There have been many significant innovations in glaucoma treatment over the past ten years. And with new scientific discoveries on the horizon, consumers can expect even more products and procedures to become available in the near future. This is exciting news for glaucoma patients, but it can also be a bit overwhelming as you weigh the pros and cons of various approaches.
In today’s blog, we’ll discuss minimally invasive glaucoma surgery, commonly called MIGS. These new procedures offer promising results – without the possible complications of traditional surgery. Let’s talk about the risks and benefits of MIGS, so you’ll be more informed when you talk to your eye doctor.
What is the purpose of glaucoma surgery?
The goal of any glaucoma surgery is to reduce your eye’s intraocular pressure. This is accomplished by improving the flow of fluid in your eye (called aqueous humor) or reducing the production of fluid. Each type of surgery is different, but the goal remains the same.
Why were Minimally Invasive Glaucoma Surgery (MIGS) developed?
According to the Glaucoma Research Foundation, traditional glaucoma surgeries are very effective, but they do carry risks such as double vision, eye infections, exposure of a drainage implant, swelling of the cornea, and excessively low IOP. Although the risks are low, most eye doctors advise delaying glaucoma surgery until they’ve tried all other less invasive treatment options (like medications and laser treatment). MIGS offers another option to reduce intraocular pressure without putting the patient at risk for these complications.
Who is a good candidate for Minimally Invasive Glaucoma Surgery (MIGS)?
While MIGS offers a safer procedure, there is a trade-off. At present, MIGS achieves only modest eye pressure reduction. Therefore, MIGS are usually advised for patients with early to moderate stage glaucoma. In some cases, it’s combined with cataract surgery. For patients with advanced glaucoma, the MIGS procedures may not lower eye pressures enough. It’s important to note that patients who undergo a MIGS procedure can still have traditional glaucoma surgery down the road if needed.
What are the types of Minimally Invasive Glaucoma Surgery (MIGS)?
Since MIGS are still relatively new, this isn’t a comprehensive list. There are many clinical trials underway and eye researchers are carefully monitoring the long-term results so far. We’ll summarize three of the most popular procedures to give you an idea of what’s involved. Your eye doctor can advise whether any of these would be right for your situation.
This outpatient procedure, which takes about ten minutes, increases the amount of fluid exiting the eye. The tip of the Trabectome removes the strainer-like tissue (trabecular meshwork) allowing more fluid to pass through. This is done through the same small corneal incision as cataract surgery. According to the Glaucoma Research Foundation, Trabectome usually lowers the eye pressure by about 30%, while also decreasing the number of glaucoma eye drops needed. However, long-term success data is not yet available.
iStent works just like the stents used to prevent heart attacks and strokes. When blood vessels get clogged, a stent creates access to the vessel flow. The concept is the same with iStent. In this MIGS procedure, a tiny titanium device creates two openings between the front part of your eye and its natural drainage pathway. This increases the flow of fluid. Like Trabectome, iStents are an outpatient procedure that’s often combined with cataract surgery.
In traditional trabeculectomy, the most common form of glaucoma surgery, the surgeon creates a new pathway for eye fluid to flow. A small hole is made in the eye wall. Then, a flap is created over it to make sure there’s not too much fluid escaping. However, using Xen, there are no incisions. Instead, the stent is placed through the eye wall, serving the same purpose. Since this device was just approved by the FDA is 2016, the American Academy of Ophthalmology is cautiously optimistic, but recommends ongoing studies to assess long-term effectiveness.
Research continues to offer better options to glaucoma patients. As these and other MIGS procedures come to market, be sure to talk with your eye doctor about any side effects or risks so you can make the best decision.