A Mount Sinai ophthalmologist\u00a0will unveil\u00a0a novel surgical technology that allows eye surgeons to measure and respond to critical fluid dynamics inside the eye in real time\u2014an advance that may significantly improve precision and outcomes in glaucoma and other ophthalmic procedures.\u00a0<\/p>\n
The technology, called miDOC (micro-interventional Dynamic Outflow Curve), will be introduced by Sean Ianchulev, MD, MPH, Professor of Ophthalmology at the Icahn School of Medicine at Mount Sinai and Director of Ophthalmic Innovation and Technology at New York Eye and Ear Infirmary of Mount Sinai (NYEE), during the prestigious Charles D. Kelman Innovator\u2019s Lecture at the American Society of Cataract and Refractive Surgery (ASCRS) annual meeting in Washington, D.C., on Sunday, April 12. The lecture is designed to highlight visionary leaders in cataract and refractive surgery and celebrate their contributions to the field.\u00a0\u00a0<\/p>\n
Developed\u00a0by Dr.\u00a0Ianchulev\u00a0at NYEE with\u00a0funding from\u00a0Mount Sinai Innovation Partners,\u00a0miDOC\u00a0is designed to provide continuous intraoperative measurement of ocular flow and pressure\u2014parameters that have historically been difficult to assess during surgery. The system enables surgeons to\u00a0monitor\u00a0changes in real time and adjust procedures accordingly for each patient.\u00a0<\/p>\n
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This is the equivalent of what optical biometry did for cataract surgery.\u00a0miDOC\u00a0brings precision to glaucoma surgery that simply has not existed before.\u00a0We are certainly on the verge of something\u00a0very exciting\u2014bringing glaucoma surgery into the age of\u00a0digital-guided precision, high fidelity,\u00a0and biometric feedback. This will allow\u00a0glaucoma surgeons to one day achieve similar outcomes as we see\u00a0in\u00a0cataract surgical interventions.\u201d\u00a0\u00a0<\/p>\n
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Dr.\u00a0Sean Ianchulev, MD, MPH, Professor of Ophthalmology, Icahn School of Medicine, Mount Sinai<\/p>\n
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Early clinical experience\u00a0<\/p>\n
NYEE is the only eye center in the country to use this technology and conduct the\u00a0first-in-human clinical study. Surgeons started using\u00a0it\u00a0in patients in July 2025 and\u00a0have completed\u00a0the first 20 cases.\u00a0According to investigators, all procedures were successfully completed with intraoperative biometric guidance.\u00a0<\/p>\n
During surgery,\u00a0miDOC\u00a0enabled continuous measurement of key parameters including:\u00a0<\/p>\n
\n\tPressure\u00a0
\n\tFlow\u00a0
\n\tOutflow facility\u00a0
\n\tOcular rigidity\/Compliance\u00a0
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These measurements\u00a0provide\u00a0new insight into how surgical interventions affect the eye in real time.\u00a0<\/p>\n
Addressing a critical gap in glaucoma surgery\u00a0<\/p>\n
While\u00a0performing glaucoma procedures without\u00a0miDOC, surgeons have no way of checking a patient\u2019s exact ocular flow and pressure, a critical variable in the operating room. They can only check intraocular pressure before and after the procedure,\u00a0which leaves\u00a0outcomes\u00a0unpredictable.\u00a0\u00a0<\/p>\n
This has held back the precision of glaucoma surgery,\u00a0where, currently,\u00a0more than 50 percent of the patients undergoing trabeculectomy and drainage device implants\u00a0fail to\u00a0achieve complete postoperative success and medication independence.\u00a0In some cases,\u00a0it is not until the follow-up appointment\u00a0that ophthalmologists discover the procedure may not have worked and\/or has\u00a0possible complications.\u00a0\u00a0<\/p>\n
This contrasts significantly to cataract surgery,\u00a0where 95 percent of patients achieve\u00a0a successful refractive\u00a0outcome\u00a0within 0.5D of\u00a0emmetropia\u2014a\u00a0very small\u00a0amount of refractive error\u2014because\u00a0accurate\u00a0biometry is\u00a0available and\u00a0critical to these outcomes.\u00a0\u202f\u00a0<\/p>\n
\u201cIntraoperative measurement of aqueous outflow has not previously been possible during ophthalmic surgery. This capability has the potential to transform outflow-based surgical interventions by advancing the field toward high-precision biometry and improved clinical outcomes,\u201d says Gautam Kamthan, MD, Assistant Clinical Professor of Ophthalmology at the Icahn School of Medicine and Assistant Director of Ophthalmic Innovation and Technology at NYEE, who co-invented this technology and is the Principal Investigator of the study. \u202f\u00a0<\/p>\n
Potential applications across ophthalmology\u00a0<\/p>\n
While initially developed for glaucoma surgery,\u00a0miDOC\u00a0may have broader applications across ophthalmic procedures.\u00a0<\/p>\n
Despite the great potential for successful refractive outcomes after cataract surgery, vision can still be jeopardized if a patient has a dangerously high spike in eye pressure during the immediate recovery period. Using the miDOC for cataract surgery\u2014the most common surgery in the world\u2014could help identify these patients and prevent permanent vision damage.\u00a0<\/p>\n
As surgeons at NYEE use\u00a0miDOC\u00a0in more procedures, they have discovered that\u00a0it can possibly detect choroidal blood flow\u00a0\u2013 this is\u00a0the high-volume vascular supply to the eye’s uveal tract, providing essential oxygen and nutrients to the outer retina, particularly the macula\u00a0which is responsible for sharp, detailed, and high-resolution central vision. Understanding the health of the choroid could inform retinal surgeons about potential\u00a0chorioretinal\u00a0diseases.\u00a0<\/p>\n
Researchers are also exploring whether the system can\u00a0provide\u00a0additional insights into\u00a0cerebrovascular, cardiac, and lymphatic\u00a0physiology, which could have implications for\u00a0the rest of the body.\u00a0<\/p>\n
Future development\u00a0<\/p>\n
Investigators at NYEE plan to further refine the technology and pursue regulatory pathways for broader clinical use. The device is currently investigational and has not yet received clearance from the U.S. Food and Drug Administration.\u00a0<\/p>\n
*Dr. Sean\u00a0Ianchulev\u00a0and Dr. Gautam\u00a0Kamthan\u00a0are named co-inventors of the technology \u201cMicro-interventional Dynamic Outflow Curve (miDOC).\u201d A patent for this technology was filed through Mount\u00a0Sinai\u00a0and\u00a0the\u00a0technology is currently unlicensed.\u00a0The inventors and Mount Sinai would\u00a0financially benefit\u00a0if this technology\u00a0is\u00a0approved and commercialized.\u00a0<\/p>\n
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