Primary open-angle glaucoma (POAG) affects an estimated 3 million Americans, many of whom are eligible to be treated with minimally invasive glaucoma surgery (MIGS) procedures. Since the 2012 introduction of the iStent trabecular microbypass device (Glaukos), continued innovation and access to new technologies have increasingly been considered the standard of care for glaucoma.

Prior to 2012, the glaucoma treatment algorithm typically began with medication, moved to laser treatment, and then moved on to more invasive procedures such as tube shunts or trabeculectomies. Current approaches include trabecular bypass procedures such as the iStent Inject W (Glaukos) or Hydrus Microstent (Alcon/Ivantis); goniotomy procedures such as the Kahook Dual Blade (New World Medical); or viscoelastic delivery procedures such as Omni (Sight Sciences), Streamline (New World Medical), or iTrack (Nova Eye Medical).

Now, ophthalmic surgeons can add a new weapon their arsenal against POAG: Glaukos’ iAccess Trabecular Trephine, a new goniotomy device designed to reduce intraocular pressure (IOP) while sparing more natural anatomy than conventional goniotomy approaches.

Current Goniotomy Techniques vs iAccess

Like other goniotomy procedures, iAccess is performed via an ab interno approach using a gonioscope lens. iAccess employs a blade, or trephine, to precisely incise the trabecular meshwork and excise 220-μm circular cores of tissue across an unlimited number of clock hours. The device is unrestricted in the ability to create numerous incisions, thereby creating an extensive opening to Schlemm’s canal and allowing aqueous to flow from the anterior chamber.

These characteristics translate to several benefits for surgeons and patients. For one, iAccess can preserve more tissue than traditional approaches.

“iAccess leaves about 95% of the normal tissue and normal trabecular meshwork intact, depending on the surgeon’s technique,” says Blake Williamson, MD, of the Williamson Eye Center in Baton Rouge, Louisiana, who has performed about 30 procedures with iAccess since the product became available in early 2022. As a result, iAccess helps maintain the eye’s natural blood–aqueous barrier and mechanical pumping mechanism. In addition, should the patient’s glaucoma continue to progress, iAccess leaves behind enough tissue for future MIGS procedures as needed.

iAccess also has safety features built into the device, such as a 300-μm backstop designed to protect against overtrephination. These features, coupled with the precise titanium nitride–coated cutting tip, offer unique advantages over other techniques available today, according to the company.

A Complementary Treatment

The iAccess procedure can be performed either standalone or, if surgeons deem medically appropriate, alongside stenting, endoscopic laser, and other treatments.

“It’s a versatile procedure,” says Dr. Williamson. “It can be done as a standalone or in combination with cataract surgery or other MIGS procedures and devices, like iStent Inject W.” Used in conjunction with iStent Inject W, iAccess can potentially further lower intraocular pressure by creating numerous additional openings through the trabecular meshwork, while having iStent in place for a long-term, permanent bypass.

A Financially Sound Investment

iAccess represents a financially shrewd option for surgeons, surgery centers, and hospital facilities.

“As we all know, when performing MIGS, there are often pressures from the facility side to keep the cost of goods lower. iAccess is competitive in terms of its pricing,” says Nathan Radcliffe, MD, of the New York Eye Surgery Center in Bronx, New York. Dr. Radcliffe notes that that iAccess is coded under category 1 CPT code 65820, making it eligible for CMS reimbursement.

A “Wonderful” Addition to Glaucoma Treatment

For surgeons who are looking for a device that provides unique tissue-sparing features, a procedure that can be used as a standalone option or combined with stenting, a procedure with a straightforward learning curve, or a procedure that creates a goniotomy while minimizing postoperative complications, iAccess is ideal, says Dr. Williamson.

“iAccess is a wonderful procedure,” he says. “We all are doing MIGS. It’s totally within our wheelhouse. This is yet another product that is straightforward to adopt, has a great safety profile, and can really help our patients, in my opinion.” GP