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Revolutionary glaucoma surgery for rural patients in Broken Hill

19 / 03 / 2018

Today four patients from rural New South Wales will be part of an Australian-first when they undergo an advanced form of glaucoma surgery at Broken Hill Base Hospital.
The surgery, which is commonly referred to as Minimally Invasive Glaucoma Surgery (MIGS), has been in use in Australia for a few years but until now, with the device being used, has never been undertaken outside a major metropolitan city.
Glaucoma surgeon Dr Ashish Agar was one of the first ophthalmologists in Australia to perform MIGS, and will be performing today's surgeries. He is a key member of the Outback Eye Service team based at Prince of Wales Hospital in Sydney and Director of the Ophthalmology Service at Broken Hill Base Hospital.
The device being used is the Hydrus® Microstent, developed by Ivantis, Inc. in Irvine, California (USA)*.
"Before today rural and remote glaucoma patients could not access this advanced technology in their own communities, despite the fact that its outcomes can be transformational," Dr Agar said.
"Today is a boon for equity of access to specialist medical services for people living in the bush. It also represents major progress in the treatment of glaucoma in Australia," he said.
Glaucoma is the leading cause of irreversible blindness in the world. Approximately 300,000 Australians have the disease, a form of optic nerve damage that causes progressive loss of vision. The only treatment is to lower the pressure in the eye (known as intra-ocular pressure or IOP).
Initially this is done by medication (daily eye drops), or laser procedures which must be repeated. If the disease is unable to be controlled, surgery becomes necessary. Traditionally, this has meant a major and complex operation, where a new drainage channel is created through which aqueous fluid can leave the eye and thus lower IOP. The surgery is invasive, it comes with a higher potential for complications and after-care is significant.
Patients from the bush requiring the surgery often need to travel to the city to have the operation. For Broken Hill patients, that means a trip to Adelaide for a week or more.
The advent of MIGS, however, has transformed offers an advanced new pathway of care.
MIGS introduces exciting new technology in the form of a tiny device - much like the stents used in heart surgery to facilitate blood flow to the heart. In fact, the Hydrus® Microstent Dr Agar will be using was developed by Ivantis based on the efforts of cardiac stent engineers.
Providing an alternative to traditional invasive surgery, the tiny stent is implanted into the patient's eye to relieve the high IOP associated with glaucoma. The operation is a form of microsurgery and takes less than half an hour, which is significantly shorter than traditional surgery.
Implantation of the stent is minimally traumatic to the delicate eye tissue, making it safer than traditional glaucoma surgery and patients experience a dramatically faster recovery time. They require fewer follow up visits and in many cases the need for ongoing medication is greatly reduced.
Today's MIGS outreach clinic at Broken Hill Base Hospital is the result of several months of planning and the drive of a number of stakeholders who were committed to making it happen.
Broken Hill Hospital management worked closely with Dr Agar to facilitate use of the technology in the bush. They have been working closely with Prince of Wales Hospital for a number of years to build a unique public specialist eye service at the hospital.
Broken Hill Health Services Director of Medical Services, Dr André Nel said the MIGS outreach clinic demonstrated the power of partnerships.
"Bringing specialist medical services to the bush is a priority for Broken Hill Hospital and this exciting new development is testament to the dedication and hard work of our staff and the work of our partners at The Outback Eye Health Service," he said.
"We are proud to be taking part in this revolutionary surgery on our patch. It paves the way for more ventures that will deliver exciting benefits to local patients."
Ivantis, the medical device company who created the Hydrus® Microstent being used in today's surgeries, has also been integral in enabling this Australian first.
"From the outset Ivantis has been exceptionally supportive in allowing our patients access to their technology," Dr Agar said.
"They have donated many of their devices to those who cannot afford them, including here in Broken Hill where all of the microstents are being provided free of charge to the patients.
"It's a great example of the way industry and the health services can work together in the interests of community," he said.
Mr Glen Burgess, Managing Director of Ivantis Asia Pacific, said the partnership had enabled Ivantis to satisfy its humanitarian goals.
"Our goal has been to bring the Hydrus stent technology to regional Australia where we can help change the lives of patients and give Australian ophthalmologists advanced treatment options in rural and remote settings," Mr Burgess said.
*Ivantis is funded by private equity including local Australian equity investment firm GBS Venture partners.
19 March 2018.
Senior Australian news and research