Minimally invasive glaucoma surgery (MIGS), is used to lower eye pressure in order to reduce or prevent optic nerve damage. Instead of standard glaucoma surgeries, which are major surgeries, MIGS operations have been used in recent years in order to reduce some of the complications related to traditional glaucoma surgeries. The standard procedures, such as external tube shunts and trabeculectomy, do reduce the eye pressure and prevent the progression of glaucoma, but they come with a long list of potential complications.
MIGS use tiny incisions and microscopic-sized equipment. These surgeries do reduce complications, but they lose some of the effectiveness as a trade-off for increased safety. There are several different categories of MIGS. These include mini versions of trabeculectomy, suprachoroidal or totally internal shunts, gentler and milder versions of laser photocoagulation, and trabecular bypass operations.
The Purpose of Glaucoma Surgery
The goal for any type of glaucoma surgery, including MIGS, is to reduce the eye’s pressure. Reducing the intraocular pressure is done to help improve the fluid in the eye or reduce the production of fluid. Even though each type of surgery will vary, the goal is still the same.
When glaucoma is first diagnosed in a patient, an ophthalmologist will typically recommend other solutions, such as prescription eye drops. If glaucoma gets to a certain point, doesn’t respond to treatments, or a patient needs a more long-lasting solution then glaucoma surgery will be done. However, traditional surgery can have a long recovery time and be invasive.
Benefits of MIGS
Technology has made it possible for even less invasive procedures. Using micro-surgical equipment lessens your chances of having a poor recovery. In addition to these procedures still lowering intraocular pressure and slowing optic nerve damage, these surgeries benefit patients with rapid recovery and less trauma to the eye tissue. These surgeries also have excellent safety profiles.
Types of Minimally Invasive Glaucoma Surgeries
The term MIGS covers a wide variety of different procedures that could be used to treat glaucoma:
- Microtrabeculectomies: These surgeries use microscopic-sized tubes inserted in the eye to drain fluid from inside the eye. There are two new devices that make this operation safer. Both devices have been shown to lower pressure in the eye and have improved safety over trabeculectomy, and they have been recently approved in the United States. One device is the Xen Gel Stent. This involves inserting a gelatin soft tube in to increase drainage. The stent is only 6mm long to create a new pathway in order for the fluid to drain. The iStent inject is the smallest medical device implanted into humans in order to create a new pathway through the eye to decrease the pressure.
- Trabecular Surgery: Part of the problems in draining fluid from the eye happen in the trabecular meshwork. There are several different operations that have been created using tiny devices and equipment to cut through the trabecular meshwork without damage to any of the tissues in the ocular drainage pathway. During this procedure with the use of a special contact lens, a tiny device is inserted into the eye using a tiny incision into the trabecular meshwork. The trabecular meshwork is either then bypassed or destroyed using a tiny snorkel-like device. Even though these types of procedures lower the eye pressure and are FDA approved, they don’t lower the eye pressure as much as some other options so they are used for those who only have early-to-moderate stages of glaucoma.
- Suprachoroidal Shunts: This procedure uses tiny tubes that have very small internal openings to connect the front of the eye to the suprachoroidal space. This is the space between the wall of the eye and the retina in order to make sure there is drainage of fluid from the eye.
- AB-Internal Canaloplasty (ABiC): This procedure uses microcatheter technology to enlarge the natural drainage system of the eye to lower eye pressure and improve outflow. It helps restore normal fluid flow without leaving behind a shunt or stent in the eye or damaging the tissue.
- New Laser Procedures: Typically, laser cyclophotocoagulation was used for those with advanced glaucoma where pressure couldn’t be controlled with other methods. The procedures were designed to reduce the fluid-forming capacity of your eye. They do this by targeting the tissue that makes the fluid. These procedures may sometimes produce inflammation that can reduce vision. There are two new additions to these laser treatment procedures that have been proven successful even before the glaucoma is more advanced.
Why Were MIGS Developed?
Traditional glaucoma surgeries have always been effective, but there are a number of risks. Some of these risks include eye infections, double vision, exposure to the drainage implant, excessively low eye pressure, and swelling of the cornea. The risks are still low, but most eye surgeons will recommend delaying glaucoma surgery until you have tried other options, such as laser treatments or medications.
Who Is The Right Candidate for MIGS?
Unfortunately, not everyone may be a good candidate for a MIGS procedure. Those who have early-stage glaucoma or those with high pressure in the eye who don’t respond to laser treatments or eye drops may be a good candidates. Patients that have moderate-to-severe glaucoma and other health conditions that can increase the risk that comes with traditional glaucoma surgery can also be good candidates. MIGS may also be a good choice for younger patients since there is less downtime after the procedure. Even if a patient undergoes a MIGS procedure, it’s still possible to have a traditional glaucoma surgery down the road if needed. When determining who is the right candidate for these procedures, it’s important to take into account medical history, as well as lifestyle.
Preparing for MIGS
Your ophthalmologist will evaluate your eyes and help you determine if you are the right candidate. Once you know which procedures are appropriate for you, you will have your procedure scheduled and have some pre-surgical guidelines to follow.
What to Expect During the Procedure
Your eyes will be numbed using a local anesthetic for this outpatient procedure. If you are also having this surgery performed with cataract surgery then the surgeon will use the incision from the cataract procedure in order to place the MIGS device.
Risks Associated with MIGS
Each procedure is going to be slightly different and each one has its own risks. Your eye surgeon will explain the risk of each procedure. However, these procedures are often suggested since there are fewer risks than traditional glaucoma surgery options.
Recovery Time with MIGS
Recovery time for MIGS is shorter than other traditional glaucoma procedures. However, recovery time can be extended if the procedure is done with other eye procedures, such as cataract surgery. Before your specific procedure, your ophthalmologist will explain what you can expect in terms of your own recovery time. Recovery time will depend on your individual health and the type of procedure you have. Typically, patients should avoid any strenuous activity for several weeks.
What to Expect after MIGS
Since MIGS is minimally invasive, you will have a much faster recovery time compared to traditional surgery. After your procedure, your eye doctor will discuss any post-treatment needs and how to care for your eyes when you get home. You will likely have a prescription to decrease side effects, such as inflammation, and prevent infection. You will also have a follow-up visit in order to monitor your progress.
MIGS and Cataract Surgery
MIGS can be performed alongside cataract surgery. In fact, many MIGS options will only be reimbursed by insurance if done alongside cataract surgery. The patient will need or have cataract surgery to consider MIGS. By combining both cataract surgery and MIGS, doctors are able to treat two conditions using just one incision and decrease the recovery time from having two different procedures.
Protect Your Vision with Florida Eye Specialists and Cataract Institute
Treatment for glaucoma has come a long way. Advanced technology found at Florida Eye Specialists and Cataract Institute makes it even easier to diagnose and manage this condition. We are committed to offering treatments that are effective and proven to be safe. Dr. Sharaby, our new glaucoma surgeon, performs these procedures along with complex cataract surgeries and treats neuro-ophthalmological conditions with a background in neurology. If you are interested in learning more about the benefits of minimally invasive glaucoma treatment options, contact us for an appointment.