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We talk to eye surgeon Arthur Benjamin about old but timeless themes, and then touch upon a new one. 

 Let’s suppose that you get tested for cataracts and you find out you have glaucoma.  What do you do?

 Modern ophthalmology has a new solution for this with the iStent, a trabecular microshunt.  Let’s first talk about the basics – the main feature of glaucoma is an increase in intraocular pressure, because the outflow of fluid has been inhibited.  We can repair this by either improving outflow or reducing the production of fluid.  Most medicines do the latter, but the eyes need this fluid, as well.

What is its role?

 The soft tissues of the eye must maintain a certain pressure, so the eye can be compared to an inflated tire.  The ciliary body acts as a pump, moving the aqueous humor to the posterior chamber, where it flows through the eye and nourishes it, before finally exiting into the bloodstream via the trabecular meshwork.

So the liquid can’t be too much or too little?

 Yes, and that’s why the best option for treating glaucoma is one that provides continual irrigation, but maintains the proper pressure.  Now there’s a new method, a device called the iStent, which is a titanium microshunt that resembles an underwater pipe, allowing the anterior chamber to drain.

So this microscopic implant helps to reduce the pressure.  Does the patient feel like they have something in their eye?  Is it generally safe?

 They don’t feel anything, and its safety depends on a steady hand.  The introduction of a micro-shunt adds 1-2 minutes to cataract surgery, but without the usual post-op complications from low intraocular pressure.  Not just any doctor can do this; it requires special training.  The part of the eye where the shunt is implanted isn’t visible, so it’s necessary to use special lenses and mirrors.  That’s the main problem.  With surgical skill, however, it is both safe and effective.

Are there many surgeons in Los Angeles that are able to do it?

In my opinion, there are a few good people.  Many doctors resist innovation because it’s outside of their comfort zone.  For example, maybe you’ve been doing cataracts for 30 years and don’t want the extra hassle.  There are also those that have tried and didn’t get the best results, so why should they continue?  And finally, not everyone loves to learn new things.

Are there many people that need this shunt?

 At Benjamin Eye Institute, practically every other patient has glaucoma, and the patient’s intraocular pressure will be normal for about 7 years.

And then?

 to be continued

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