Case of the Month: By Deborah Ristvedt, DO

Case 1: A Patient on Maximum Medical Therapy

An 81-year-old pseudophakic female with primary open-angle glaucoma (POAG) and significant ocular surface disease presented with a primary complaint: she could no longer enjoy reading, her favorite activity. She was on maximum medical therapy and was referred for further management.

We initially performed selective laser trabeculoplasty (SLT), which produced a meaningful response—allowing her to discontinue one of her medications. SLT was repeated with some success, but over time her intraocular pressure (IOP) gradually increased into the 20s. Despite relatively mild glaucoma and preserved visual fields, retinal nerve fiber layer (RNFL) thinning was noted, along with emerging nasal field changes.

At this stage, she was on one medication and had an IOP of 24 mmHg. Given her goal to to be medication-free which may improve her vision-related quality of life, I proceeded with the OMNI® Surgical System as a standalone procedure. I performed a 360° viscocanaloplasty combined with a 180° goniotomy.

Now six months postoperative, her IOP has decreased to 16 mmHg, and she remains completely off medications. This intervention helped improve her ocular health.

Case 2: Pseudophakic Patient with Mild POAG

A 77-year-old pseudophakic female with mild POAG presented with elevated IOP despite triple topical therapy. Her Goldmann IOP was 28 mmHg OD and 29 mmHg OS. Central corneal thickness measured 540 μm OD and 539 μm OS, with reduced corneal hysteresis (9.1 OD / 9.0 OS). Her medical history included cataract surgery in 2015, prior ALT in both eyes, and a past optic nerve hemorrhage OD.

In addition to elevated pressure, she experienced ocular surface discomfort, including redness, tearing, fluctuating vision, and lid erythema—likely due to chronic drop use.

Given the lack of IOP control and her intolerance to medications, I performed OMNI® Edge canal-based MIGS, completing a 360° canaloplasty and 180° trabeculotomy in both eyes. At her three-month follow-up, IOP had decreased to 16 mmHg OD and 18 mmHg OS, and she was medication-free.

This case demonstrates how OMNI® Edge can be an effective implant-free solution for patients with medication intolerance and uncontrolled IOP, even with prior laser treatment.

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.

Deb Ristvedt, DO 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.

© 2025 Sight Sciences, Inc. 08/2025 OM-3612-US.v1