Case of the Month: By Jai Parekh, MD, MBA

A 46-year-old man with a 10-year history of primary open-angle glaucoma (POAG) presented to our office with fluctuating vision and ocular surface complaints. He had a significant family history of POAG-related blindness, and his medical background included hypertension, hyperlipidemia, and tobacco use. Despite being on oral medications, a prostaglandin analog, and combination topical therapy, his disease continued to progress.

His vision was 20/40 and fluctuated with blinking. The anterior segment exam revealed mild hyperemia and signs of ocular surface disease. Intraocular pressure (IOP) had previously peaked at 26 mmHg, with recent readings averaging between 16 and 19 mmHg. He exhibited superficial punctate keratopathy (SPK), filaments, small pinguecula, and early cortical lens changes. Posterior segment evaluation showed glaucomatous damage and signs of vascular retinopathy. OCT confirmed retinal nerve fiber layer thinning, and visual field testing revealed superior arcuate defects. The optic nerve showed a 0.75 cup without disc hemorrhage.

He had undergone selective laser trabeculoplasty (SLT) and received Durysta in the past. His preoperative IOP was 18 mmHg. I proceeded with a standalone procedure using the OMNI® Surgical System, performing a 180° canaloplasty and a 45° trabeculotomy.

Postoperatively, his IOP stabilized in the low teens, and we were able to significantly reduce his medication burden. To support his ocular surface, I added punctal plugs and prescribed preservative-free artificial tears. The patient experienced improved visual quality, healthier ocular surface, and better IOP control—and was pleased enough with the outcome to refer five family members for evaluation.

From a surgical perspective, OMNI was designed with ergonomics in mind. As an anterior segment surgeon, I like to visualize the surgical field when I am working inside the eye. OMNI gives me this field, so I can look at the patient the whole time. The device feels natural and comfortable and requires little manipulation once placed in my hand; furthermore, the handle feels the same whether I am working from one direction or the other.

In my opinion, OMNI is patient-centric, ergo-centric, operating room centric, and tech-centric. This centricity, across the board, has made me a very proficient and efficient surgeon when it comes to MIGS.

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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.

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. All rights reserved. Sight Sciences and OMNI are registered trademarks of Sight Sciences. All other trademarks are owned by their respective owners. Jai Parekh, MD, MBA is a paid consultant of Sight Sciences. 05/2025