Mount Sinai Ophthalmologists Unveil Revolutionary miDOC Technology for Real-Time Ocular Fluid Dynamics
Mount Sinai ophthalmologists have developed miDOC (micro-interventional Dynamic Outflow Curve), a new surgical technology designed to measure and respond to fluid dynamics inside the eye in real time during ophthalmic procedures. The technology aims to enhance precision and outcomes, particularly in glaucoma surgery, by providing continuous intraoperative data on ocular flow and pressure. Dr. Sean Ianchulev is scheduled to introduce miDOC at the American Society of Cataract and Refractive Surgery (ASCRS) annual meeting.
miDOC is designed to improve precision and outcomes in glaucoma and other ophthalmic procedures by enabling real-time measurement and response to critical fluid dynamics within the eye during surgery.
Introduction of miDOC Technology
miDOC (micro-interventional Dynamic Outflow Curve) is a surgical technology developed by Mount Sinai ophthalmologists. Its design allows for real-time measurement and response to critical fluid dynamics within the eye during surgery, with the stated aim of improving precision and outcomes in glaucoma and other ophthalmic procedures.
The technology was developed by Dr. Sean Ianchulev, Professor of Ophthalmology at the Icahn School of Medicine at Mount Sinai and Director of Ophthalmic Innovation and Technology at the New York Eye and Ear Infirmary of Mount Sinai (NYEE), at NYEE with funding from Mount Sinai Innovation Partners. Dr. Ianchulev is scheduled to present miDOC during the Charles D. Kelman Innovator's Lecture at the American Society of Cataract and Refractive Surgery (ASCRS) annual meeting.
Functionality and Early Clinical Use
miDOC provides continuous intraoperative measurement of ocular flow and pressure, parameters that have historically been challenging to assess during eye surgery. The system is designed to enable surgeons to monitor changes in these parameters in real time and adjust procedures for individual patients accordingly.
The New York Eye and Ear Infirmary of Mount Sinai (NYEE) is the initial eye center utilizing this technology and conducting a first-in-human clinical study. Surgeons began using miDOC in patients in July 2025 and have completed 20 cases. Investigators reported that all procedures were successfully completed with intraoperative biometric guidance.
During surgery, miDOC enabled continuous measurement of key parameters, including:
- Pressure
- Flow
- Outflow facility
- Ocular rigidity/Compliance
These measurements are intended to offer new insight into how surgical interventions affect the eye in real time.
Addressing a Surgical Gap in Glaucoma
Prior to miDOC, surgeons performing glaucoma procedures reportedly lacked a method to check a patient’s exact ocular flow and pressure during surgery. Intraocular pressure could typically only be checked before and after the procedure, a limitation cited as contributing to less predictable outcomes. Over 50 percent of patients undergoing trabeculectomy and drainage device implants currently do not achieve complete postoperative success and medication independence, with issues sometimes identified only during follow-up appointments. This situation contrasts with cataract surgery, where 95 percent of patients achieve a successful refractive outcome, attributed to the availability of accurate biometry.
Dr. Gautam Kamthan, Assistant Clinical Professor of Ophthalmology at the Icahn School of Medicine, Assistant Director of Ophthalmic Innovation and Technology at NYEE, and a co-inventor of miDOC, stated that intraoperative measurement of aqueous outflow was previously not possible during ophthalmic surgery and has the potential to advance the field towards high-precision biometry and improved clinical outcomes.
Potential Broader Applications
While initially developed for glaucoma surgery, miDOC may have wider applications across ophthalmology. In cataract surgery, it could potentially identify patients at risk of high eye pressure spikes during immediate recovery, which may help prevent permanent vision damage. Surgeons at NYEE have also observed that miDOC might detect choroidal blood flow, which is crucial for oxygen and nutrient supply to the outer retina, potentially informing retinal surgeons about chorioretinal diseases. Researchers are also exploring whether the system can provide insights into cerebrovascular, cardiac, and lymphatic physiology.
Development Status and Outlook
Investigators at NYEE plan 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 (FDA).
Drs. Sean Ianchulev and Gautam Kamthan are listed as co-inventors of miDOC. A patent for this technology has been filed through Mount Sinai and is currently unlicensed. Financial benefits for the inventors and Mount Sinai would result if the technology is approved and commercialized.