Double Play

Microstent for glaucoma treatment safe and effective.

Until 2016, young men and women vying for entrance into the University of Central Florida College of Medicine in Orlando had to go through Ronald Portervint. The Missoula, Montana, native worked in the school’s admissions office, where he processed all relevant data on applicants for the admissions committee’s review. Ronald retired in August 2016.

Photo by Jordan Pysz.

Ronald is seeing glasses-free following
cataract surgery.

“My job was to gather all the information so that the committee, which includes medical doctors and PhDs, could get an idea of what the applicants were like,” Ronald explains. “The information also helped the committee determine what questions to ask the applicants in their interviews.

“Mostly, the committee looked for people who were not only knowledgeable but dedicated to the medical field, people who genuinely wanted to help people and were not motivated solely by financial gain.

“When I first started fifteen years ago, there weren’t so many students applying to the medical school. But by the end of my career, there were more than five thousand applicants each year for one hundred and twenty available slots, so admissions was quite a process.”

Shortly before retiring, Ronald began getting his annual eye exam at Brandon Eye Associates. At the time, he became a patient of Amy Martino, MD, a board-certified, fellowship-trained eye surgeon who discovered during a routine exam that he had two eye disorders, glaucoma and cataracts.

Cataracts are the clouding of the eye’s natural lens. Treatment involves surgery to remove the affected natural lens and the replacement of that lens with a clear, synthetic lens implant.

Glaucoma is characterized by increasing eye pressure due to a build-up of fluid. The most common form is open-angle glaucoma, which occurs when the eye’s drainage system becomes blocked.

“When I first saw him, Ronald had very high eye pressure, measuring in the thirties,” Dr. Martino reports. “Normal is twenty-one or less, so I started him on pressure-lowering eye drops. But over the years, the medications either became ineffective or he became allergic to them, so it became necessary to change the medications to stronger ones to try to control his pressure.

“Then, about three months ago, we decided to proceed with cataract surgery to improve his vision and to treat his glaucoma by implanting stents to lower his eye pressure. The stent I chose for Ronald was the Hydrus® Microstent. It is FDA approved for patients with mild to moderate primary open-angle glaucoma who are also undergoing cataract surgery.”

Drain Opener

Healthy eyes constantly produce a fluid called aqueous humor that flows across the front of the eye. The eyes also drain this fluid through specialized tissue called the trabecular meshwork and through the eye’s natural drain, Schlemm’s canal. This canal is located at the angle where the iris, the colored part of the eye, meets the white of the eye, or sclera.

“With glaucoma, Schlemm’s canal is typically clogged and not working properly, so fluid accumulates in the eye, causing pressure to increase,” Dr. Martino explains. “Consistently high eye pressure damages the optic nerve, which can cause a slow, permanent loss of vision over time.”

The Hydrus Microstent is designed to treat the clogging of the canal and reduce the pressure that can damage the optic nerve. It is inserted during a procedure that’s in a class of relatively new and less invasive glaucoma surgeries called microincisional glaucoma surgery, or MIGS. During surgery the Hydrus Microstent is implanted into the Schlemm’s canal to help improve outflow of fluid in the eye, thereby lowering pressure.

“The Hydrus was approved for use in the United States about two years ago, and I was the first surgeon in Hillsborough County to implant it,” Dr. Martino reports. ”It is very safe. Implanting it at the time of cataract surgery does not pose any additional risks over cataract surgery alone.

“It is also effective. The Hydrus lowers eye pressure and enables patients to get off of their glaucoma eye drops in eighty percent of cases. It is more effective than the other, similar devices available, and it’s easy to implant for surgeons like me who are comfortable working in the angle of the eye.”

The mechanism of action of the Hydrus Microstent is similar to that of a cardiac stent. If there’s a blockage in a coronary artery of the heart, cardiologists place a stent, which expands in the artery, opens up the blocked blood vessel and improves blood flow. In much the same way, the Hydrus Microstent opens up the clogged Schlemm’s canal and improves fluid drainage from the eye.

“Using the Hydrus was quite effective for Ronald,” Dr. Martino notes. “At his most recent follow-up appointment, his eye pressure measured around ten to twelve, and it was in the thirties before surgery. In addition, he was using two different glaucoma eye drops before surgery. Now, he uses no eye drops.”

“Surgery with the stents reduced my eye pressure tremendously,” Ronald verifies. “Before surgery, my pressure was very high. The week after surgery, it was twelve.”

Goodbye to Glasses

Prior to undergoing cataract surgery, Ronald did not notice that he was experiencing any of the symptoms most commonly associated with cataracts, which include glared or blurred vision, especially at night.

Ivantis Hydrus

The Hydrus Microstent by Ivantis (left)
is tiny compared to a dime

“But after I had the cataract surgery on my first eye, my vision brightened substantially, and I realized there had been a yellowish haze over everything!” Ronald exclaims. “I had that first surgery on December 4 and the second one, on my right eye, December 18.”

For Ronald, one of the biggest benefits of having cataract surgery was that it allowed him to become glasses-free. Saying goodbye to glasses was a satisfying outcome for a man who wore them for more than 30 years.

“Since my surgery, my vision is good, very good,” Ronald enthuses. “I can read everything and see pretty well at a distance without glasses. I don’t need them at all.”

To better control his glaucoma, the stents were placed in Ronald’s eyes at the same time he had the cataract surgeries. Robert remains concerned about his eye pressure and the future of his vision, but Dr. Martino always puts him at ease.

“Dr. Martino is very knowledgeable, and she’s concerned about more than the health of my eyes,” he says. “She cares about my overall health as well. She’s very professional and always treats me well. I certainly recommend Dr. Martino and Brandon Eye Associates to anyone with eye problems like mine.”

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    • Brandon Eye Associates, PA

      The doctors at Brandon Eye Associates use their hearts to help care for your eyes. In addition to being lauded, board-certified physicians at the height of their careers, your Brandon, Sun City Center and Plant City Ophthalmologists are car... Read More

    • Amy Martino, MD

      Amy Martino, MD, is board certified by the American Board of Ophthalmology. Dr. Martino attended the University of North Carolina at Chapel Hill, where she graduated summa cum laude with a Bachelor of Science degree in biology, with a minor in ... Read More