ESNOPER CLIP

 

Drainage implants act as flow controllers, space maintainers, and healing modulators, reducing the risk of scleral fibrosis.

The suprachoroidal implantation of drainage devices improves deep sclerectomy (DS) techniques by decreasing aqueous production by detachment of the ciliary body or by increasing the choroidal resorption of aqueous humor.

DS creates a trabeculo-descemet window by removing the deep scleral flap and the corneal stroma. This allows gradual aqueous filtration through the thin trabeculo-descemet membrane (TDM) and prevents dangerously rapid IOP decreases.

DS preserves the integrity of the anterior chamber and has the advantage of superior filtration control and reduced occurrence of perioperative and postoperative complications (e.g., hypotonia, flat anterior chamber, and choroidal detachment).

The Esnoper Clip is a nonabsorbable foldable implant made from HEMA, a nonionic polymer with a low tendency for protein deposits. The implant has a double-plate design, which facilitates both trabecular and uveoscleral drainage. It is also found to reduce fibrosis, ensuring maintenance of both the above-mentioned spaces, thus avoiding their collapse over time.

The implant has internal channels to facilitate aqueous humor flow through the device and has lateral notches for non-sutured supraciliary placement.

This implant has 2 plates, one is placed on the scleral bed and the other in the supraciliary space. The shape of the implant has been designed to preserve the patency of the intrascleral and suprachoroidal spaces and to maximize both aqueous-humor drainage pathways long after surgery.

A significant limiting factor in the long-term success of DS with uveoscleral implants is the inflammatory potential of the suprachoroidal region, characterized by significant cell infiltration and fibrosis.

A study of 39 eyes by Alina-Dana Baxant, from Charles University, Prague, showed a 87.2% success rate at one year, following DS with Esnoper Clip implantation in patients with uncontrolled glaucoma.

REFERENCE:

Baxant AD, Klimešová YM, Holubová L, Pluhovský P, Bartošová J, Veselý Ľ, Nemčoková M, Rosina J, Studený P. Efficacy and Safety of Deep Sclerectomy With the Esnoper Clip Implant for Uncontrolled Primary Open Angle Glaucoma: A 1 Year Prospective Study. J Glaucoma. 2023 Mar 1;32(3):227-235. doi: 10.1097/IJG.0000000000002137. Epub 2022 Oct 14. PMID: 36256952; PMCID: PMC9981320.

PER-001 INTRAVITREAL IMPLANT

 

Endothelin is the most potent vasoconstrictor in the human body and is upregulated in glaucoma. Endothelin is involved in inflammation and cell death through its receptors expressed in retinal vascular and neuroretinal cells. Multiple lines of evidence implicate vascular dysregulation as a driver of glaucomatous disease progression, and excess endothelin levels play a key role in reducing ocular blood flow.

PER-001 is a small molecular endothelin 1 receptor antagonist administered as a bio-erodible intravitreal implant. It is being evaluated for treating open-angle glaucoma and other ocular indications driven by ischemia, such as diabetic retinopathy, geographic atrophy, and retinal vein occlusion. It is administered into the vitreous using a single-use, 25-gauge applicator. It is designed to provide a sustained release of PER-001, allowing for a convenient every 6 months dosing frequency.

The intended treatment is pursuing both vascular benefits, such as improved autoregulation and perfusion by targeting the entire retinal vasculature and choroid, as well as non-vascular benefits, such as blocking ET-1-mediated “neurotoxicity” involving apoptotic and oxidative injury pathways in the neuroretina.

Perfuse Therapeutics, Inc. (“Perfuse Therapeutics”), a biopharmaceutical company, announced the details of PER-001. Data from three cohorts of patients with glaucoma in the completed Phase 1/2a clinical trial demonstrate that PER-001 is well tolerated and shows promise as the first disease-modifying therapy for glaucoma. A study in rabbit and monkey eyes demonstrated controllable biodegradation and sustainability of the implant without any ocular or systemic adverse findings for up to 3 and 6 months in rabbits and non-human primates, respectively.

https://perfusetherapeutics.com/perfuse-therapeutics-announces-oral-presentation-on-per-001-intravitreal-implant-for-glaucoma-at-the-association-for-research-in-vision-and-ophthalmology-arvo-meeting/

DENGUE ASSOCIATED ACUTE ANGLE CLOSURE GLAUCOMA

 

Dengue is a mosquito-borne viral disease transmitted by Aedes aegypti. It is caused by one of four dengue virus serotypes (DENV-1 to DENV-4) from the Flavivirus family.

Ophthalmic complications range from subconjunctival hemorrhage and anterior uveitis to severe optic neuritis, retinal vasculitis, maculopathy, and panophthalmitis. Other diverse ocular effects include central retinal artery occlusion, bilateral vitreous hemorrhage, and uncommonly acute angle-closure glaucoma (AACG).

From: Pierre Filho Pde T

Dengue can directly inflame ocular anatomical tissues. The ocular structures have a particularly poor tolerance for inflammatory insult and disruption of vessel regulation due to their rich choroid and ciliary body vasculature. These structures are involved in vascular leakage, which causes forward displacement of the lens-iris diaphragm and narrowing of the anterior chamber angle, potentially leading to AACG. 

Edema in the ciliary body exacerbates the mechanical crowding of the angle structures, increasing outflow resistance through the trabecular meshwork.

AACG can also be precipitated by certain drugs used to treat dengue complications, or by medications that patients may have been taking before hospitalization. For example, sulfonamide-based antibiotics and anti-epileptics, such as topiramate, have been associated with drug-induced AACG due to ciliochoroidal effusion and angle closure. Severe dengue may cause systemic capillary leak syndrome, which acts synergistically with these pharmacologic triggers to worsen anterior segment crowding and precipitate glaucoma. In addition, systemic hypovolemia and electrolyte imbalances may exacerbate vascular instability in ocular tissues, leading to fluid extravasation and segmental edema.

Dengue may have an associated autoimmune-mediated inflammation in the anterior segment. Such immune responses would further augment ciliary body edema, interfere with aqueous production and outflow, and have detrimental effects on IOP regulation. In addition, genetic predispositions associated with human leukocyte antigen (HLA) alleles could participate in the autoimmune eye inflammation induced by the dengue virus and need to be further studied.

Hypothesized Sequence of Events:

Dengue virus infection generates a systemic inflammatory response mediated by cytokines. This, in turn, leads to vascular permeability and extravasation of fluid from the ciliary body, resulting in ocular edema. The resulting anterior segment anatomical changes lead to narrowing or closure of the anterior chamber angle, ultimately leading to AACG. Additionally, the dengue pathophysiology, medications, individual anatomical predispositions, and possibly autoimmune pathways provide a multifactorial basis for AACG development in dengue-affected individuals.

REFERENCE:

Al-Essa A (April 11, 2025) Acute Angle-Closure Glaucoma as an Ocular Complication of Dengue Fever: A Comprehensive Review. Cureus 17(4): e82119. doi:10.7759/cureus.82119.

Pierre Filho Pde T, Carvalho Filho JP, Pierre ET. Bilateral acute angle closure glaucoma in a patient with dengue fever: case report. Arq Bras Oftalmol. 2008 Mar-Apr;71(2):265-8. doi: 10.1590/s0004-27492008000200025. PMID: 18516431.

SMART EYE PRESSURE MONITORING DEVICE

 

Prakhar Austin Mohan, a third-year B.Tech student at MIET Engineering Institute in Meerut, India, has designed A non-contact tonometer, called the 'Smart Eye Pressure Monitoring Device'.

In conversation with ETV Bharat, Prakhar said that traditional machines for glaucoma testing cost up to Rs 1.5 lakh, but the device he has developed will cost between Rs 20,000 and Rs 25,000 only.

According to Prakhar, the device was developed using a microcontroller.

“It provides data processing and wireless connectivity. It has a non-invasive IOP sensor, which accurately measures eye pressure without pain,” Prakhar said. He explained that he had used a cloud-connected model, which analyzes the data and monitors the pressure pattern in the eye.

The device has an OLED display and is linked to a mobile app, which provides real-time readings and alerts to patients as well as doctors. Its IOT integration enables continuous monitoring, remote access, and emergency alerts, Prakhar said.

WHEN WILL THE DEVICE HIT THE MARKET?
Prakhar informed the news portal that the device is in the final stage of development, and he has also applied for a patent to launch the device in the market. He said that the tonometer has provided accurate results during the testing phase.

https://www.etvbharat.com/en/!offbeat/eye-catching-news-for-glaucoma-patients-uttar-pradesh-engineering-student-develops-frugal-device-to-measure-eye-pressure-enn25040501950

RED-FREE (GREEN) FILTER-ENHANCED GONIOSCOPY

 

A study has shown that gonioscopy using a red-free (green) filter can enhance visibility of the iridocorneal angle.

The angles were imaged with an indirect 4-mirror goniolens with standard halogen light, red-free green filter and also warm light filter of the slit lamp. The images and videos were recorded using a smartphone adaptor to the slitlamp. The illumination was set at 1/4^th with 20x magnification.

The study found that the contrast of the gonioscopy images was enhanced objectively with a red-free filter compared to standard light photos. The built-in warm filter of the slit lamp also provided better visualization of the iridocorneal angle structures.

The evaluation of the images and videos by two glaucoma specialists revealed that the red-free (green) filter provided enhanced tissue visualization for the pigmentation of the trabecular meshwork in 90% (n = 9) of the cases, and the quality of visualization did not worsen during regular gonioscopy.

Also, the warm color provided good contrast between the angle structures, as well as being less irritating to the photosensitive patients. This filter was also found to be superior in identifying the Schlemm’s canal, as it appeared orange or red, unlike the usual halogen light appearance, where it appears white and is often difficult to identify.

This enhancement can facilitate the accurate identification of the angle structures, particularly in instances where gonioscopic interpretation is challenging and when the patient is sensitive to light.

VIEW VIDEO HERE: https://www.youtube.com/watch?v=bgRP3EmCC3Q

REFERENCE: Iqbal MI. Red-Free (Green) Filter-Enhanced Gonioscopy with Smartphone: A Pilot Study. Cureus. 2024 Jan 3;16(1):e51559. doi: 10.7759/cureus.51559. PMID: 38313936; PMCID: PMC10835508.

FOOD INSECURITY AND GLAUCOMA

 

Food insecurity is a complex social determinant of health (SDOH) that refers to the household-level economic and social conditions of limited or uncertain access to adequate food.

Food insecurity is typified by alternating periods of food adequacy and scarcity, creating a cyclical stressor that has been proposed to have complex health effects through altered feeding behaviors, nutritional status, and financial decision-making.

Food insecurity has been proposed to lead to a broad set of behaviors that increase an individual’s risk for disease and disease progression.

These feeding behaviors predispose individuals to metabolic dysregulation, reduced antioxidant intake, and chronic inflammation, which may further exacerbate the impact on individual physical and mental health. This could cause chronic eye diseases such as GLAUCOMA.

78,964 participants from The National Institutes of Health All of Us (AoU) Research Program were included in a study to assess the association of food insecurity with chronic eye diseases. Among the participants, 9732 (12.4%) had food insecurity. [1]

Of the total 78,695 participants, 2095 (2.7%) had GLAUCOMA, 1398 (1.8%) had AMD, 1127 (1.4%) had DR, and 10,135 (12.9%) had cataracts.

Participants who reported food insecurity had significantly higher odds of GLAUCOMA (adjusted odds ratio [aOR]: 1.43, 95% confidence interval [CI]: 1.18e1.72, P 0.001) compared with those without food insecurity. Participants had a 43% increased likelihood of GLAUCOMA.

No significant associations were observed between food insecurity and AMD (aOR: 0.91, 95% CI: 0.67e1.21, P ¼ 0.544), DR (aOR: 1.15, 95% CI: 0.93e1.42, P ¼0.180), or cataracts (aOR: 0.97, 95% CI: 0.87e1.08, P ¼ 0.635) in adjusted regression models.

REFERENCE:

[1] Talebi R, Yu F, Tseng VL, Coleman AL. Association between food insecurity and chronic eye disease in the National Institutes of Health’s All of US Research Program. Ophthalmology Science. 2025;5(3):100697.

VisuALL ANALYZER

 

The Olleyes VisuALL  Analyzer (vFA) is a virtual reality visual function platform designed to monitor the retinal sensitivity in patients with eye diseases. This mobile device performs Standard Automated Perimetry and other psychophysical tests, including assessment of visual acuity, color vision, contrast sensitivity, pupillometry, and extraocular motility.

The VisuALL is a portable automated perimeter that uses a virtual interface that has the potential to provide an immersive testing experience for patients. The VisuALL has two displays (one for each eye), allowing it to test both eyes simultaneously but separately with a similar test duration to other perimeters. 

The VisuALL Virtual Reality Software suite works with the seamless synergy of three elements: the WebApp, the Cloud, and Olleyes Approved VR Headset.

Annie, a Virtual Assistant, is designed to boost efficiency, monitor patients, explain the testing process to patients, and organize the test data for easy reading.

The headset runs the VisuALL Patient Testing Application (PTA), which was written in Unity (a cross-platform gaming engine). By leveraging this engine, VisuALL can create a fully immersive and self-contained environment in order to perform self-directed, interactive training tutorials for the patient and then proceed to the VF test. 

Another key component of the VisuALL PTA is the proprietary thresholding algorithms, which implement complex decision trees to determine most efficiently what the patient's threshold for light detection is at each location. 

The VisuALL uses Goldmann size III test stimuli in each VF protocol and tests both eyes simultaneously. 

The vFA has both strong short-term and long-term test-retest reliability in addition to high correlation with HFA in a standard clinical setting.

After testing is complete, the software generates a report that includes the patient's name, date of birth, gender, test ID, examination date, test time, and test strategy. It also lists the fixation losses, false positives, and false negatives. Below is a plot of the threshold values for each of the 50 points tested, and a grayscale representation of the threshold values.

COMPANY WEBSITE: https://olleyes.com/

OMNI SURGICAL SYSTEM

 

The OMNI Surgical System from Sight Sciences is an implant-free, minimally invasive technology, despite being a comprehensive procedure, indicated for canaloplasty (microcatheterization and transluminal visco-dilation of Schlemm’s canal) followed by trabeculotomy (cutting of trabecular meshwork) to reduce intraocular pressure in adult patients with or without cataract surgery, for mild, moderate, and advanced primary open-angle glaucoma (POAG).

The OMNI is a handheld instrument with a hollow tip through which ophthalmic viscosurgical device (OVD) can be injected to perform visco-dilation and through which a microcatheter can be deployed to perform trabeculotomy. Other features of the device include a gear wheel for advancement and withdrawal of the microcatheter, a port for loading OVD into the device, and a reservoir to hold it.

Under gonioscopic view, the handpiece tip is introduced into the OVD-filled anterior chamber through a temporal corneal incision and advanced to the nasal angle.

The tip then engages and passes through trabecular meshwork, and the microcatheter is deployed via the cannula into and through 180° of Schlemm’s canal.

The microcatheter is then retracted slowly as a fixed volume of OVD is injected to visco-dilate the canal and collector channels.

The procedure is then repeated on the remaining 180° of the canal.

To perform the trabeculotomy, the same catheter is advanced once again through 180° of Schlemm’s canal and withdrawn using a cheese-wire technique to unroof the canal; this process can be repeated on the remaining 180° of the canal.

Standard anti-inflammatory (dexamethasone) and anti-microbial (ofloxacin) therapy are prescribed postoperatively.

Newer modifications include a cannula tip featuring a new profile that allows for gentle and precise access to Schlemm’s canal, while still enabling a complete 360-degree catheterization associated with the OMNI procedure.

New enhancements enable surgeons to more easily rotate and position the cannula tip within Schlemm’s canal using precise finger rotations rather than wrist adjustments.

COMPANY WEBSITE: https://omnisurgical.com/