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Newly Approved Glaucoma Treatment is First to Uniquely Target the Suprachoroidal Space of the Eye

Posted on May 11, 2017 by Glaucoma Research Foundation

Update on CyPass Micro-Stent: On August 29, 2018, Alcon announced an immediate, voluntary market withdrawal of the CyPass Micro-Stent from the global market and advised surgeons to immediately cease further implantation with the CyPass Micro-Stent. Alcon's decision and corresponding recommendation was based on an analysis of five-year post-surgery data from the COMPASS-XT long-term safety study. At five years, the CyPass Micro-Stent group experienced statistically significant endothelial cell loss compared to the group who underwent cataract surgery alone. For more information, please read the Novartis press release.

New treatments for glaucoma are constantly being researched, with scientists always on the lookout for parts of the eye that are affected and new ways to administer treatment. In October 2016, the first microstent to lower eye pressure by increasing drainage through the suprachoroidal space of the eye was launched. It was approved by the FDA for use in conjunction with cataract surgery in adults with mild to moderate primary open-angle glaucoma.

What is the Suprachoroidal Space of the Eye?

Like a tiny, finely-crafted machine, the eye contains many small parts that work in sync to create vision. The iris and pupil determine how much light enters the eye, then the cornea and lens focus the light so it precisely hits the retina in the back of the eye. That’s where the magic happens, as millions of photoreceptor cells—120 million rods and 6 to 7 million cones—turn light waves into nerve signals that communicate with the brain.

So where does the suprachoroidal space fit into the picture? The eye is surrounded by two layers. One of them, the sclera, is the outermost layer that forms the white part of your eye. The next layer beneath the sclera—the choroid—is home to the blood vessels that nourish the retina. Now imagine the miniscule space between the sclera and the choroid—that’s where you find the suprachoroidal space.

Thanks to advances in imaging that finally let doctors see the space, it’s now a promising location for innovative glaucoma treatments.

Using the Suprachoroidal Space for Glaucoma Treatment

In a search for better drug delivery to the eye, doctors started thinking about the suprachoroidal space, but recent improvements in imaging technology let them actually see the space well enough to learn what happens when they inject fluids. Meanwhile, glaucoma experts were hard at work, searching for ways to use the suprachoroidal space to decrease intraocular pressure … and they have succeeded. For the first time ever, eye pressure can be lowered via the suprachoroidal space.

Eye surgeons use minimally invasive glaucoma surgery (MIGS) to insert the CyPass® Micro-Stent. It slips into an area called the supraciliary space which connects to the suprachoroidal space. The stent can improve eye fluid drainage and absorption through the suprachoroidal space. Of course, once the stent is in place, the patient can’t tell it’s there because it’s so tiny, flexible and designed to follow the natural curve of the eye.

When the Micro-Stent was inserted in patients with refractory or earlier-stage glaucoma, intraocular pressures went down by 30 percent. IOPs remained low for two years, enabling patients to cut medications in half.1 When stent insertion was combined with cataract surgery, lower pressure was maintained for three years.2 As a result, in July 2016, the US Food and Drug Administration approved the Micro-Stent for use. More work will need to be done to see how devices that target the suprachoroidal space can help other forms of glaucoma in addition to mild to moderate open-angle glaucoma, perhaps in combination with other therapies or drug treatments.

It is research like this, funded by people like you, that gives hope to the glaucoma community. Your generous donation to Glaucoma Research Foundation goes to support researchers developing the next generation of glaucoma treatments.

1 “Suprachoroidal Access: The Next Big Thing?” September 2016, http://glaucomatoday.com/2016/10/suprachoroidal-access-the-next-big-thing/

2 “Alcon Launches the CyPass Micro-Stent at the American Academy of Ophthalmology (AAO) 2016 Annual Meeting,” October 2016, https://www.alcon.com/news/media-releases/alcon-launches-cypassr-micro-stent-american-academy-ophthalmology-aao-2016

Last reviewed on August 29, 2018

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