One way to lower elevated eye pressure, and reduce or avoid damage to the optic nerve, is through minimally, or micro, invasive glaucoma surgery (MIGS). Here, ophthalmologists Thomas W. Samuelson, M.D. and Patrick J. Riedel, M.D. describe this group of surgeries and explain how they can be advantageous for people with glaucoma.*

Glaucoma management ‘renaissance’

Samuelson has been fascinated by the rapid evolution–two distinct “Renaissance periods”–in glaucoma treatment over the past 20+ years. Initially, he says, major leaps in treatment centered on medications. For the last 10 years, however, the focus shifted to surgical advances.

Though there have long been effective surgical procedures to treat glaucoma, he adds, they’ve been “somewhat high risk” and often required follow-up medications. Today, MIGS include safer surgical options, such as:

• iStent®,
• XEN® Gel Stent, and
• PRESERFLO® MicroShunt (formerly InnFocus MicroShunt).

Samuelson says there are now about a half-dozen MIGS options for patients, allowing for individualized care. For example, iStent may be ideal for those with mild-to-moderate glaucoma, whereas XEN may be appropriate for people with advanced disease or higher eye pressure.

Safer and more diverse options

Reidel explains that effective glaucoma management requires lowering intraocular (internal eye) pressure, or IOP. This can be achieved through:

• medication,
• laser therapy, and
• surgery.

Though medicated eye drops are still most ophthalmologists’ firstline treatment for glaucoma, he says, it’s exciting that today there are many microscopic surgical implants available, like stents and drainage tubes, “that allow for much safer surgery with still excellent results.” 

*Minnesota Eye Consultants. (2018, December 27). Glaucoma | MIGS (Minimally Invasive Glaucoma Surgery) [Video file]. Retrieved from https://www.youtube.com/watch?v=HaEcvnOG5gU