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Game Changing Visual Field Findings for Hydrus Microstent

New data from the five-year HORIZON pivotal trial shows that the Hydrus Microstent (Ivantis) lowers the rate of visual field loss in glaucoma patients by 47% versus cataract surgery alone. The findings position the Hydrus Microstent as the first glaucoma procedure to reduce vision loss, compared to standard medical treatment, in a large randomised clinical trial since trabeculectomy, the gold standard surgical intervention for glaucoma, first did so in the Collaborative Initial Glaucoma Treatment Study over 20 years ago.

The preliminary findings were presented on 13 November during the Original Paper session at the 2021 American Academy of Ophthalmology (AAO) meeting by Dr Iqbal ‘Ike’ Ahmed, research director at the Kensington Eye Institute and director of the Glaucoma and Advanced Anterior Segment Surgery (GAASS) Fellowship Program at the University of Toronto. The visual field findings are from work done by Dr Gus Gazzard, professor of ophthalmology at Moorfields Eye Hospital.

The data, released just a week after Alcon announced its intention to acquire Ivantis was described by Dr Amed as a “game-changer”.

“Since the inception of MIGS, the impact narrative has been largely restricted to surrogate endpoints – intraocular pressure lowering and medication reduction. At three years, we saw that Hydrus was impacting the rate of invasive secondary surgery, which was exciting. Now at five years, we have data indicating the Hydrus is affecting the underlying disease itself, which alters forever how we think of MIGS,” said Dr Ahmed. “I applaud Dr Gazzard and commend Ivantis for its tireless commitment and investment in furthering the science of MIGS, without which we would not have these significant outcomes.”

this finding makes MIGS one of the most essential solutions for the globally escalating glaucoma burden and further demonstrates the clinical benefit being provided to patients by Hydrus

The new five-year data was derived from a review of all visual field follow-ups, from baseline through five years, for patients in the HORIZON study.

Involving over 3,000 data points, eyes treated with the Hydrus Microstent show 47% lower rate of visual field loss after five years.1

Protecting visual field is critical because each decibel reduction in visual field loss from glaucoma has a dramatic impact on patient quality of life and healthcare costs.2 Even a slight loss of vision can create a cascade of medical costs, from added glaucoma medications, surgeries, and doctor visits to additional hospitalisations from fractures and falls, to lost productivity at work.

The retrospective analysis was led by Professor Gus Gazzard, chief of the glaucoma service at Moorfields Eye Hospital in London, United Kingdom.  Full analysis will be presented in its entirety by Dr Gazzard in early 2022.

“The public health implications of these findings are enormous as a reduction in the rate of visual field progression has the potential to delay or prevent vision loss and blindness in millions of individuals afflicted with glaucoma worldwide,” said Dr Douglas Rhee, professor and chair of ophthalmology at Case Western Reserve University and University Hospitals and president-elect of the American Society of Cataract and Refractive Surgeons (ASCRS). “Several studies have shown that even small amounts of visual field loss can lead to limitations in common activities such as driving, reading, and a patient’s ability to exercise or go outside the house. Combining Hydrus with cataract surgery is an opportunity to treat patients early in their disease state. With a safe glaucoma surgery like Hydrus, the procedure can be performed in mild or early onset disease before significant visual loss has occurred.”

“In 1925, Dr J. Stefansson of Winnipeg, Canada published results of his pioneering bypass glaucoma drainage procedure using a T-shaped tube device in the American Journal of Ophthalmology3,” said Dave Van Meter, Ivantis president and CEO. “Nearly 100 years later, his vision has come full circle with the pivotal findings that the Hydrus technology, and its revolutionary, flow enhancing design, reduces vision loss. Overnight, this finding makes MIGS one of the most essential solutions for the globally escalating glaucoma burden and further demonstrates the clinical benefit being provided to patients by Hydrus. It is tremendously gratifying to see the singularly significant impact of Hydrus on glaucoma patients and their quality of life.”

Key Five-Year HORIZON Findings

The HORIZON study is the largest prospective, randomised, controlled trial conducted for a MIGS device and the first with continuous five-year follow-up. HORIZON included 556 patients with mild to moderate glaucoma treated in 38 centres in nine countries in North America, Europe, and Asia. Patients were treated with cataract surgery plus the Hydrus Microstent or cataract surgery alone, respectively. Earlier results showed significant reductions in intraocular pressure (IOP), medication use, and secondary glaucoma surgeries:

73% of ‘mild’ Hydrus Microstent patients (those on one glaucoma medication at baseline) remained medication-free at five years, compared with 48% in the cataract surgery-alone arm.

There was a 20% to 30% improvement in the medication-free rate in the Hydrus group versus control, at all time points. This represents the highest margin total of medication eliminations compared to a control group reported for any MIGS pivotal trial.

With Hydrus, patients had a more than 60% (2.8x) reduction in the likelihood for requiring subsequent invasive glaucoma surgery – a clinically meaningful and statistically significant difference. Hydrus had a 2.5% rate of subsequent invasive glaucoma surgery, compared with 6.4% for cataract surgery alone.

Confirmed safety at five years, including continued stability of endothelial cell loss compared to control.

Alcon agreed to pay US$475 million upfront as part of an agreement to acquire Ivantis, the developer and manufacturer of Hydrus Microstent, in early November 2021. Future payments will be based on regulatory and commercial goals. The intended acquisition affirms Alcon’s commitment to the surgical glaucoma space, further strengthening its industry-leading portfolio across cataract, refractive, retina and glaucoma.



  1. Gazzard et al. AGS 2022 Abstract (in review)
  2. Wang, Yue MD; Alnwisi, Sameh MD; Ke, Min PhD* The impact of mild, moderate, and severe visual field loss in glaucoma on patients’ quality of life measured via the Glaucoma Quality of Life-15 Questionnaire, Medicine: December 2017 – Volume 96 – Issue 48 – p e8019
  3. Stefansson J. An operation for glaucoma. Am J Ophthalmol 1925;8:681-693.