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MIGS: A New Option for Patients with Glaucoma

Minimally invasive glaucoma surgical procedures (MIGS) have been developed to provide patients with a safer alternative to glaucoma surgery and help them reduce the burden of their medications.

MIGS minimizes the complications associated with traditional glaucoma procedures, such as trabeculectomy, EXPRESS shunts and external tube-shunts. These long-established procedures are effective at lowering eye pressure, but have potential complications.  MIGS also accelerates the patient’s recovery time.

“MIGS procedures have been revolutionary and, within the last few years, have opened up a menu of safer options that we can now offer our patients,” said OCB Ophthalmologist Joshua Ney, MD., a glaucoma specialist.

In patients with most common type of glaucoma, open-angle glaucoma, intraocular pressure increases because the channels that normally drain fluid from the eye become blocked. Higher than normal pressure can damage the optic nerve, causing irreversible vision loss. In the past, glaucoma surgery was reserved for more severe cases. Now, MIGS can be offered when glaucoma is at a mild stage.

OCB Ophthalmologist Tom Hsu, MD, points out that while MIGS procedures do not cure glaucoma, even when introduced at a mild stage, they enable patients to reduce the number of medicated drops they must use daily to keep their eye pressure under control.

“Many patients have difficulty manipulating the drops properly and they might have as many as three different drops,” says Dr. Hsu. “A patient may have arthritis for example, and the drops require good hand-eye coordination. While patients have the best intentions, on follow up visits we may discover that eye pressure has increased due to difficulties with administering the eye drops. MIGS removes the drops from the equation and, in most cases, eye pressure is well controlled.”

MIGS and Cataract Surgery

Some MIGS procedures are performed during cataract surgery, using the same incisions that are used for the cataract portion of the procedure. These include implantation of tiny stents such as the iStent, which is 1 mm long, or the Cypass Micro-Stent, which is 6 mm, roughly the size of an eyelash.

"Glaucoma patients are well informed and are aware of these devices," says Dr. Ney. "Any patient with glaucoma who is having cataract surgery and taking a minimum of one eye drop will be evaluated to determine if they are a candidate for a MIGS implants. The MIGS procedure does not add any additional risk or recovery time to cataract surgery."

MIGS without Cataract Surgery

There are also MIGS options for patients with mild glaucoma who are not having cataract surgery and for patients with more severe glaucoma who would normally be a candidate for traditional open-incision glaucoma surgery. For those patients with severe glaucoma, the XEN stent may be an option.

"There are not many ophthalmology groups using the XEN implant because it was approved by the Food and Drug Administration in 2017 and not yet covered by insurance," said Dr. Ney. "From what I have seen, the XEN effectively controls pressure, without the long recovery time and risks that come with trabeculectomy surgery."

All of OCB's glaucoma specialists have experience with MIGS procedures. To learn more, please follow up with your OCB glaucoma specialist at your next visit.

All OCB glaucoma specialists offer MIGS procedures. To learn more visit our glaucoma service pages.


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