an increased risk of infection and possibly eye loss. One of the potential benefits of the procedures that use the stents includes avoiding traditional surgery, such as trabeculectomy, Iwach said.

“We try to avoid these types of surgeries,” he said.

While glaucoma treatment has experienced gradual advances over the years, the past 15 years have been good for the field.

“It’s been a really exciting time,” Vold said. “You can’t imagine how much change there’s been.”

If the past few years serve as a road map for the future, it looks bright. New devices continue to be developed by smaller companies, and those companies have been purchased by larger ones, Iwach said. Doctors have more options when it comes to treating their patients, and surgery is an option that’s being considered sooner as the devices become safer.

“It is changing how we are looking at surgery,” Iwach said. “We’re much more apt to doing a procedure. The risk profile as different.