Five Key Things I Tell Patients About MIGS

BY RACHEL G. SIMPSON, MD

Micro-invasive glaucoma surgery (MIGS) is perhaps the fastest-growing surgical sphere in ophthalmology. The term applies to any surgical procedure designed to lower eye pressure that requires minimal tissue disruption, has a high safety profile, and can be completed quickly, sometimes as part of cataract surgery. As with any surgery, appropriate patient counseling is vital for the patient to understand what to expect with their MIGS procedure.

MIGS is a tool to treat glaucoma — not a cure.

With any surgery, expectation management is important. I start by telling patients that the procedure is designed to give us an edge when treating their glaucoma, but it’s not a cure. Glaucoma is a chronic disease.

MIGS is quick, and so is the recovery.

One of the nicest things about MIGS procedures is that they can be quick. Unlike more traditional glaucoma surgeries that can take up to an hour, a typical MIGS procedure with cataract surgery adds only 3-4 minutes to the procedure. The recovery from MIGS, while a little longer than with cataract surgery alone, is also usually much faster than traditional glaucoma surgery.

MIGS is safe.

If there is one area where all glaucoma surgeons can agree, it’s that the risk posed by MIGS is minute compared to some of the more traditional glaucoma surgeries. The risk posed by MIGS is essentially equal to that of cataract surgery, and I usually counsel my patients as such.

MIGS might get patients off a drop (or two), but don’t count on it.

One of the major potential benefits of MIGS is the possibility of getting a patient off one or more of their prescription eye drops. However, outcomes vary. While I counsel this is a potential added benefit, I am sure to remind them it’s not the primary reason for surgery. Lower intraocular pressure is the hoped-for outcome. I usually tell them that, on average, about 50% of patients with mild or moderate glaucoma can reduce their use of drops.

MIGS is sometimes a one-chance-only opportunity.

Two of the most popular MIGS procedures, the Hydrus Microstent and the iStent inject, only have FDA approval to be implanted at the time of cataract surgery. Currently, insurance will only cover these stents when implanted during cataract surgery. For now, I tell my patients that if we decide not to place these stents during their cataract surgery, we can’t easily go back a few years later and implant them. Once that ship sails, it’s gone.

Dr. Simpson is associate program director of education. She specializes in the medical and surgical treatment of glaucoma and cataracts and advanced anterior segment surgeries.