G360 2025: The latest in glaucoma devices and pharmaceuticals

John Berdahl, MD, practicing in Sioux Falls, South Dakota discussed the FYXS Ocular Pressure Adjusting Pump during the recent Glaucoma 360 meeting. This is the first non-surgical, non-drug treatment for glaucoma approved by the FDA in June 2024. The pump consists of 2 ocular chambers that attach to a negative pressure pump. When worn, the negative pressure draws some of the weight off the eye, causing the intraocular pressure (IOP) to decrease. Berdahl explains this using a simple analogy - if you press on the eye, the pressure increases, and when you release the pressure, it decreases.

Berdahl describes the HERCULES trial, which looked at 186 patients with normal tension glaucoma. The study found that 100% of patients experienced IOP lowering while wearing the pump, with 97% having more than a 20% reduction and an average 39% decrease from 20.2 mmHg to 12.2 mmHg. The safety profile was good, with only 17% experiencing some eyelid puffiness. Berdahl suggests the pump will be useful for patients with IOP less than 21 mmHg who have tried other therapies like eye drops, SLT or MIGS, but need additional IOP lowering before considering more invasive glaucoma surgery. He sees this as a significant innovation, marking a new category in glaucoma treatment after previous advancements in imaging, MIGS, and drug delivery.

Finally, Berdahl discusses the collaboration between optometry and ophthalmology in his rural state, where patients often travel long distances for care. He works closely with optometrists who manage the day-to-day clinic, while he is involved in surgical decisions and complex cases. This allows them to provide the most effective and efficient care for their patients.