Optometrist Dr. David Kordish often talks to patients about glaucoma and cataracts in doing general eye care. Now, he can see his patients with clearer vision and freedom from glaucoma medication drops – thanks to tiny devices implanted in fall 2020.
Kordish, 70, plans to keep working part time at Brisbane Eyecare in Spokane Valley for the foreseeable future. But nearly two years ago, he needed cataract surgery and a solution for eye irritation after years of using eye drop medication for glaucoma. That’s when Kordish’s own eye doctor, Dr. Jonathan Haymore, suggested three strategies.
During cataract surgery, Kordish also got microscopic devices implanted – two per eye. His devices are called iStent inject W, to help drain eye fluids and reduce pressure in the eye caused by glaucoma.
With device upgrades in the past couple of years, some patients can stop using their daily medication drops. That was the case for Kordish, and because cataract surgery requires replacing natural eye lenses that have become cloudy, Kordish received new lenses that also correct his vision, so he no longer needs to wear prescription eyeglasses.
“I haven’t seen like this since the third grade,” Kordish said.
“I required cataract surgery as I got into my late 60s, and Dr. Haymore talked to me about a couple different procedures he could do while doing cataract surgery that would hopefully replace my need for eye drops.
“He inserts the device in the place where he wants to put it, and it’s like a little injector. It pushes this device into your drainage system and then creates a connection so fluid can flow out into your body and away from the eye.”
The devices today are about the size of one number on a penny, or a little bigger than a grain of salt, he said.
“They put it in an area of the eye that naturally drains fluid, but this is a larger opening for fluid to flow out, so it supplements the natural drain in the eye.”
Daily medication drops are the typical defense to allow the pressure to drop in the eye and open the drainage system. Kordish used the drops for about 15 years, and his mother also had glaucoma. But he sometimes had a reaction such as redness because of preservatives in the drops.
A while back, he had a laser procedure to open the drain in the eye as another approach, but that didn’t do enough to keep the pressure low, so he supplemented with eye drops.
“Then these new minimally invasive glaucoma surgeries came out, and there were several of them, to go into the eye and create a drain mechanically.”
Glaucoma occurs when fluid builds up in the front portion of your eye. Cataracts develop for a majority of people with aging, when the eyes’ natural lenses get cloudy over time.
“Cataracts are pretty much universal to everybody – most people have to have cataract surgery at some point in their life,” said Haymore, an ophthalmologist with MultiCare Rockwood Eye and Optical Center.
“Glaucoma, luckily, is not as common but affects at least a small percentage of the population. Glaucoma is where the internal pressure inside your eye is typically too high, so it puts pressure on your optic nerve and can damage your optic nerve over time. When it does that, you can lose your peripheral vision without really knowing it.”
Earlier eye stents for glaucoma, under different brand names, were released around 2012 when doctors inserted one stent. Then studies showed that the drainage worked better with two stents in each eye, Haymore said. They’re smaller now.
“They are the smallest medical devices on the planet – about one-third of a millimeter – and they’re inside the eye, so you never see them, feel them or really even know they’re there other than your eye pressure is lower,” Haymore said. “You’re already operating on the eye to help with the cataracts, and in addition, you can treat two conditions with minimally invasive surgery.”
The glaucoma procedure is called MIGS, or minimally invasive glaucoma surgery. The glaucoma stents go through the incision done for the cataract surgery, and the recovery time is the same, he said.
“The iStent inject just adds a couple minutes to the surgery typically, and we place these microscopic stents inside the eye, and it acts as a kind of pass-through or an internal drain in the eye that lowers your eye pressure and oftentimes can take the place of drops.”
“Dr. Kordish is a perfect example. He was on three previous medications for glaucoma, and luckily we were able to get him off all three, which makes your eye a lot more comfortable. The cost of drops, the cumbersome putting them in every day, it’s a big advantage to not have to do that anymore.
“There are other (stent) devices, too, and it depends on the severity of the glaucoma. But the stents have been a big plus as far as the latest technology, and putting in two stents really just has been in the last couple of years.”
The stent procedure is covered by insurance if you have a glaucoma diagnosis, and a majority of people are good candidates, Haymore said.
Kordish also opted for replacement lenses that provide more than the typical correction, so that was an out-of-pocket expense.
“He was extremely nearsighted before, and we put in these specialty lenses called multifocal lenses,” Haymore said.
“What’s nice about those is we were able to get rid of his high prescriptions, and also those lenses give you distance and up-close vision without glasses, so it was a great surgery for him. We always put a lens in during cataract surgery, but there are choices as far as the types of lenses. The traditional ones help you see far away.”
Kordish said he’s thrilled with the outcome. He thinks insurance eventually will catch up to the option for full-vision correction during cataract surgery.
“I’d normally need bifocal or trifocals in eyeglasses, or in my case, I tried to make contact lenses work,” Kordish said.
“I’m now eyeglasses free and contact lens free because the lens implants he put in corrected my sight at all three distances – far, near and in-between. Insurers now will pay for a basic lens implant.
“I think eventually, insurers may start to cover it or partially cover it.”
Kordish has worked part time since 2014. He’s lived in Spokane for 40 years, and he enjoys days off having “fun time and grandchildren time.”
Kordish said his two days a week at the practice help him stay in contact with longtime patients and keep his skills up. And now for patients, he can recommend new options firsthand.
“In my practice, I bring it up to people who have both conditions,” he said. “I tell them to discuss with their surgeon if they are a good candidate.”