Dr. Callahan was professional, knowledgeable, and caring. She listened, explained clearly, and answered all my questions. It was refreshing. She also helped my son, and staff was friendly and kind.
Jeffrey Moore
Kahook Dual Blade Goniotomy for Glaucoma
Are You a Candidate for KDB Goniotomy?
Not every patient with glaucoma needs surgery, and KDB goniotomy is not right for everyone. Our eye doctors will evaluate your eyes thoroughly to determine whether this procedure is safe and likely to be effective for you.
We may suggest KDB goniotomy when your eye pressure is not controlled well enough with medications alone, or when glaucoma drops are causing side effects that affect your daily life. It is also a practical option for patients who have difficulty remembering to use their drops consistently, since reducing pressure surgically can lower or eliminate the need for daily medications.
Many patients choose to have KDB performed at the same time as cataract surgery, combining both procedures in a single operation for added convenience and effectiveness.
Several signs may indicate that your current glaucoma plan is not working as well as it should. If any of these apply to you, it is worth discussing your options with your eye doctor as soon as possible.
- Your eye pressure readings stay above your target range even when you use drops as directed
- Follow-up imaging shows that your optic nerve continues to worsen
- Visual field tests reveal new areas of vision loss
- You experience uncomfortable side effects from your glaucoma medications
- Your drop schedule is too complex to follow reliably
Good candidates for KDB goniotomy typically have mild to moderate open-angle glaucoma that is not fully controlled with medications. Patients who are already scheduled for cataract surgery are especially well-suited because combining the two procedures adds minimal risk while improving pressure control beyond what cataract surgery alone can achieve.
Patients who prefer to reduce their reliance on daily eye drops, or who have difficulty affording or consistently using multiple medications, may also benefit from this approach. A clear view of the drainage angle is necessary for our eye doctors to perform the procedure safely.
Certain eye conditions can make KDB goniotomy less safe or less effective for a given patient. Your eye doctor will review your full eye history before recommending this surgery.
- Closed or very narrow drainage angles that limit surgical access
- Neovascular glaucoma or abnormal blood vessel growth in the drainage angle
- Extensive scarring or adhesions in the drainage angle from prior surgery or inflammation
- Active eye inflammation or uveitis that has not been brought under control
- Poor view of the drainage angle due to corneal clouding or scarring
- Advanced glaucoma requiring very low target pressures that may need more aggressive surgery
The main benefit of KDB goniotomy is better eye pressure control with a lower burden of daily drops. Many patients reduce or stop some of their glaucoma medications after the procedure, which simplifies their routine and reduces medication-related side effects. The surgery is quick, minimally invasive, and has a favorable safety profile compared to traditional glaucoma operations.
As with any surgical procedure, there are risks to understand. Bleeding in the front chamber of the eye, called hyphema, is one of the most common findings after surgery and may take a week or longer to clear, especially in patients on blood thinners. Temporary spikes in eye pressure can occur after surgery and are managed with medications. Some patients may develop a pressure rise from the steroid drops used during recovery. Scarring in the drainage angle can develop over time and may reduce the long-term effectiveness of the surgery. If KDB is combined with cataract surgery, there is a small risk of swelling in the central retina, called cystoid macular edema, particularly in patients with diabetes. Some patients will need to resume medications or undergo additional procedures over time. Serious complications such as infection, severe bleeding, or retinal detachment are rare but possible. We will review all relevant risks with you in detail before you decide to move forward.
Before scheduling your surgery, we perform a thorough eye examination to confirm that KDB goniotomy is safe and appropriate for your situation. This includes checking your eye pressure, examining your optic nerve, and evaluating your drainage angle with a special contact lens called a gonioscopy lens. We also assess the health of your cornea and look for any other conditions that might affect your surgery or recovery.
You may also need updated visual field testing and optic nerve imaging to document your current glaucoma status. These baseline results help us track your progress after surgery and confirm that the procedure is delivering the expected benefit.
Alternatives to KDB Goniotomy
KDB goniotomy is one of several options for managing glaucoma when medications are not enough. Understanding the full range of treatments helps you and your eye doctor make the most informed decision together.
Selective Laser Trabeculoplasty, commonly known as SLT, is a gentle laser treatment that stimulates the trabecular meshwork to improve fluid drainage without removing any tissue. It is a good first-line option for many patients and can be repeated if needed. Our eye doctors offer SLT at our offices as an alternative for patients who prefer a non-incisional approach or who are not yet ready for surgery.
Before recommending surgery, we always evaluate whether adding or changing medications might provide better pressure control. In some situations, adjusting your medication plan is all that is needed. This approach is most appropriate for patients with mild pressure elevation or those whose glaucoma is not progressing despite imperfect control.
Several other minimally invasive glaucoma surgeries exist and may be appropriate depending on your anatomy and glaucoma type. Unlike KDB, some MIGS procedures place a tiny implant in the drainage system rather than removing tissue. YAG Laser Peripheral Iridotomy, called YAG PI, is another laser option our office provides for patients with narrow angles. Our eye doctors will discuss which approach best matches your specific needs.
For advanced glaucoma that requires very low target pressures, traditional surgeries such as trabeculectomy or tube shunt implants may be necessary. These procedures are more complex and are performed by glaucoma specialists. When your case requires this level of care, our eye doctors will refer you to a trusted specialist while continuing to coordinate your overall eye health management.
The KDB Goniotomy Procedure
Knowing what to expect on the day of your surgery can ease anxiety and help you prepare. The procedure itself is brief and well-tolerated by most patients.
You will need to arrange for someone to drive you home on the day of surgery because your vision will be blurry and you will have received sedation. We generally ask you to avoid eating or drinking for several hours beforehand if anesthesia is being used. Continue taking your regular medications unless our eye doctors instruct otherwise. If you take blood thinners or antiplatelet medications, let us know well in advance so we can coordinate with your prescribing doctor before making any changes.
Wear comfortable clothing and avoid applying makeup, lotions, or perfume on the day of your procedure. Some patients may be instructed to begin antibiotic eye drops one to two days before surgery to reduce infection risk.
Most patients receive numbing eye drops along with a mild sedative to help them relax. You will remain awake but comfortable throughout, and you should not feel any sharp pain. In some cases, a small numbing injection around the eye may be used for additional comfort, or monitored anesthesia care with an anesthesiologist may be arranged.
The type of anesthesia used depends on whether you are having KDB alone or combined with cataract surgery, as well as your personal preferences and medical history. Our team will discuss the best approach with you before your surgery day.
Once your eye is numb, our eye doctor uses a surgical microscope and a specialized viewing lens to see the drainage angle inside your eye. A tiny incision is made at the edge of the cornea, and the Kahook Dual Blade is gently inserted through this opening to carefully cut and remove a precise strip of the trabecular meshwork without harming the surrounding structures.
- Your eye is numbed and positioned under the surgical microscope
- A gonioscopy lens is placed on your eye to visualize the drainage angle
- A small incision is created at the edge of the cornea
- The Kahook Dual Blade removes a controlled arc of the trabecular meshwork
- The incision is small enough to seal on its own without stitches in most cases
KDB goniotomy performed on its own typically takes only five to ten minutes. When combined with cataract surgery, the total operating time is usually around twenty to thirty minutes. Your overall time at the surgical center will be longer when you account for preparation, anesthesia administration, and recovery monitoring before you are cleared to go home.
Performing KDB goniotomy at the same time as cataract removal is a very common and efficient approach. Cataract surgery is completed first, and then the same or a nearby incision is used to access the drainage angle and perform the goniotomy. This means one operation, one recovery period, and better combined pressure control compared to cataract surgery alone.
For patients who have both cataracts and glaucoma, combining the procedures is often the most sensible path forward. Our eye doctors will help you determine whether this approach is appropriate for your situation.
Recovery and Aftercare
Most patients recover well from KDB goniotomy and return to normal activities within a few days. Following your post-operative instructions carefully gives you the best chance of a smooth recovery and a good long-term outcome.
Your eye may feel mildly scratchy or irritated for the first few days, similar to having a small particle in your eye. Vision will be blurry at first and should gradually improve over the first week. Some redness on the white of the eye is normal and will fade as healing progresses.
Plan for a few days of rest after surgery. Avoid rubbing or pressing on your eye, and wear the protective shield we provide when sleeping to prevent accidental contact during the night.
We will prescribe anti-inflammatory and often antibiotic eye drops to prevent infection and control swelling after surgery. You will use these drops several times daily for a few weeks, with the frequency gradually tapering as your eye heals. Steroid drops can occasionally cause a rise in eye pressure in susceptible patients, so we will monitor your pressure closely at each follow-up visit and adjust your treatment if needed.
- Use all prescribed drops exactly as directed and on schedule
- Wash your hands thoroughly before applying any eye drops
- Avoid touching the dropper tip to your eye or any surface
- Wait at least five minutes between different types of drops when using more than one
For the first week after surgery, avoid heavy lifting, strenuous exercise, or bending with your head below your waist, as these activities can raise eye pressure. Avoid swimming, hot tubs, and getting water directly in your eye while showering to reduce infection risk. Wearing sunglasses outdoors during recovery helps protect your healing eye from bright light and dust.
Reading, watching television, and using a computer are generally fine as long as they do not cause discomfort. Most patients can return to desk work within a few days if their job does not involve physical labor or exposure to dust and chemicals.
Your first follow-up visit is usually scheduled within one to two days after surgery so we can check your eye pressure and confirm that healing is progressing normally. Additional visits over the following weeks and months allow us to monitor your results, adjust your medications, and evaluate your optic nerve and visual field over time.
Long-term follow-up is essential for patients with glaucoma because the condition requires ongoing management throughout your life. We will continue to track your progress and make adjustments to your care plan as needed.
Serious complications after KDB goniotomy are rare, but it is important to know which symptoms require urgent evaluation. Contact our office right away or seek emergency care if you notice any of the following.
- Severe eye pain that does not improve with over-the-counter pain relievers
- Severe headache with nausea, vomiting, or halos around lights, which may signal very high eye pressure
- Sudden decrease in vision or complete vision loss
- A visible layer of blood in the eye that is visibly growing larger
- Increasing redness, swelling, or discharge from the eye
- Worsening light sensitivity accompanied by pain and reduced vision
- Flashes of light or a sudden shower of new floaters
- A curtain or shadow moving across your field of view
What Results Can You Expect?
Understanding what KDB goniotomy can realistically achieve helps you set appropriate expectations and stay engaged in your long-term glaucoma care. Results vary from patient to patient and depend on many factors unique to your eyes.
Most patients begin to notice a reduction in eye pressure within the first few weeks after surgery. The full effect of the procedure may take one to three months to stabilize as inflammation resolves and the new drainage pathway matures. During this period, we monitor your pressure closely and adjust your glaucoma medications as needed.
It is not unusual for pressure to spike temporarily in the days right after surgery before settling into a lower stable range. This is one reason why early follow-up visits are so important.
On average, KDB goniotomy can lower eye pressure by roughly 20 to 30 percent from pre-surgery levels, though individual results vary widely. Some patients experience less reduction, and occasionally some see greater improvement. Achieving very low pressures in the low-teen range is not guaranteed and may not be realistic for every patient.
Patients who combine KDB with cataract surgery often see additional pressure lowering because cataract removal itself can improve fluid drainage. Your personal outcome will depend on your starting pressure, glaucoma severity, and other factors unique to your eye.
Reducing dependence on daily glaucoma drops is one of the primary goals of KDB goniotomy. After surgery, many patients can stop one or more of their medications while still maintaining safe pressure levels. Some patients are able to eliminate all of their drops, while others continue using fewer medications than before.
Our eye doctors will adjust your medication plan based on your post-surgery pressure readings and your individual target pressure range. All changes will be made gradually, with careful monitoring to ensure your pressure stays within a safe range throughout the process.
KDB goniotomy can provide durable pressure reduction over several years for many patients. However, glaucoma is a lifelong condition, and some patients will experience a gradual return of elevated pressure over time as the drainage pathway changes or the disease progresses. A portion of patients will need to add back medications or consider additional procedures down the road.
Even when the full effect of KDB gradually diminishes, the procedure often provides several valuable years of improved pressure control, reduced medication burden, and slower disease progression.
If your eye pressure rises again after a period of successful control, we may recommend adding medications back or considering a further intervention. Options may include SLT laser treatment, another minimally invasive procedure, or in more advanced cases requiring very low target pressures, a referral for traditional glaucoma surgery such as trabeculectomy or tube shunt placement.
Needing additional treatment does not mean your original surgery failed. KDB goniotomy often reduces the burden of glaucoma management significantly during the years it remains effective, and any subsequent treatment builds on that foundation.
Frequently Asked Questions
Here are answers to common questions patients ask when considering KDB goniotomy, including guidance on decision-making and practical next steps.
The procedure itself should not be painful because your eye is fully numbed with anesthetic drops, and many patients also receive a mild sedative. You may be aware of some pressure or gentle instrument movement near your eye, but sharp pain is not expected. After surgery, most patients describe only mild scratchiness or irritation for the first few days, which responds well to the prescribed drops and resolves on its own.
We typically treat one eye at a time, with several weeks or months between procedures if both eyes need surgery. This staged approach allows us to fully evaluate how the first eye responds, including how much pressure reduction is achieved and how your eye tolerates recovery, before proceeding with the second eye. It also ensures that one eye always has clearer vision while the other is healing.
Whether you need drops after surgery depends on your individual pressure response and your target pressure range. Some patients eliminate all of their medications, while others continue with fewer drops than before. Our eye doctors will adjust your plan gradually based on your actual post-surgery readings rather than making assumptions. Even if some medication remains necessary, most patients find their overall routine is simpler and more manageable than before.
SLT is a non-incisional laser treatment that stimulates the trabecular meshwork to improve drainage without removing tissue, while KDB goniotomy removes a strip of the meshwork through a small surgical incision. SLT is typically tried first because it is non-invasive and repeatable, but it may not provide sufficient pressure control for every patient. KDB tends to offer more substantial and sustained pressure reduction, making it a stronger option for patients who need more aggressive intervention or who are already having cataract surgery. Our eye doctors can help you weigh the two approaches based on your specific situation.
Most insurance plans, including Medicare, cover KDB goniotomy when it is medically necessary for glaucoma treatment. Coverage details vary based on your specific plan and whether the procedure is combined with cataract surgery. We recommend contacting your insurer with your diagnosis and procedure codes to understand your benefits fully. Our team will work with you to verify your coverage and explain any expected out-of-pocket costs before you commit to scheduling.
If KDB does not achieve your target pressure or its effect diminishes over time, we have additional options available. These include SLT laser treatment, other minimally invasive glaucoma procedures, or in cases requiring very low pressures, a referral to a glaucoma specialist for traditional filtration surgery. In some situations, a repeat KDB goniotomy may be possible if enough untreated trabecular meshwork remains. We will monitor your results closely and adjust your care plan before pressure reaches a level that puts your vision at risk.
Explore Your Glaucoma Treatment Options at NewView Eye Center
If glaucoma is threatening your vision and your current treatment is not keeping your pressure under control, our team at NewView Eye Center is here to help. We are proud to serve patients across Northern Virginia with personalized, physician-led care and advanced surgical options including KDB goniotomy and a full range of glaucoma treatments. Schedule a consultation with our eye doctors to find out whether KDB goniotomy is the right next step for protecting your sight.
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