Optometrist Dr. David Kordish often talks to patients about glaucoma and cataracts as part of general eye care. Now he can see his patients with clearer vision and without drips of glaucoma medication – thanks to tiny devices implanted in the fall of 2020.
Kordish, 70, plans to continue working part-time at Brisbane Eyecare in the Spokane Valley for the foreseeable future. But almost two years ago he needed cataract surgery and a solution for eye irritation after years of using eye drops for glaucoma. That’s when Kordish’s own eye doctor, Dr. Jonathan Haymore, suggested three strategies.
During the cataract surgery, Kordish also had microscopic devices implanted – two in each eye. Its devices are called iStent inject W, to help drain eye fluids and reduce pressure in the eye caused by glaucoma.
With device upgrades over the past two years, some patients may stop using their daily medicine drops. This 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 glasses.
“I haven’t seen this since third grade,” Kordish said.
“I had to have cataract surgery in my late 60s, and Dr. Haymore told me about a few different procedures he could perform while doing cataract surgery that would hopefully replace my need for eye drops.
“He inserts the device 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 that fluid can flow into your body and away from the eye.
Today’s devices are about the size of a digit on a penny, or a bit larger than a grain of salt, he said.
“They put it in an area of the eye that naturally drains fluid, but it’s a bigger opening for fluid to drain out, so it complements the natural drain in the eye.”
Daily medicine drops are the typical defense to allow pressure to drop in the eye and open up the drainage system. Kordish used the drops for about 15 years and his mother also had glaucoma. But sometimes he had a reaction like rash because of the preservatives in the drops.
A while back he had a laser procedure to open the drain in his 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 along, and there were several of them, to get into the eye and create a drain mechanically.”
Glaucoma occurs when fluid builds up in the front part of the eye. Cataracts develop in the majority of older people when the natural lenses of the eyes become cloudy over time.
“Cataracts are pretty much universal for everyone — most people need cataract surgery at some point in their lives,” said Haymore, an ophthalmologist at MultiCare Rockwood Eye and Optical Center.
“Glaucoma, fortunately, is not as common but affects at least a small percentage of the population. Glaucoma is where the internal pressure inside your eye is usually too high, which puts pressure on your optic nerve and can damage your optic nerve over time.When it does this, you may lose your peripheral vision without really knowing it.
Earlier eye stents for glaucoma, under different brand names, were launched around 2012 when doctors inserted a stent. Then studies showed that drainage worked better with two stents in each eye, Haymore said. They are smaller now.
“These are the smallest medical devices on the planet – about a third of a millimeter – and they’re inside the eye, so you never see them, feel them or even know they’re there. there, except your eye pressure is lower,” Haymore said. “You already operate on the eye to help with cataracts, plus you can treat two conditions with minimally invasive surgery.”
The glaucoma procedure is called MIGS, or minimally invasive glaucoma surgery. Glaucoma stents go through the incision made for cataract surgery, and the recovery time is the same, he said.
“The iStent injection usually only adds a few minutes to the surgery, and we put these microscopic stents inside the eye, and it acts like a kind of internal passageway or drain in the eye that lowers your eye pressure and can often take the place of drops.
“Dr. Kordish is a perfect example of that. He was on three medications for glaucoma, and luckily we were able to get him off all three, which makes your eye much more comfortable. The cost of the drops, the cumbersomeness of putting them all on every day, it’s a big advantage not to have to do that anymore.
“There are also other devices (stents) and it depends on the severity of the glaucoma. But the stents have been a big plus as far as the latest technology goes, and the installation of two stents has really been that over the of the past two years.
The stent procedure is covered by insurance if you have a diagnosis of glaucoma, and the majority of people are good candidates, Haymore said.
Kordish also opted for replacement lenses that provide more than the typical correction, so it was an out-of-pocket expense.
“He was extremely myopic before, and we put in these specialized lenses called multifocal lenses,” Haymore said.
“The nice thing about these is that we were able to get rid of his high prescriptions, and also these lenses give you distance and near vision without glasses, so it was a great operation for him. We always put a lens in during cataract surgery, but there are choices when it comes to lens types.The traditional ones help you see far.
Kordish said he was delighted with the result. He thinks insurance will eventually catch up with the option of full vision correction during cataract surgery.
“I would normally need bifocals or trifocals, or in my case, I tried contact lenses to work,” Kordish said.
“I no longer have glasses or contact lenses because the lens implants he put in corrected my sight at all three distances – far, near and in between. Insurers will now pay for a basic lens implant.
“I think eventually insurers could start covering it or partially covering it.”
Kordish has worked part-time since 2014. He’s lived in Spokane for 40 years and uses his days off to “have fun and spend time with his grandkids.”
Kordish said her two days a week at the practice helps her stay in touch with long-time patients and maintain her skills. And now, for patients, he can recommend new options first-hand.
“In my practice, I talk about it to people who have both conditions,” he said. “I tell them to discuss with their surgeon if they are a good candidate.”