A novel surgical technology that allows eye surgeons to measure and respond to critical fluid dynamics inside the eye in real time has been unveiled.
It is hoped the advance will significantly improve precision and outcomes in glaucoma and other ophthalmic procedures.
According to a media release, the technology, called miDOC (micro-interventional Dynamic Outflow Curve), was introduced by Sean Ianchulev, 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 American Society of Cataract and Refractive Surgery (ASCRS) annual meeting in Washington, D.C., on April 12.
The release said the technology, developed by Prof Ianchulev at NYEE with funding from Mount Sinai Innovation Partners, was designed to provide continuous intraoperative measurement of ocular flow and pressure – parameters that have historically been difficult to assess during surgery.
The system enables surgeons to monitor changes in real time and adjust procedures accordingly for each patient.
“This is the equivalent of what optical biometry did for cataract surgery. miDOC brings precision to glaucoma surgery that simply has not existed before,” said Prof Ianchulev.
¨We are certainly on the verge of something very exciting – bringing glaucoma surgery into the age of digital-guided precision, high fidelity, and biometric feedback. This will allow glaucoma surgeons to one day achieve similar outcomes as we see in cataract surgical interventions.”
NYEE is the only eye centre in the country to use this technology and conduct the first-in-human clinical study.
Surgeons started using it in patients in July 2025 and have completed the first 20 cases.
According to the release, investigators said all procedures were successfully completed with intraoperative biometric guidance.
During surgery, miDOC enabled continuous measurement of key parameters, including pressure, flow, outflow facility, and ocular rigidity/compliance.
These measurements provide new insight into how surgical interventions affect the eye in real time, it said.
While performing glaucoma procedures without miDOC, surgeons have no way of checking a patient’s exact ocular flow and pressure, a critical variable in the operating room. They can only check intraocular pressure before and after the procedure, which can leave outcomes unpredictable.
This has held back the precision of glaucoma surgery, where, currently, more than 50% of the patients undergoing trabeculectomy and drainage device implants fail to achieve complete postoperative success and medication independence.
In some cases, it is not until the follow-up appointment that ophthalmologists discover the procedure may not have worked and/or has possible complications.
This contrasts significantly to cataract surgery, where 95% of patients achieve a successful refractive outcome within 0.5D of emmetropia – a very small amount of refractive error – because accurate biometry is available and critical to these outcomes.
“Intraoperative measurement of aqueous outflow has not previously been possible during ophthalmic surgery,” said Assistant Professor Gautam Kamthan, from the Icahn School of Medicine.
“This capability has the potential to transform outflow-based surgical interventions by advancing the field toward high-precision biometry and improved clinical outcomes.”
The release said that investigators at NYEE planned 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.
