MIGS: The Next Frontier in Glaucoma Surgery
When taken reliably, and with periodic monitoring of the results by office visits 3 or 4 times a year, most (but not all) can be successfully managed.
However, one of the most frustrating situations in Ophthalmology is caring for glaucoma patients who seem to be poorly controlled despite our best medicines or even laser. The surgical treatment for glaucoma has existed for over a century, but has failed to get the spotlight due to the difficulties in balancing the benefits with the risks. If there were a simple, risk free, operation which could offer lasting control of the intraocular pressure for the life of a patient it would have many advantages over the approaches we favor today.
MIGS stands for Minimally Invasive Glaucoma Surgery and represents a new group of procedures and implantable devices which look promising in the near future to provide us with new weapons in the battle against this blinding disease. Today, even though Trabeculectomy remains the “Gold Standard “, the predictability of the results sometimes remains disappointing. For incisional glaucoma surgery, a few new MIGS options are commercially available or are as of yet investigational. The iStent is a tiny intraocular snorkel recently approved for implantation in the US. We await trials to be completed on the Hydrus, as well as the CyPass Microstent and the AqueSys. Also approved is the Trabecutome, a device to perform a new technique for lowering IOPs. Even ECP, a procedure to internally laser the aqueous producing tissues behind the pupil, which has been around for many years without gaining a lot of popularity, is making resurgence.
The hope is that a relatively simple, safe and effective addition to a cataract operation, will emerge, that could benefit the 650,000 patients a year that have both glaucoma and cataracts.
Our practice already offers the latest in the testing and management of glaucoma, including being early adopters of the SLT laser treatment over a decade ago when it first became available. We also have had good success with the ExPress shunt for difficult to control cases. Nonetheless we share the enthusiasm of many that future devices may offer quicker and surer ways to keep save more of the precious sight of our patients.