OMNI Canaloplasty/Trabeculotomy
What Is OMNI Canaloplasty/Trabeculotomy?
OMNI works by opening two key areas inside your eye that drain fluid. The device is used to open and remove a portion of the trabecular meshwork over a longer segment, often 180 to 360 degrees around the drainage angle. This procedure, called trabeculotomy, improves outflow through Schlemm's canal and the collector channels that carry fluid away. Then the same instrument gently expands Schlemm's canal by injecting a specialized gel-like substance called a viscoelastic to further widen the canal and improve access to the collector channels.
The exact length of the drainage angle treated varies based on your eye's anatomy and your surgeon's assessment. By targeting both structures in one procedure, we can often achieve better pressure reduction than treating just one area alone, helping fluid flow more freely out of your eye and lowering the internal pressure that damages the optic nerve in glaucoma.
Traditional glaucoma surgery often creates a new hole through the eye wall to drain fluid into a blister-like space under the outside tissue. OMNI takes a different path by restoring your eye's own drainage pathways instead of creating an artificial exit route.
- The procedure uses a much smaller incision and works from inside the eye
- Recovery time is typically shorter with fewer activity restrictions
- Risk of serious complications is generally lower than with trabeculectomy or tube shunt procedures, although risks still exist
- Most patients experience less discomfort during healing
We most often recommend OMNI for open-angle glaucoma, the most common form of the disease. In this type, the drainage angle of your eye appears open during examination, but the trabecular meshwork and canal have become less efficient over time.
The procedure can also help some patients with pigmentary glaucoma or pseudoexfoliative glaucoma. These conditions involve material clogging the drainage system, and OMNI can help clear these blockages while widening the outflow channels.
Good candidates typically have mild to moderate open-angle glaucoma that continues to progress despite using eye drops. You might benefit from OMNI if you struggle to use your medications consistently or experience bothersome side effects from multiple drops.
- Your eye pressure remains too high even with medication
- You have early to moderate damage to your optic nerve
- You prefer to avoid more invasive surgery when possible
- Your eye anatomy shows an open drainage angle on examination
Certain eye conditions or anatomic features can make OMNI less safe or less effective. We will carefully examine your eyes to rule out conditions that would prevent you from benefiting from this procedure.
- Narrow or closed drainage angles, or significant scarring in the angle from prior inflammation or surgery
- Neovascular glaucoma, where abnormal blood vessels grow in the drainage angle
- Active inflammation inside the eye such as uveitis or iritis
- Significant corneal cloudiness that prevents a clear view of the angle during surgery
- Very advanced glaucoma requiring extremely low target eye pressures that OMNI may not achieve
Evaluating You for OMNI Surgery
We will measure your eye pressure at multiple visits and different times of day to understand your pressure patterns. High readings or large fluctuations tell us how urgently we need to improve your drainage system.
Visual field testing maps any blind spots caused by glaucoma damage. These tests show us whether your current treatment plan is protecting your vision well enough or whether surgery should be considered to prevent further loss.
We perform gonioscopy to directly examine the drainage angle and confirm it is open and accessible for the OMNI procedure. This examination uses a special lens placed on your eye to see the angle structures that the device will treat.
In some cases, anterior segment imaging such as optical coherence tomography or ultrasound may be used as an adjunct to further evaluate angle anatomy. We also use imaging to examine your optic nerve and the layers of nerve fibers that glaucoma damages. By comparing scans over time, we can track how quickly the disease is progressing and whether surgery makes sense for your situation.
We will discuss how long you have had glaucoma and which treatments you have tried. The number of medications you currently use and how well they control your pressure helps us predict how much benefit OMNI might provide.
- Previous eye surgeries or laser treatments you have undergone
- Any allergies or problems you have experienced with glaucoma drops
- Your ability to attend follow-up appointments after surgery
- Other medical conditions that might affect healing or anesthesia
- Blood thinners or antiplatelet medications you take, and any history of inflammation, angle closure, neovascular disease, or prior surgery affecting the drainage angle
We may recommend OMNI when you need better pressure control than laser treatment typically provides but want to avoid the risks and recovery of traditional filtering surgery. The procedure works especially well for patients who need surgery combined with cataract removal.
OMNI typically provides mild to moderate pressure lowering and may not achieve the very low target pressures sometimes needed in advanced glaucoma. If you have very advanced glaucoma or extremely high eye pressure, we might suggest a more powerful procedure instead. OMNI is most effective for patients whose disease has not yet caused severe damage.
Alternatives to OMNI
Several other treatment options can lower eye pressure in glaucoma, each with different benefits and risks. We will discuss which approach best matches your specific situation and goals.
- Medication optimization by adding or changing glaucoma eye drops
- Selective laser trabeculoplasty to improve drainage without surgery
- Other minimally invasive glaucoma surgeries such as trabecular bypass stents, goniotomy devices, or canal-based scaffolds
- Subconjunctival minimally invasive devices that create new drainage pathways
- Trabeculectomy, a traditional filtering surgery that creates a drainage bleb under the outer eye tissue
- Tube shunt implants that drain fluid to a space behind the eye
- Cyclophotocoagulation procedures that reduce fluid production for advanced or difficult cases
- Continued observation with closer monitoring if glaucoma is stable and not immediately threatening your vision
The OMNI Procedure: Step by Step
We will give you specific instructions about which medications to take or skip on surgery day. You should arrange for someone to drive you home since your vision will be blurry and you cannot drive after the procedure.
- Follow anesthesia instructions about fasting, which often means nothing to eat or drink after midnight before morning surgery
- Take only the medications we specifically approve with small sips of water
- Leave contact lenses out and avoid wearing eye makeup
- Wear comfortable, loose-fitting clothing to your appointment
Most patients receive numbing eye drops along with a mild sedative to help you relax. You will be awake but drowsy and should feel little to no discomfort during surgery. Some patients choose slightly deeper sedation for extra comfort.
We continuously monitor your vital signs throughout the procedure. You may feel gentle pressure on your eye but should not experience sharp pain. If you feel uncomfortable at any point, let us know right away so we can adjust your sedation.
Our eye doctor makes a tiny incision in the clear front window of your eye called the cornea. The OMNI device is then guided into the eye's drainage angle at the junction of the cornea and iris, known as the iridocorneal angle.
First, the doctor uses the tip of the device to create controlled openings in the trabecular meshwork around the inner circle of the drainage angle. Next, a small catheter threads through Schlemm's canal, and the doctor injects a clear viscoelastic gel that gently expands the canal. This two-step approach addresses both layers of the drainage system.
The OMNI procedure itself usually takes about fifteen to thirty minutes when performed alone. If we combine it with cataract surgery, the total time in the operating room will be closer to forty-five minutes to an hour.
You will spend additional time before surgery getting prepared and afterward resting in our recovery area. Plan to be at the surgery center for approximately three to four hours total, even though the actual procedure is quite quick.
Recovery and Healing After OMNI Surgery
Your eye will likely feel scratchy or mildly sore on the day of surgery, similar to having an eyelash stuck in your eye. Vision will be blurry at first from the surgical gel and any swelling. These symptoms are common after surgery, but call us if they are severe or worsening.
- If advised, use a cool compress lightly on the closed eyelid without pressing on the eye to reduce swelling
- Rest with your head elevated on pillows when lying down
- Use acetaminophen for pain relief unless we advise otherwise, and ask before using aspirin or other anti-inflammatory medications
- Wear the protective eye shield we provide when sleeping
We will prescribe antibiotic eye drops to prevent infection and anti-inflammatory drops to control swelling. You must use these drops exactly as directed, usually several times each day for the first few weeks.
You may be able to stop some or all of your glaucoma medications temporarily while your eye heals. We will tell you specifically which drops to continue and which to pause. Never stop or start any eye medication without checking with us first.
For the first week after surgery, avoid any activities that might put pressure on your eye or increase the risk of infection. We know these restrictions can be frustrating, but they protect your healing eye and improve your final results.
- Do not rub or press on your treated eye for at least two weeks
- Avoid heavy lifting, straining, or bending over at the waist
- Keep water, soap, and shampoo out of your eye when bathing
- Skip swimming, hot tubs, and dusty or dirty environments
- Wait for our approval before resuming exercise or sports
We will see you the day after surgery to check your eye pressure and make sure your eye is healing properly. Additional appointments are typically scheduled at one week, one month, and three months after the procedure.
At each visit, we measure your eye pressure and examine the inside of your eye. These checkups let us monitor your healing and determine whether we can reduce your glaucoma medications. Missing follow-up appointments can put your vision at risk, so please keep every scheduled visit.
Your eye pressure often drops within the first few days or weeks after OMNI surgery. However, the full effect may take two to three months as inflammation resolves and the drainage channels fully heal.
Some patients notice they need fewer glaucoma drops within the first month, while others require more time. We will work with you to gradually reduce medications only when your pressure readings confirm it is safe to do so.
Possible Risks and Complications
Most patients experience mild redness, light sensitivity, and blurred vision for a few days after OMNI surgery. Blood in the front chamber of your eye, called hyphema or microhyphema, is common and can cause blurry vision for several days as it clears.
- Temporary increase in eye pressure in the first few days after surgery
- Mild to moderate inflammation in the front of the eye
- Corneal swelling that causes temporary vision cloudiness
- Mild discomfort or foreign body sensation
- Slightly bloodshot appearance on the white of the eye that fades over one to two weeks
Although serious problems are uncommon with OMNI, any eye surgery carries some risks. Infection inside the eye is extremely rare but requires urgent treatment with strong antibiotics to save your vision.
Bleeding inside the eye, damage to other structures, or significant inflammation can also occur in rare cases. Some patients do not achieve enough pressure lowering and need additional surgery or must continue using multiple glaucoma medications. Other rare complications include persistent scar tissue formation in the drainage angle, injury to the cornea or its inner lining, very low eye pressure from a separation in the drainage structures, and suprachoroidal hemorrhage, which is a severe bleeding event more common in patients on blood thinners or with other risk factors. Long-term complications remain less common with OMNI than with traditional filtering surgeries.
Call our office right away or seek emergency eye care if you develop sudden severe pain that is not relieved by prescribed medication or that worsens despite your drops. Other urgent warning signs include sudden vision loss, increasing redness, or discharge that looks like pus.
- Vision that becomes much worse instead of gradually improving, or new flashes of light or a curtain-like shadow
- Halos around lights accompanied by worsening pain, which may signal a pressure spike
- Severe headache with nausea or vomiting
- Light sensitivity that keeps getting worse
- Increasing swelling or bruising around the eye
Frequently Asked Questions
Some patients can stop all glaucoma medications after successful OMNI surgery, while others still need one or two drops to keep pressure at a safe level. Most people use fewer medications than before the procedure, which makes daily routines easier and reduces side effects. Your final medication needs depend on your target pressure, how well your eye responds to surgery, and how advanced your glaucoma is when we perform the procedure.
OMNI offers the advantage of treating a larger area of the drainage system in one procedure compared to some other minimally invasive glaucoma surgeries. Devices that only place a tiny stent or create a single opening may not lower pressure as much as the combined canaloplasty and trabeculotomy that OMNI provides. However, the best choice depends on your specific type of glaucoma, eye anatomy, and pressure goals.
We typically treat one eye at a time, waiting at least a few weeks or months before considering surgery on the second eye. This approach lets us see how well the first eye responds and ensures you always have one eye available for clear vision during recovery. If glaucoma affects both eyes and the first surgery goes well, we may recommend treating your other eye in the future.
While OMNI can sometimes be repeated, we usually consider different surgical options if the first procedure does not provide lasting pressure control. Repeating the exact same surgery tends to be less effective the second time. If your pressure rises again years later, we might suggest traditional filtering surgery, a different type of drainage device, or additional laser treatment depending on your situation.
Many insurance plans, including Medicare, may cover OMNI when it is medically necessary to treat glaucoma that is not well controlled with medications. Coverage depends on your plan's specific rules, proper documentation of medical necessity, and whether the procedure is performed alone or combined with cataract surgery. Our office will verify your specific coverage and benefits before scheduling surgery. You may be responsible for deductibles, copayments, or coinsurance amounts according to your individual plan details.
Getting Help for OMNI Canaloplasty/Trabeculotomy
If you have glaucoma that is not well controlled with eye drops alone, or if you want to learn whether OMNI might be right for you, please schedule an evaluation with our eye doctor. We will carefully assess your eyes, discuss all your treatment options, and help you make an informed decision about protecting your vision for the future.