ONLINE EXCLUSIVE
Glaucoma
July 2023
by Liz Hillman
Editorial Co-Director
Source: Jella An, MD
A group of surgeons came together to draft and publish consensus guidelines for MicroPulse Transscleral Laser Therapy (Iridex). This therapy, using the company’s Cyclo G6 Laser and MicroPulse P3 Delivery Device, both of which have FDA 510(K) clearance, is used for a non-incisional laser glaucoma treatment that has been demonstrated to be safe and effective but, as the authors of the guidelines wrote, does not have recommendations on optimal treatment protocols.
“I think the technology itself has good potential to be used in so many different types of glaucoma patients, but there were no guidelines put together. Like all great tools, it depends on how you use it and on whom you use it that will determine the outcome,” Jella An, MD, one of the authors of the guidelines, told EyeWorld. “With any technology, sometimes you have to learn things by trial and error because there is not enough evidence.”
Dr. An said the guidelines were born from a group of surgeons who had started using the technology early on, expanding the types of patients they treated with it and other best practices as they gained additional experience.
“We’ve already learned a great deal from each other, and we thought now that we’ve done it for more than 5 years and have some evidence and patient data that this is a good time to put it together and share it with the rest of the world,” she said.
The guidelines include understanding about the mechanism of action for MicroPulse Transscleral Laser Therapy, indications for its use, patient selection, dosimetry, starting settings, and dose escalation. The paper also includes consensus guidelines on treatment technique and postop management, as well as information on expected outcomes and retreatment/enhancements.
Dr. An said one of the things she learned in discussing results with the co-authors was about the importance of how slow you move the probe (fluence). She said if you didn’t know about this and were starting to use the device for the first time with insufficient fluence, you might think the technology wasn’t effective.
“But it’s because you didn’t apply the same amount of energy because you went too fast,” she said. “That parameter was not conveyed in the past.”
Dr. An said that it’s important to review how technology can be used to its fullest advantage.
“With collective wisdom you can learn so much without having to do the trial and error yourself,” she said. “A consensus paper is a good place to start.”
About the physician
Jella An, MD
Wilmer Eye Institute
Johns Hopkins School of Medicine
Baltimore, Maryland
Reference
Grippo TM, et al. Evidence-based consensus guidelines series for MicroPulse Transscleral Laser Therapy – surgical technique, post-operative care, expected outcomes and retreatment/enhancements. Clin Ophthalmol. 2023;17:71–83.
Relevant disclosures
An: Iridex
