At the heart of every groundbreaking innovation lies a vision to solve the unsolved. Dr. Rick Lewis, Chief Medical Officer at ViaLase (Aliso Viejo, CA, USA), took to the stage at the ESCRS 2024 iNovation Day in Barcelona to share the company’s journey from pioneering femtosecond laser technology to a first-of-its-kind, incision-free interventional glaucoma solution.
After earning his PhD in Hungary, ViaLase CEO Tibor Juhász was fortunate to secure a research position at the University of Rochester (New York, USA) under the mentorship of Gérard Mourou – the world leader in ultrashort pulse laser technology at the time. Collaborating with Ron Kurtz, MD, their groundbreaking work demonstrated the femtosecond laser’s ability to make precise incisions in ocular tissue with micron-level accuracy, without harming surrounding tissue. The femtosecond laser would go on to revolutionize laser refractive surgery, cataract surgery and corneal transplantation.
Fast forward to 2017, when ViaLase was founded with a laser-sharp focus on creating a non-invasive intervention for glaucoma. “The LenSx femtosecond laser cataract surgery was introduced almost 20 years ago,” noted Dr. Lewis. “But glaucoma has always been the goal of our founder.” Leveraging approximately two centuries of collective expertise in developing femtosecond lasers, the company’s leadership team set out to create a system that combined micron-accurate OCT imaging with the precision of a femtosecond laser. “The goal here is to reduce the intraocular pressure using a micron-accurate femtosecond laser to noninvasively create a precise drainage channel in the trabecular meshwork,” Dr. Lewis explained.
Dr. Lewis made it clear that the choice of femtosecond laser technology wasn’t just a nod to history—-it was a deliberate move to reconcile the unmet needs in glaucoma care. He highlighted that while topical medications are often the first line of defense, non-compliance is rampant—nearly half of patients stop using their drops within six months, leading to worsening disease conditions. Selective laser trabeculoplasty (SLT), though popular, has inconsistent efficacy, and its results diminish over time. MIGS, though a minimally invasive glaucoma surgery, still involves cutting into the eye and are often only performed with cataract procedures. Filtration surgeries are complicated, highly invasive, and have a high risk of failure, especially after five years.
The femtosecond laser, with its track record of safety, precision and predictability in anterior segment procedures, offers a promising alternative that is truly non-invasive and does not require opening the eye. It uses photodisruptive energy in such small amounts that it minimizes collateral damage to surrounding tissues. This well-established safety profile has made this technology a cornerstone of ophthalmic surgery, and ViaLase believes it’s time to bring that same reliability to glaucoma treatment.
Enter ViaLase’s latest innovation: the ViaLuxe Laser System, which delivers the first ever femtosecond laser image guided high-precision trabeculotomy (FLigHT). Unlike MIGS, which requires opening up the eye, FLigHT uses a femtosecond laser to create a precise drainage channel in the trabecular meshwork, offering a noninvasive solution that mitigates the potential risks associated with traditional incisional procedures. “Not only is it outpatient, but it’s not incisional,” Dr. Lewis noted.
Another significant advantage to FLigHT is its broad indication. The procedure is performed outside of cataract surgery—a common and limiting requirement for MIGS procedures—which expands patients’ access and may improve outcomes for a wider range of patients.
With its proprietary HD gonioscopic camera and micron-accurate OCT imaging technology, ViaLuxe offers advanced visualization capabilities so that surgeons can precisely target the trabecular meshwork. This is a significant improvement over traditional gonioprism-based techniques, which can distort the surgeon’s view and make it difficult to accurately visualize the anatomy of the eye.
ViaLuxe also offers a highly customizable treatment approach. surgeons can target any of the four quadrants of the eye, allowing for individualized treatment based on the patient’s specific needs. This flexibility is particularly important as traditional angle-based procedures are often limited to the nasal quadrant.
The first-in-human study suggests promising results. “We looked at 18 eyes,” Dr. Lewis said. “These are single channel placements, 500 by 200 microns in the trabecular meshwork.” At 24 months post-treatment, the channels created by the laser remained patent, with no signs of closure or scarring. Notably, the surrounding trabecular meshwork and Schlemm’s canal remain undisturbed—a testament to the precision of the femtosecond laser.1
Clinical data from the study showed a durable mean IOP reduction of 34.6%, with 88% of treated eyes achieving IOP levels of 18 mmHg or lower. Moreover, 82% of patients experienced at least a 20% reduction in IOP, with more than half achieving a 25% drop or more. Equally significant is the absence of serious adverse events, reinforcing the procedure’s safety profile.2
With the recent CE Mark approval, ViaLase is gearing up for the next phase for its ViaLuxe system— a selective commercial rollout in key European markets.
As ViaLase prepares for the commercial debut of ViaLuxe, the excitement surrounding its technology is palpable. By combining the precision of femtosecond lasers with advanced imaging, the company is on track to introduce a new standard in interventional glaucoma care. For patients and clinicians alike, this could mean fewer compromises and better outcomes—without the invasiveness typically associated with glaucoma surgery.
“We feel ViaLase’s femtosecond laser treatment is uniquely positioned to unlock one of the largest eye care markets,” Dr. Lewis emphasized. “It’s the first and only femtosecond laser treatment for glaucoma.”
As Dr. Lewis concluded his talk, one thing was clear: the future of glaucoma care is brighter, more precise and less invasive, thanks to the pioneering work of ViaLase.
References
- Mikula ER, Raksi F, Ahmed II, et al. Femtosecond laser trabeculotomy in perfused human cadaver anterior segments: A novel, noninvasive approach to glaucoma treatment. Transl Vis Sci Technol. 2022;11(3):28.
- Nagy ZZ, Kranitz K, Ahmed II, et al. First-in-human safety study of femtosecond laser image-guided trabeculotomy for glaucoma treatment: 24-month outcomes. Ophthalmol Sci. 2023;3(4): 100313.
