Is minimally invasive glaucoma surgery (MIGS) right for you?

Glaucoma is a group of eye diseases that can lead to irreversible vision loss if not managed effectively. Traditional glaucoma treatments, such as medication or more invasive surgery, have been the primary options for patients. However, advancements in technology have introduced minimally invasive glaucoma surgery (MIGS) as an alternative treatment option that offers less recovery time and fewer risks. If you are considering your options for glaucoma management, you may be wondering whether MIGS could be a suitable choice for you. We speak to a leading opthalmologist, who explains the surgery, including how it works and the benefits.

What is minimally invasive glaucoma surgery (MIGS) and how does it work?

Minimally invasive glaucoma surgery (MIGS) refers to a range of surgical procedures designed to reduce intraocular pressure (IOP) in the eye with minimal trauma to the surrounding tissues. Intraocular pressure is the pressure created by the fluid inside your eye, which can build up and damage the optic nerve, leading to glaucoma. Unlike traditional glaucoma surgeries, which may require significant incisions, MIGS procedures involve very small incisions and specially designed tools to target the trabecular meshwork or other drainage areas in the eye.

The goal of MIGS is to improve the eye’s natural drainage system, either by increasing fluid outflow or decreasing fluid production, thus reducing the pressure inside the eye. Several types of MIGS procedures exist, and each targets different parts of the eye’s drainage system to help reduce IOP.

What are the different types of MIGS?

There are various MIGS techniques, each with its unique approach to lowering eye pressure. Some of the most commonly performed MIGS procedures include:

iStent: A tiny titanium stent is placed in the eye to help drain fluid more effectively. The iStent is one of the smallest implants used in surgery and works by creating a pathway for fluid to escape, reducing intraocular pressure.

Trabectome: This procedure uses an electrode to remove a portion of the trabecular meshwork, the eye’s drainage tissue. Removing a part of this tissue can enhance fluid outflow, thus lowering eye pressure.

XEN gel stent: This involves implanting a soft, gelatin-based stent to create a channel for fluid to drain from the eye. It is particularly effective for patients with moderate to severe glaucoma.

Each of these techniques has its strengths, and the choice of procedure will depend on factors such as the severity of your glaucoma, the structure of your eye, and any previous treatments you may have had.

What are the benefits of MIGS?

MIGS offers several advantages over traditional glaucoma surgeries. Firstly, since the incisions made during MIGS are very small, there is generally less scarring and a faster healing process. MIGS procedures are usually performed under local anaesthesia, reducing the risks associated with general anaesthesia.

Another significant benefit is that MIGS can often be combined with cataract surgery, allowing patients to address both glaucoma and cataracts in a single procedure. This can be a convenient option for patients, as it eliminates the need for two separate surgeries.

Who is a good candidate for MIGS?

MIGS is generally recommended for patients with mild to moderate open-angle glaucoma. Open-angle glaucoma is the most common form of the disease and is characterised by slow clogging of the drainage canals, resulting in increased eye pressure. If you have been managing your glaucoma with eye drops but are interested in reducing or eliminating the need for medication, MIGS may be an option worth discussing with your ophthalmologist.

However, MIGS may not be suitable for everyone. Patients with advanced glaucoma or certain eye structures may require more traditional surgical methods to effectively control eye pressure. A thorough eye examination and consultation with an eye care specialist will help determine whether MIGS is the right treatment option for you.

What can you expect after MIGS?

Recovery from MIGS is typically quicker and less complicated than with more invasive glaucoma surgeries. Patients may experience mild discomfort or blurred vision for a few days post-procedure, but these symptoms usually resolve quickly. Most patients are able to resume their normal activities within a few days, although it’s essential to follow post-operative instructions carefully and attend all follow-up appointments to monitor your eye pressure and ensure the best possible outcome.

If you’re interested in learning more about MIGS or would like to discuss your treatment options, speak with your ophthalmologist. They can provide personalised recommendations based on your specific needs and help you make an informed decision about managing your glaucoma.