Nova Eye Medical’s iTrack Advance improves ergonomics.
Advancing the minimally invasive glaucoma surgery (MIGS) armamentarium, the iTrack Advance from Nova Eye Medical Limited can boost canaloplasty efficiency with its improved design. In April 2023, the iTrack Advance canaloplasty device, which builds on the original iTrack introduced in 2008, was cleared by the FDA for microcatheterization and viscodilation to reduce IOP in adult patients with primary open-angle glaucoma.
ERGONOMIC HANDPIECE
A major benefit of the iTrack Advance is that the surgeon uses a slider on a handpiece to advance the 200-µm illuminated canaloplasty microcatheter around Schlemm’s canal instead of using microforceps. Glaucoma surgeon Mary Qiu, MD, was experienced in using microforceps with the original iTrack 250A and even taught residents how to perform this procedure as a faculty member at the University of Chicago. Dr. Qiu was excited by the ability to more easily advance the microcatheter around Schlemm’s canal with the iTrack Advance.
“The iTrack Advance is easy to use because you just hold the handpiece and push the slider forward with one finger, and it can advance the microcatheter all the way around Schlemm’s canal much more easily and quickly rather than advancing it around manually with microforceps,” Dr. Qiu explains.
“You can perform an entire 360° canaloplasty all in one go without having to move or reposition the instrument,” she adds. “In my experience, the iTrack Advance is the most efficient way for me to accomplish a 360° canaloplasty.”
And although the device is not indicated for trabeculotomy, “if you wanted to perform a trabeculotomy after the canaloplasty, you can also perform an entire 360° trabeculotomy with it,” Dr. Qiu says.
EXTERNAL OVD
With the iTrack Advance, notes Kate Hunt, chief commercial officer at Nova Eye Medical, an external reservoir, called the ViscoInjector, holds ophthalmic viscosurgical devices (OVDs) instead of it being stored inside the handpiece. During the procedure, the technician rotates or clicks the ViscoInjector to dispense a bolus of roughly 2.5 mL of OVD per click. “The beauty of that system design is if a surgeon wants to deliver more or less OVD, they can,” she says.
The iTrack Advance allows a surgeon to dispense as much as 100 µL of OVD in Schlemm’s canal, Dr. Qiu says. “It allows you to control exactly how much viscoelastic you are dispensing into Schlemm’s canal and at what time and position.”
What’s more, the device allows pressurized viscodilation, Dr. Qiu notes, which can force OVD through blockages in Schlemm’s canal and downstream to the collector channels. To force OVD through the collector channels, according to Ms. Hunt, “you need to do it with sufficient pressure, otherwise the OVD will egress to the path of least resistance.”
The surgeon can dispense OVD both as the microcatheter is being advanced as well as retracted. In the past, notes Ms. Hunt, if a surgeon encountered an obstruction during intubation, Nova Eye would advise withdrawing the microcatheter and proceeding in the opposite direction to see if the microcatheter would feed through. However, “what a lot of our surgeons have started to do is deliver a little bit of OVD. It dilates the canal at that point and allows the microcatheter to pass.”
“We dispense viscoelastic under pressure at the same time we’re catheterizing the canal,” says Analisa Arosemena, MD, glaucoma and anterior segment surgeon, CorrectVision Laser Institute, Weston, Fla. “If we encounter a block in the canal, we can dilate that block using viscoelastic. That is much gentler than just pushing through with a catheter. That’s a very good added safety of this device,” says Dr. Arosemena.
In performing a 360° canaloplasty, Dr. Qiu will inject viscoelastic into Schlemm’s canal both as she advances the microcatheter and retracts it. “I like visco on the way in because it dilates Schlemm’s canal slightly, which helps make it easier for the catheter to slip through the canal and slide forward. There’s not as much resistance because you’ve already filled the inside of Schlemm’s canal with a slippery viscoelastic,” she says.
TWISTING THE TIP
Another advantage of the iTrack Advance device includes the ability to twist the tip of the instrument so the catheter emerges from the tip of the handpiece oriented in any direction relative to the location of the slider. According to Dr. Qiu, “This allows you to hold the handpiece in a comfortable ergonomic way, so the slider is located at an angle that is comfortable for your finger to push it forward without blocking your view with your finger, which can sometimes happen if the slider is located on the top of the handpiece. This also allows the catheter to be oriented precisely in the angle that you want relative to the slider and to Schlemm’s canal.”
GUIDING LIGHT
The iTrack Advance allows surgeons to easily track the progress of the procedure via an illuminated microcatheter, which was available in the original device. “The blinking light is a critical safety feature in my opinion and makes it a much safer way to perform canaloplasty and trabeculotomy when you know exactly where the tip of your catheter is,” says Dr. Qiu. “This feature distinguishes this device from others because as you advance the catheter into Schlemm’s and all the way around, the blinking light can be seen from outside of the eye, so you know exactly where the catheter tip is.”
Dr. Arosemena agrees. “After using the iTrack Advance with the guidance light, you realize how many times you may not be in the canal when you treat. The safety really tilts the scale towards using this device versus some of the other devices because of the security of knowing that you are perfectly located in the area of Schlemm’s canal you want to treat.” OM
Dr. Qiu is a consultant for Nova Eye Medical. Dr. Arosemena is a speaker and consultant for Nova Eye Medical.
