Professor Dan Lindfield’s ELIOS™ patient outcomes have contributed to a major European glaucoma research collaboration published in the British Journal of Ophthalmology, comparing ELIOS with iStent.
The multicentre research brought together glaucoma specialists across Europe to examine what Professor Lindfield describes as the largest series of ELIOS patients published to date, while directly comparing outcomes from ELIOS with iStent.
The study examined 343 eyes undergoing cataract surgery combined with either ELIOS or iStent, providing important new comparative evidence around two different approaches to minimally invasive glaucoma surgery (MIGS).
For people living with glaucoma or ocular hypertension, this research adds to the evidence available when considering how best to control eye pressure while selecting an approach appropriate for the individual patient.
ELIOS is a minimally invasive glaucoma procedure that uses a specialised excimer laser to create small openings in the trabecular meshwork.
The trabecular meshwork is part of the eye's natural drainage system. In glaucoma and ocular hypertension, resistance to the drainage of fluid from the eye can contribute to raised intraocular pressure (IOP).
By creating precisely placed openings in the trabecular meshwork, ELIOS is intended to improve access to the eye's natural drainage pathways and help reduce IOP.
Importantly, ELIOS does not leave a permanent implant inside the eye.
Professor Dan Lindfield introduced ELIOS to the UK and has extensive experience using and teaching the technique. At Farnham Eye Care, ELIOS is one of several treatment options considered for suitable patients with glaucoma or ocular hypertension.
The newly published study looked at 343 eyes undergoing cataract surgery combined with either ELIOS or iStent.
At 12 months, the reduction in intraocular pressure was comparable between the two groups.
The study reported an average IOP reduction of:
The researchers also found comparable results in relation to safety and the need for further glaucoma surgery.
One notable difference was seen in the use of glaucoma medication. At 12 months, 46.4% of eyes in the ELIOS group had reduced their glaucoma medication, compared with 31.3% in the iStent group.
This difference was statistically significant in the study.
The results are encouraging, particularly because they add to the evidence surrounding an implant-free MIGS approach.
However, it would be wrong to interpret the study as showing that ELIOS is universally better than iStent.
The study was retrospective rather than a randomised controlled trial, and only around 70% of the original eyes had one-year follow-up available. As with any study, the results need to be considered alongside the wider body of evidence and the characteristics of the individual patient.
The key message is that ELIOS is another potentially useful option for appropriately selected patients, rather than that one MIGS procedure is best for everyone.
One of the situations in which ELIOS may be considered is when a patient with glaucoma or ocular hypertension is already undergoing cataract surgery.
Cataract surgery itself can have an effect on eye pressure. In an appropriate patient, combining cataract surgery with a MIGS procedure may provide an opportunity to address both the cataract and glaucoma during the same operation.
The decision depends on factors including the type and severity of glaucoma, the patient's target eye pressure, current medication, previous treatments and the overall health of the eye.
There is no single glaucoma procedure that is right for every patient.
ELIOS sits within a much wider range of glaucoma treatment options.
Selective laser trabeculoplasty (SLT) is a well-established laser treatment for open-angle glaucoma and ocular hypertension.
SLT is generally considered a very minimally invasive treatment and may be appropriate before surgery for many patients.
ELIOS is different because it involves creating openings in the trabecular meshwork from inside the eye, and is a surgical MIGS procedure rather than an external laser treatment delivered through the front of the eye.
The two treatments therefore have different roles, and the appropriate choice depends on the patient's circumstances.
The new British Journal of Ophthalmology study provides particularly useful information here.
Both approaches can be performed alongside cataract surgery, but their mechanisms are different.
iStent uses a small permanent titanium implant to bypass part of the eye's drainage resistance.
ELIOS is implant-free, using laser-created openings in the trabecular meshwork instead.
The new study found comparable IOP reduction at 12 months, while a greater proportion of ELIOS patients reduced their glaucoma medication.
Further research will help establish how these approaches compare over longer periods and in different patient groups.
ELIOS is also different from other MIGS procedures such as OMNI®, Hydrus and other approaches that work on the eye's drainage system in different ways.
Some MIGS procedures involve a permanent implant, while others are implant-free.
The choice is therefore not simply about selecting the newest or most advanced procedure. It is about matching the treatment to the patient's anatomy, glaucoma severity, target pressure and previous treatment.
Glaucoma treatment continues to evolve.
For patients, that means there are increasingly more ways of approaching raised eye pressure, but it also means that understanding the evidence behind each treatment is important.
Professor Dan Lindfield has been involved in the introduction, clinical use and teaching of newer glaucoma procedures, including ELIOS. His involvement also extends to clinical research, with his own patients and outcomes contributing to this latest European collaboration.
The publication of this comparative research in a leading peer-reviewed ophthalmology journal provides an opportunity to better understand where newer procedures sit within the wider glaucoma treatment landscape.
Rather than asking “Which glaucoma procedure is the best?”, the more useful question is:
“Which treatment is most appropriate for this particular eye?”
ELIOS is not suitable for every patient with glaucoma or ocular hypertension.
Your ophthalmologist will consider factors such as:
For some patients, drops or SLT may remain the most appropriate approach. For others, MIGS such as ELIOS, OMNI or another procedure may be considered. Patients with more advanced glaucoma or very low target pressures may require more traditional glaucoma surgery.
The aim is always to choose the most appropriate treatment for the individual patient, rather than assuming that one procedure will suit everyone.
Professor Dan Lindfield is a Consultant Ophthalmologist specialising in glaucoma and cataract surgery at Farnham Eye Care.
His involvement with ELIOS extends beyond performing and teaching the procedure. His own patients and clinical outcomes contributed to this latest European research collaboration and the developing evidence base for ELIOS.
Professor Lindfield introduced ELIOS to the UK and has extensive experience with the procedure, as well as teaching other ophthalmologists about newer approaches to glaucoma surgery.
His work with ELIOS forms part of a wider interest in developing, evaluating and researching less invasive approaches to glaucoma treatment.
At Farnham Eye Care, patients can discuss a range of glaucoma treatments, including SLT, ELIOS and other MIGS procedures, as well as more established surgical approaches where appropriate.
The new British Journal of Ophthalmology study adds useful comparative evidence for ELIOS, particularly in relation to IOP reduction, medication use and safety alongside cataract surgery.
It also represents Professor Lindfield's direct contribution to a wider European research effort examining outcomes from ELIOS and comparing the procedure with iStent.
Its results are encouraging, but they do not establish ELIOS as universally superior to other glaucoma treatments.
As glaucoma is a long-term condition with different levels of severity and different treatment requirements, the right approach needs to be determined on an individual basis.
If you have glaucoma or ocular hypertension and would like to understand your treatment options, an assessment with a glaucoma specialist can help determine which approaches may be appropriate for your eyes.
