MIGS: Advancements in Glaucoma Surgery by Allison Dublin, M.D.

March 18, 2020

Dr. Dublin is an ophthalmologist at the Marietta Eye Clinic who specializes in cataracts and glaucoma.

Microinvasive glaucoma surgery (MIGS) is a less invasive alternative to more traditional forms of glaucoma surgery, such as trabeculectomy and external tube shunts. The goal of glaucoma surgery is to reduce intraocular pressure (IOP) and prevent further damage to the optic nerve. Damage done to the optic nerve is irreversible and could result in blindness, so it’s important to treat glaucoma early. Advances in health care have resulted in newer procedures with fewer complications.

What Kinds of Patients are Candidates for MIGS?

Broadly speaking, MIGS lowers eye pressure less than traditional glaucoma surgeries, but the microscopic equipment used and incisions made make MIGS a much safer alternative. For mild to moderate glaucoma that does not respond to medication, MIGS is the preferred treatment option, as it is generally effective enough but is without the increased risk of complications.

What are the Different Types of MIGS?

There are many different types of MIGS procedures, but they all share a few similar characteristics. MIGS uses a clear cornea approach that provides a direct view of the angle. This means MIGS can be performed safely alongside cataract surgery and produces less conjunctival scarring than traditional glaucoma surgeries. MIGS also results in less trauma to the eye; incurs less complication from surgery; and offers a shorter recovery period.

MIGS can generally be broken down into 4 categories. Those categories are:

  • Microtrabeculectomy
  • Trabecular bypass
  • Suprachoroidal shunts
  • Laser cyclodestruction

Read more about the different types of MIGS procedures below.

Microtrabeculectomy

In a microtrabeculectomy, a  microscopic tube finer than an eyelash is inserted into the eye and used to drain aqueous humor, the fluid in the eye that causes pressure.

Trabecular Bypass

In a trabecular bypass, small devices are used to cut into the trabecular meshwork. A device is inserted into a small incision in the eye using a special contact lens. The trabecular meshwork is then either destroyed or bypassed with a stent.

Suprachoroidal Shunts

Suprachoroidal shunts are implanted to help aqueous humor drain from the eye. Small tubes are used to connect the front of the eye to the space between the retina and the wall of the eye. Suprachoroidal shunts are proven to be successful in cases of even moderately severe glaucoma.

Laser Cyclodestruction

Historically, laser surgery was reserved for patients with severe glaucoma due to the inflammation experienced as a side effect. Recent laser technology has made laser-assisted glaucoma surgery less invasive and more effective.

These are the two most common types of laser-assisted MIGS:

  • Endoscopic cyclophotocoagulation, also called endocyclophotocoagulation or ECP, involves using a laser endoscope to destroy the ciliary body (a process referred to as cyclodestruction) and reduce fluid production. The laser allows for more targeted cyclodestruction compared to a traditional incision, reducing collateral damage.
  • MicroPulse cyclophotocoagulation involves using a series of laser pulses. Between pulses, the targeted tissue is able to cool, resulting in less thermal damage. Similar to ECP, MicroPulse cyclophotocoagulation causes destruction to the ciliary body, which produces fluid in the eye.

Speak to a Glaucoma Specialist about MIGS

If you are experiencing mild to moderate symptoms of glaucoma that do not respond to medication, MIGS might be an option for you. While your symptoms may not yet be severe enough to warrant more invasive surgery, treating glaucoma before it progresses is important, as damage to the optic nerve is irreversible. The decreased risk associated with MIGS makes it a more attractive option than more invasive traditional glaucoma surgeries. However, whether MIGS is right for you and which type of MIGS might best suit you depends on your unique health conditions. Speak to your ophthalmologist about treatment options for your glaucoma before it’s too late.

More About Glaucoma Specialist Allison Dublin, M.D.

Dr. Dublin is an ophthalmologist with the Marietta Eye Clinic who specializes in glaucoma and cataracts. She serves the Kennestone, Douglasville, and West Cobb locations. Dr. Dublin received her undergraduate degree in biology from the University of Texas and her medical degree from the University of Texas Health Science Center. Dr. Dublin is a member of the American Glaucoma Society, the American Academy of Ophthalmology, the American Medical Association, the Houston Ophthalmological Society, the Texas Medical Association, and the Texas Ophthalmological Association. Read her full bio here.

References and Additional Resources

The American Academy of Ophthalmology (AAO) is the world’s largest association of eye physicians and surgeons. It describes itself as a “global community of 32,000 medical doctors who protect sight and empower lives by setting the standards for ophthalmic education and advocating for our patients and the public.” Its website is a great resource to learn more about how to care for your eyes.

The American Optometric Association (AOA) describes itself as the leading authority on quality care and an advocate for our nation’s health, representing more than 44,000 doctors of optometry, optometric professionals, and optometry students.

What is MIGS?

https://www.glaucoma.org/treatment/what-is-migs.php

MIGS: Expanding Options for Glaucoma Treatment

https://www.aao.org/eyenet/article/expanding-options-for-glaucoma-treatment

The Great Debate: MIGS v Traditional Surgery

https://www.aao.org/annual-meeting-video/great-debate-migs-v-traditional-surgery

Endoscopic Cyclophotocoagulation (ECP)

https://eyewiki.org/Endoscopic_Cyclophotocoagulation_(ECP)

Glaucoma: Cyclodestruction

https://www.aao.org/disease-review/glaucoma-cyclodestruction

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