The iStent: Managing Glaucoma while Treating Cataracts

If you have glaucoma and cataracts, we can add another step to cataract surgery to manage mild‑to‑moderate open‑angle glaucoma in a completely new way.

The iStent Trabecular Micro‑Bypass stent is a new surgical device for glaucoma that is designed to improve aqueous outflow to safely lower intraocular pressure and reduce the medication burden.


This is important because once diagnosed with glaucoma, most patients will spend the rest of their lives putting one, two or even three different kinds of drops in every day. All of these drops are not only inconvenient, but expensive. The iStent is designed to reduce eye pressure and is implanted during cataract surgery.

The iStent is the smallest medical device ever approved by the FDA and is placed in your eye during cataract surgery. It is so small, you won’t be able to see or feel it after surgery but it will be continuously working to help reduce your eye pressure.

As an iStent‑trained surgeon, Dr. Joseph Parisi, Medical Director at Clemson Eye, offers this treatment solution to glaucoma patients who come to us for cataract surgery.

Implanting the iStent during cataract surgery is covered by most insurance plans, Medicare and Medicaid. Currently, the FDA only permits the procedure to be performed in conjunction with cataract surgery.


Open-angle Glaucoma

While mild‑to‑moderate open-angle glaucoma is very common, many people are unaware of their condition, especially in the early stages, when their vision may be unaffected.

Open-angle glaucoma is characterized by an increase in the intraocular pressure (IOP) of your eye. This pressure is caused by the buildup of fluid within the eye. Too much fluid raises pressure, which can cause the gradual loss of vision. And while glaucoma moves slowly, its damage is irreparable.

The world’s smallest medical device, the iStent is 20,000 times smaller than the intraocular lenses (IOL) used in cataract surgery, and is inserted through the same corneal incision.

Implanting the iStent does not significantly lengthen the time a patient spends in surgery and has a safety profile comparable to cataract surgery alone.1 The stent helps control eye pressure while reducing or eliminating the need for drops. This is a significant advantage, as it helps address the high rate of medication non‑compliance among glaucoma patients.

As many as 90% of patients do not adhere to their prescribed regimen of drops and more than half stop using them completely. This is a serious problem as when pressure in the eye is out of control, it can increase the risk of permanent vision loss.

So far, iStent results have been very positive with about 68% of patients remaining medication free 12 months after their procedure.2


How the iStent Works

iStent works like other stents used to prevent heart attacks and strokes. When blood vessels get clogged, a stent creates access to the vessel flow. While a highly innovative technology, the iStent is elegantly simple:

  • If you have glaucoma, over time the eye’s natural drainage system becomes clogged.
  • iStent creates a permanent opening through the blockage to improve the eye’s natural outflow.
  • If you have glaucoma, over time the eye’s natural drainage system becomes clogged.
  • Restoring this mechanism lowers and controls pressure within the eye.

The bottom line is the new, innovative iStent provides an opportunity to safely reduce intraocular pressure during cataract surgery.

More Information on the iStent


  1. Saheb H, Ahmed II. Micro‑invasive glaucoma surgery: current perspectives and future directions. Curr Opin Ophthalmal. 2012;23(2):96‑104
  2. Samuelson, et al. US IDE Trial – IOP and Medication Reduction. Ophthalmology 2011;118:459‑467

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