Over the last several years, there’s been a revolution in glaucoma surgery that’s gaining significant popularity. Minimally invasive glaucoma surgery, commonly referred to as MIGS, can be your next step in the treatment of glaucoma.
Often called the “silent thief of sight,” glaucoma is a disease that causes progressive damage to the optic nerve, the pathway connecting the retina and eyeball to the brain. Although the relationship is complex, patients with glaucoma generally have an elevated intraocular pressure( IOP). This high pressure within the eye either “presses” on the microscopic fibers of the nerve or reduces the blood flow to them which, in turn, weakens nerve tissues that are essential for seeing.
It is the second leading cause of blindness worldwide and it is estimated that approximately 1-2% of the world’s population has some form of the disease. Even more troubling, only half of that number know that they have it.
Treatment of Glaucoma: Drops vs. Surgery
Treatment of glaucoma is aimed at trying to lower the eye pressure and could include a wide combination of treatments. The most common first treatment is using prescription medicated eye drops on a regular basis to prevent the buildup of fluid in your eye.
Eye drops emerged as the first line of defense in the 70s and 80s when surgical therapy was risky; however, with advancing technologies over the past several years, surgical procedures and their outcomes are better now than ever.
Additionally, while eye drops have been effective for many—especially those in the early stages of glaucoma—some may find a low success rate. For those people with more difficult cases of glaucoma that don’t respond well to eye drops, there are various surgical treatment options.
Glaucoma surgeries include:
- Conventional surgery (trabeculectomy)
- Laser surgery (trabeculoplasty)
- Drainage implants
While reducing intraocular pressure in the eye, glaucoma surgery can be very invasive and involve aggressive management of the pressure. Associated risks include double vision, swelling of the cornea, eye infections, exposure of a drainage implant, and excessively low IOP. Although these risks are relatively infrequent, most surgeons will delay glaucoma surgery until all other less invasive treatment options have been attempted. Fortunately, with the emergence of minimally invasive glaucoma surgeries, glaucoma treatment will never be the same.
As the name suggests, the goal of MIGS is to be less aggressive while still accomplishing the goal of lowering eye pressure. While no surgery is without risk, MIGS has improved safety while providing mild-to-moderate IOP lowering.
What is MIGS?
MIGS refers to a group of procedures in which a surgeon creates minimal incisions in the eye to implant a microscopic-sized device in the trabecular meshwork to help drain intraocular pressure.
There are different categories of MIGS, such as improving fluid outflow using the eye’s inherent drainage system, OR shunting fluid to the outside of the eye. MIGS is low risk with high rewards.
Most MIGS can be performed in conjunction with cataract surgery. This offers treatment for two eye diseases while only undergoing one procedure.
About iStent®, iStent inject®, Hydrus®
During the iStent® procedure, a microscopic device is inserted into the drainage pathway in the eye to increase the outflow of fluid. By creating this bypass through the primary blockage site (trabecular meshwork), the device is designed to improve your eye’s natural outflow and safely lower intraocular pressure
This type of MIGS will help lower the eye pressure and also reduce or eliminate the need for prescription drops — all in a matter of a few extra minutes as an adjunct to standard cataract removal. This can be beneficial, convenient, and cost-effective for a variety of older adults suffering from both conditions.
Another promising MIGS device is the Hydrus® implant. In a fashion similar to the iStent®, the Hydrus increases the outflow of fluid from the eye in order to lower pressure. This particular stent is larger than the iStent®, has potentially greater ability to lower IOP, but has somewhat greater risk. As with any glaucoma surgery, risk versus reward must be considered!