EyeWorld Asia-Pacific December 2018 Issue

EWAP FEATURE 19 December 2018 tially leading to a new set point pressure between the eye and the CSF pressure present in the optic nerve. In the case of suction, this may lead to a rebalance of the translaminar pressure (pressure on either side of the lamina cri- brosa) and ease stress on the ax- ons traveling through this space. In the case of added pressure, the rebalancing of translaminar pressure is intended to counter- act higher CSF pressure that may occur, for example, during space flight when optic nerve swelling can lead to loss of vision.” In December 2015, Dr. Berdahl founded Equinox, the company developing the goggles, which he said should enter clini- cal multicenter trials within the next year. The trials will first test the goggles on a low-risk patient population that could be helped the most, Dr. Berdahl said. But be- cause the concept of the goggles is physics, he and others involved with the company think the treat- ment could apply to any type of glaucoma. Dr. Berdahl thinks that treat- ment with the goggles, which would be set to a specific IOP-low- ering level by the ophthalmolo- gist, customized to patient needs, will be used as adjunctive therapy. “Drops and prior surgical procedures are effective at lower- ing IOP to a certain level, then for those who need additional IOP lowering, I think the goggles would be a great option,” he said. Could the goggles elimi- nate the need for pharmaco- logic therapy? Dr. Berdahl said he thinks there is the potential but “I wouldn’t hang my hat on it yet.” “It’s easy to put in a drop, and drops work well when they’re used properly,” he said. “[The goggles] give doctors one more tool in the toolkit to treat glaucoma, and I think the goggles will help us treat some of the toughest forms of glaucoma.” He envisions that the goggles would be worn primarily at night when patients are sleeping and most vulnerable to nocturnal pres- sure spikes. “We think that is a time when patients are quite vulnerable to their eye pressure, so we can help during that difficult-to-treat time, and perhaps those with the most severe forms of glaucoma would wear them longer,” he said. If born out in clinical trials, the Balance Goggles would pro- vide a “nonsurgical, nonpharma- cologic, on-demand, titratable way to set the person’s eye pressure right where we want it to be,” Dr. Berdahl said. Dr. Swan thinks this technol- ogy could be especially useful in hard-to-treat glaucoma. “I think it has broad utiliza- tion and opportunity in all areas of glaucoma. … For patients with normal tension glaucoma, who we have struggled to find reasonable options for and some of the surgi- cal options like a trabeculectomy or a tube put them at significant risk, it’s nice to have something in the pipeline that decreases patients’ risk but still allows them to get to their IOP goal,” Dr. Swan said. “My message to people would be to keep an open mind in terms of the opportunity. Having seen the clinical results and having worn them myself, knowing what the tolerability of them is, I think it’s a unique opportunity for pa- tients that has a high safety profile but also a high level of comfort,” Dr. Swan said. “We have a dearth of new treatment mechanisms for glau- coma,” said Dr. Kahook, a member of the Equinox Advisory Board. “I will be excited to see data from a longer-term treatment with the Balance Goggles, and I think the company is completing these studies in a systematic and precise way. They have a top-notch engi- neering and clinical team who are all meticulous.” EWAP Reference 1. Berdahl JP, et al. Cerebrospinal fluid pressure is decreased in primary open-angle glaucoma. Ophthalmol. 2008;115:763–8. Editors’ note: The physicians have financial interests with Equinox. Contact information Berdahl: john.berdahl@vancethompsonvision. com Kahook: malik.kahook@gmail.com Swan: russell.swan@vancethompsonvision. com