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Mivision
June 2026

A United States ophthalmologist has unveiled a novel surgical technology that allows eye surgeons to measure and respond to critical fluid dynamics inside the eye in real time – an advance that may significantly improve precision and outcomes in glaucoma and other ophthalmic procedures.

The technology, called micro-interventional dynamic outflow curve (miDOC), was introduced by Professor Sean Ianchulev, from the Icahn School of Medicine at Mount Sinai and Director of Ophthalmic Innovation and Technology at New York Eye and Ear Infirmary (NYEE) of Mount Sinai, during the prestigious Charles D. Kelman Innovator’s Lecture at the American Society of Cataract and Refractive Surgery (ASCRS) annual meeting in Washington in April.1

The lecture is designed to highlight visionary leaders in cataract and refractive surgery and celebrate their contributions to the field.

Eye Surgery

Developed by Dr Ianchulev, miDOC is 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.”

Addressing a Critical Gap

NYEE is the only eye centre in the United States to use this technology and co duct the first-in-human clinical study. Surgeons started using it in patients in July last year and have completed the first 20 cases. According to investigators, 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.

“Intraoperative measurement of aqueous outflow has not previously been possible during ophthalmic surgery. This capability has the potential to transform outflow-based surgical interventions by advancing the field toward high-precision biometry and improved clinical outcomes,” said Dr Gautam Kamthan, Assistant Clinical Professor of Ophthalmology at the Icahn School of Medicine and Assistant Director of Ophthalmic Innovation and Technology at NYEE, who co-invented this technology and is the Principal Investigator of the study.

Other Potential Applications

In a news release, Mount Sinai Health System said that while initially developed for glaucoma surgery, miDOC may have broader applications across ophthalmic procedures.1

“Despite the great potential for successful refractive outcomes after cataract surgery, vision can still be jeopardised if a patient has a dangerously high spike in eye pressure during the immediate recovery period.

“Using the miDOC for cataract surgery – the most common surgery in the world – could help identify these patients and prevent permanent vision damage.”

As surgeons at NYEE have used miDOC in more procedures, they have discovered that it can possibly detect choroidal blood flow – understanding the health of the choroid could inform retinal surgeons about potential chorioretinal diseases. Researchers are also exploring whether the system can provide additional insights into cerebrovascular, cardiac, and lymphatic physiology, which could have implications for the rest of the body.

This article has been republished courtesy of mivision.