Glaucoma devices and pharmaceuticals with John Berdahl, MD

In conversation with John Berdahl, MD, an ophthalmologist in Sioux Falls, South Dakota and professor at the University of South Dakota, his shared insights on a noninvasive and nonpharmacological intraocular pressure (IOP)-lowering device consisting of goggles attached to a negative pressure (NP) pump.

This new non-surgical, non-drug treatment for glaucoma that was approved by the FDA in June 2024. The pump consists of 2 ocular chambers that fit over the eyes and are attached to a negative pressure pump. By drawing negative pressure, the device reduces the weight and pressure on the eyes, causing the intraocular pressure (IOP) to decrease. This is based on the principle that if pressing on the eye increases pressure, then reducing pressure should lower it.

The effectiveness of the device was demonstrated in the HERCULES trial, which involved 186 patients with normal tension glaucoma. The study found that 100% of patients experienced IOP lowering while wearing the goggles, with 97% seeing a reduction of more than 20%. On average, IOP decreased from 20.2 mmHg to 12.2 mmHg at night, a 39% reduction. The safety profile of the device is excellent, with only minor side effects reported, such as puffiness under the eyelids in about 17% of patients.

Berdahl discusses how this may be good option for patients whose IOP is less than 21 mmHg and who need additional lowering after trying other therapies like SLT, eye drops, or MIGS procedures. He suggests it could be preferable to moving on to more invasive glaucoma surgery. Overall, this device represents an innovative non-invasive approach to managing glaucoma that has demonstrated strong efficacy in clinical trials. Its approval provides a new treatment option for patients seeking to lower their eye pressure without drugs or surgery.