Mount Sinai ophthalmologists unveil a new surgical technique that allows eye surgeons to measure and respond to critical intraocular fluid dynamics in real time. This is an advancement that has the potential to significantly improve the accuracy and outcomes of glaucoma and other eye surgeries.
The technology, called miDOC (micro-interventional Dynamic Outflow Curve), will be introduced by Sean Iantuleff, MD, MPH, professor of ophthalmology at the Icahn School of Medicine at Mount Sinai and director of ophthalmology innovation and technology at New York Eye, Ear, and Throat (NYEE) at Mount Sinai, at the prestigious Charles D. Kelman Innovator Lecture at the American Cataract and Refractive Society. ASCRS Annual Meeting in Washington, DC, Sunday, April 12th. This talk aims to highlight visionary leaders in cataract and refractive surgery and celebrate their contributions to the field.
Developed by Dr. Ianchulev at NYEE with funding from Mount Sinai Innovation Partners, miDOC is designed to provide continuous intraoperative measurement of ocular flow and intraocular pressure parameters that have historically been difficult to assess intraoperatively. The system allows surgeons to monitor changes in real-time and adjust procedures for each patient.
This is comparable to what optical biometry did for cataract surgery. miDOC enables glaucoma surgery with a precision never before available. We are certainly on the cusp of something very exciting, bringing glaucoma surgery into the era of digitally guided precision, high fidelity, and biometric feedback. This could one day allow glaucoma surgeons to achieve results similar to those seen with cataract surgical interventions. ”
Dr. Sean Iantuleff, MD, MPH, Professor of Ophthalmology, Icahn School of Medicine at Mount Sinai
Early clinical experience
NYEE is the only ophthalmology center in the country to use this technology and conduct the first human clinical study. Surgeons began using it on patients in July 2025, with the first 20 cases completed. All surgeries were completed successfully with intraoperative biometric guidance, according to the researchers.
During surgery, miDOC enabled continuous measurement of important parameters, including:
- pressure
- flow
- Spill facility
- Eye hardness/compliance
These measurements provide new insight into how surgical interventions affect the eye in real time.
Addressing critical gaps in glaucoma surgery
When performing glaucoma surgery without miDOC, surgeons have no way to determine the patient’s accurate ocular flow and pressure, which are important variables in the operating room. Intraocular pressure can only be tested before and after surgery, and the results will be affected. Unpredictable.
This impedes the precision of glaucoma surgery, and currently more than 50 percent of patients undergoing trabeculectomy and drainage device implants do not achieve complete postoperative success and medication independence. In some cases, it is not until a follow-up appointment that the eye doctor realizes that the procedure may not have worked or that there may be complications.
This is in sharp contrast to cataract surgery, where 95% of patients achieve successful refractive results within 0.5D of emmetropia (refractive errors are very small) because accurate biometry is available and critical to these outcomes.
“Intraoperative measurement of aqueous humor outflow has not previously been possible in ophthalmic surgery. This capability has the potential to transform outflow-based surgical interventions by moving the field toward high-precision biometry and improved clinical outcomes,” said Gautam Kamtan, MD, assistant professor of ophthalmology at the Icahn School of Medicine, co-inventor of this technology, and associate director of ophthalmology innovation and technology at NYEE. Investigator of the study.
Potential applications across ophthalmology
Although miDOC was initially developed for glaucoma surgery, it has the potential to have broader applications across ophthalmic surgery.
Despite the high likelihood of a successful refractive outcome after cataract surgery, vision may still be at risk if the patient’s intraocular pressure rises dangerously high during the recovery period. Using miDOC for cataract surgery, the most common surgery in the world, can help identify these patients and prevent permanent vision loss.
NYEE surgeons discovered that as they use miDOC in more surgeries, they have the potential to detect choroidal blood flow. This is the massive vascular supply to the uveal tract of the eye, providing essential oxygen and nutrients to the outer retina, especially the macula, which is responsible for sharp, detailed, high-resolution central vision. Understanding choroidal health can potentially inform retinal surgeons about potential chorioretinal disease.
The researchers are also investigating whether this system can provide further insight into cerebrovascular, cardiac, and lymphatic physiology that may affect other parts of the body.
Future developments
NYEE researchers plan to further refine this technology and pursue regulatory pathways for broader clinical use. The device is currently in the research phase and has not yet been cleared by the U.S. Food and Drug Administration.
*Dr. Sean Ianchulev and Dr. Gautam Kamthan have been named co-inventors of the “Micro-Interventional Dynamic Outflow Curve (miDOC)” technology. A patent for this technology has been filed through Mount Sinai and is currently not licensed. If this technology is approved and commercialized, the inventors and Mount Sinai will benefit financially.
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