Sponsored by Nova Eye Medical
At ESCRS 2025, Nova Eye Medical’s “5 Burning Questions” campaign sparked bold conversations about canaloplasty and its role in interventional glaucoma care.
Nova Eye Medical (California, United States) lit up the exhibition floor in Copenhagen with the 5 Burning Questions campaign—a live, in-booth series of talks that tossed canaloplasty straight into the fire at the 43rd Congress of the European Society of Cataract and Refractive Surgeons (ESCRS 2025).
There were no softballs and no rehearsed monologues—just raw questions that global cataract and glaucoma surgeons want answered—and some of the best in glaucoma were there to address them.
Across three sessions, six global experts, including Dr. Morgan Micheletti (United States), Dr. Ike Ahmed (Canada) and Prof. Henny Beckers (The Netherlands) stepped forward to field unfiltered questions on all things canaloplasty and iTrack™ Advance. The goal? To bring canaloplasty out of the shadows and into the fire—one where only strong answers survive.
The burning truth about medication compliance
Burning Question: Prescribing drops is just easier than convincing a patient to undergo MIGS. How do I educate my patients on such a big step?
Ms. Neeru Vallabh (United Kingdom) and Dr. Micheletti tackled this first hotseat question on Saturday, addressing canaloplasty versus conventional pharmaceutical approaches.
While drops may look simple on paper, in real life they often burn out fast—and this was a key point for both doctors. Dr. Micheletti cited a telling statistic: Nearly half of patients abandon their drops within six months, raising questions about long-term adherence in a world with interventions like canaloplasty.
Both surgeons emphasized reframing drops as a bridge rather than a destination. They pointed to ocular surface disease (OSD), fluctuating adherence and the sheer burden of decades-long drop use as reasons to reconsider medication as the primary approach. As Ms. Vallabh noted, “Our goal isn’t simply to prescribe—it’s to protect vision over a lifetime. And sometimes, that means stepping in sooner.”
In a later session, Dr. Larissa Camejo (United States) added a cautionary note on patients and their ability to truly tolerate therapy. “Medications are not the most benign option…sometimes we as doctors feel patients are fine on drops when in reality they’re not.”
The panel reminded surgeons that decades of preserved topical therapy can leave behind hidden damage. Drops may smolder, but they rarely put the glaucoma fire out.
Rethinking drops
Burning Question: MIGS requires us to intervene surgically when it may not be warranted to do so, especially given that my patients don’t complain about their glaucoma medications. How do you justify the role of MIGS, such as canaloplasty?
This question marked a key shift from medication to surgical decision-making—but Prof. Beckers warned that this mindset is a trap. “Everyone is on multiple drops nowadays. If you don’t educate them about other options, in five years when they’ve progressed, they may not thank you.”
Dr. Paul Singh (United States) agreed, adding that physicians need to dig for the truth rather than take surface answers at face value. “Don’t wait for them to tell you. Everyone is guilty [of drop non-compliance],” he said with a grin, urging surgeons to ask about blurred vision or skipped doses. These questions, he added, often reveal the toll of OSD—another key reason for proactive, rather than reactive, treatment.
Both Prof. Beckers and Dr. Singh argued that reducing medication load isn’t just about patient convenience. It improves quality of life, protects the ocular surface and, perhaps most importantly, stabilizes 24-hour IOP control—a key predictor of long-term glaucoma treatment outcomes.
Dr. Singh pointed to data from the LiGHT study, which showed that patients who were off drops were less likely to progress and less likely to need secondary surgery, even when IOP reductions appeared identical.1
For Dr. Camejo, the hidden risk lies in decades of preserved topical therapy accelerating trabecular decline. By stepping in sooner with a tissue-sparing, restorative approach, surgeons can offer patients not only lower pressure but healthier outflow for years to come.
In a final point, Prof. Beckers noted that canaloplasty’s flexibility is among what is most appealing to her. It spares tissue, she argued, preserves future surgical options and plays well with other procedures if escalation is needed.
Dr. Singh added his own twist by bringing up his approach to canaloplasty in the context of combined surgery: “I have a glaucoma patient who happens to have a cataract. And the cataract is my excuse to go in there and take care of the glaucoma.”
Flexibility and a truly hot tip
Burning Question: I hear a lot about the illuminated microcatheter tip of the iTrack™ Advance. Is this just a marketing gimmick?
When the spotlight turned to innovation, the iTrack™ Advance’s illuminated tip stole the show. Far from a marketing throw-in, Ms. Vallabh highlighted the safety reassurance it provides: “The beauty of it is that you know you’re in that space. It’s very satisfying to know exactly where you’re injecting your viscoelastic.”
For Dr. Micheletti, the light is just the beginning for iTrack™ Advance innovation. The smooth, flexible microcatheter makes it easier and faster to complete a full 360-degree pass around Schlemm’s canal without snagging or creating false passages. Combine that with the controlled pressurized delivery of viscoelastic, and the entire outflow system gets addressed in one sweep.
This matters because resistance doesn’t always stop at the trabecular meshwork. By dilating the distal collector channels too, canaloplasty widens the “plumbing system” when the exact blockage point isn’t clear. As Dr. Singh later put it, “What’s beautiful about canaloplasty is that it is addressing the entire outflow system from proximal to distal.”
Stoking the flames of tissue rejuvenation
Burning Question: Canaloplasty doesn’t leave any hardware in the eye, so how can it achieve duration of effect? Isn’t it only a temporary flushing effect?
Canaloplasty may be described as a flushing procedure, but the experts in Copenhagen framed it more as a restoration. Dr. Ahmed suggested that viscodilation may actually rejuvenate the tissue. “We’re changing something on a tissue level to enhance aqueous outflow that may potentially delay trabecular disease,” he said.
During his Saturday session, Dr. Micheletti offered a similar perspective. Once the canal and collector channels turn fibrotic, the treatment window narrows. “The earlier you treat and try to restore physiologic outflow, the better the long-term outcome,” he said.
Skeptics naturally question durability without an implant. Dr. Micheletti answered with another plumbing metaphor: “Like a good Roto Rooter, when you flush out the debris, that effect can last a long time.”
The volume of viscoelastic was another key point in addressing durability concerns. Schlemm’s canal holds only four to six microliters, yet iTrack™ Advance delivers over 100 microliters. Ms. Vallabh explained why going beyond Schlemm’s canal volume is critical: “You need a larger amount because you’re also reaching the distal outflow beyond the canal.”
The white-hot future of canaloplasty
Amidst the fire, flames and spirited debate, all six surgeons shared a common message. For patients with early to moderate glaucoma, especially those already in line for cataract surgery, canaloplasty offers a way to reduce the drop burden while preserving tissue and leaving doors open for future treatment.
And it doesn’t end here in Copenhagen. Burning questions like these will always arise, For the world-renowned panel of experts on hand at the Bella Center for ESCRS 2025, canaloplasty looks less like a niche option and more like a strategy tested in the heat of battle for better patient outcomes in modern glaucoma care. By addressing the whole outflow system without leaving behind implants, it gives surgeons a chance to turn down the heat of glaucoma progression before it rages beyond control.
Editor’s Note: The 43rd Congress of the European Society of Cataract and Refractive Surgeons (ESCRS 2025) is being held from 12-16 September in Copenhagen, Denmark. Reporting for this story took place during the event. This content is intended exclusively for healthcare professionals. It is not intended for the general public. Products or therapies discussed may not be registered or approved in all jurisdictions, including Singapore.
Reference
- Gazzard G, Konstantakopoulou E, Garway-Heath D, et al; LiGHT Trial Study Group. Laser in Glaucoma and Ocular Hypertension (LiGHT) Trial: Six-Year Results of Primary Selective Laser Trabeculoplasty versus Eye Drops for the Treatment of Glaucoma and Ocular Hypertension. Ophthalmology. 2023;130(2):139-151.