Case of the Month: By Arkadiy Yadgarov, MD

I’m sharing not one, but four cases that showcase the practical application of the OMNI® Surgical System across different clinical scenarios. Each case illustrates how this minimally invasive procedure can provide meaningful benefits for patients at various stages of primary open-angle glaucoma, offering an alternative to more invasive treatments and potentially reducing medication burden which may lead to improvement in vision-related quality of life.

Case 1: Mild Primary Open-Angle Glaucoma

A male in his mid-60s came to me for a second opinion. He was already diagnosed with mild primary open-angle glaucoma and had dense trabecular meshwork pigmentation suggestive of an exfoliative component to his disease. He took two hypotensive medications, yet his IOP remained around 30 mmHg. Another physician had recommended a tube shunt procedure. Upon evaluating his condition, I offered a minimally invasive alternative, which I felt would work well in the setting of mild disease stage. I performed the OMNI procedure as a standalone treatment, significantly reducing his IOP to 17 mmHg. Furthermore, we decreased his medication load to just one topical agent. I advised him that at some point in the future, if IOPs rise, we may need to consider a tube shunt but that we could monitor him every 3-4 months. He is now four years out and doing well.

Case 2: Moderate Primary Open-Angle Glaucoma

A 68-year-old pseudophakic female with a history of selective laser trabeculoplasty (SLT) was under treatment with latanoprost and timolol. Despite this regimen, her IOP was 20 mmHg, and she exhibited a superonasal field defect indicative of moderate stage primary open angle glaucoma. Instead of modifying her medication schedule, I recommended the option of the OMNI procedure. She was immediately receptive as she vocalized her challenges with obtaining and self-administering her glaucoma drops. I performed OMNI as a standalone intervention, which resulted in her IOP dropping to 15 mmHg. Moreover, she was able to discontinue latanoprost, leaving her on timolol monotherapy.

Case 3: Dry Eye and Medication

An 80-year-old female with mild primary open angle glaucoma on a regimen of latanoprost and dorzolamide-timolol fixed combination exhibited chronic eye redness and used topical cyclosporine and artificial tears to manage dry eye symptoms. She had active ocular discomfort and worsening dry eye symptoms. I informed her that a minimally invasive OMNI procedure could improve her eye’s drainage system and possibly reducing her medication burden. She was eager to pursue this option and was appreciative that someone had finally offered an alternative to reduce daily medication. After undergoing the OMNI procedure, we successfully discontinued latanoprost and switched the dorzolamide-timolol fixed combination to timolol once daily, increasing the patient’s ocular comfort and satisfaction with her glaucoma treatment regimen.

Case 4: MIGS Intervention in a Non-Adherent Glaucoma Patient

A 71-year-old man presented for a routine glaucoma follow-up. He was phakic with 20/25 best-corrected visual acuity (BCVA) in both eyes, though central vacuoles were noted. On a prior visit, glare testing reduced his vision to 20/40, but he declined cataract surgery, stating he was satisfied with his vision. MIGS was not discussed at that time. He was diagnosed with moderate primary open-angle glaucoma (POAG) in both eyes, with an intraocular pressure (IOP) of 16 mmHg OU and a historical maximum of 23 mmHg. Central corneal thickness measured 510 microns OU. The patient was using latanoprost QHS and timolol QAM; however, his adherence was estimated at just 60–70%.

During the visit, his comments revealed troubling compliance issues. He shared, “I do miss a dose here and there,” “It takes many tries to get one drop in,” and “I often run out of the bottle early.” These admissions raised red flags, considering the strong correlation between poor adherence and glaucoma progression. With this in mind, I opted for a proactive treatment approach rather than waiting for further visual field or lens changes. I discussed the benefits of combining cataract extraction with MIGS—specifically canaloplasty and trabeculotomy using the OMNI® Edge Surgical System—to improve natural outflow and reduce reliance on topical medications. Once he understood the potential for better glaucoma control and a reduced medication burden, he was enthusiastic about moving forward.

After undergoing the OMNI procedure, the patient was pleased with his controlled IOP and appreciated not having to rely solely on medications for glaucoma management.

Conclusion

As the field of glaucoma treatment continues to evolve, the procedure enabled with the OMNI® Surgical System stands out as a versatile, safe, and durable solution for managing primary open-angle glaucoma across the spectrum of glaucoma disease.1 By integrating the OMNI procedure into practice, we can offer patients a potential alternative to polypharmacy, improving the glaucoma treatment experience and potentially improving overall vision-related quality of life.2,3 The standalone OMNI procedure is particularly beneficial for patients who struggle with medication compliance or have insufficient medicated IOP control.

Important Product Information

Indications for Use: The OMNI Surgical System is indicated for canaloplasty (microcatheterization and transluminal viscodilation of Schlemm’s canal) followed by trabeculotomy (cutting of trabecular meshwork) to reduce intraocular pressure in adult patients with primary open-angle glaucoma. Contraindications: Do not use the OMNI in any situations where the iridocorneal angle is compromised or has been damaged (e.g., from trauma or surgery), since it may not be possible to visualize the angle or to properly pass the microcatheter. Do not use the OMNI in patients with angle recession; neovascular glaucoma; chronic angle closure; narrow-angle glaucoma; traumatic or malignant glaucoma; or narrow inlet canals with plateau iris. Do not use the OMNI Surgical System in quadrants with previous MIGS implants.

Arkadiy Yadgarov, MD is a paid consultant of Sight Sciences. For additional information, email us at glaucoma@sightsciences.com. Please visit sightsciences.com/omni for the full instructions for use, warnings, precautions, and adverse event information.

References

¹ Yadgarov A. et al., Real-World Outcomes of Canaloplasty and Trabeculotomy Combined with Cataract Surgery in Eyes with All Stages of Open-Angle Glaucoma. Clinical Ophthalmology 2023:17 2609-2617
² Kashiwagi K, Matsubara M. Reduction in Ocular Hypotensive Eyedrops by Ab Interno Trabeculotomy Improves Not Only Ocular Surface Condition But Also Quality of Vision. J Ophthalmol. 2018;2018:8165476. doi:10.1155/2018/8165476
³ Rossi GC, et al. Dry eye syndrome-related quality of life in glaucoma patients. Eur J Ophthalmol. 2009;19(4):572–9. doi:10.1177/112067210901900409

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