MIGS: A New Option for Patients with Glaucoma

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    It is estimated that over 3 million Americans over the age 40 have glaucoma, and it is said that half the people living with this disease are unaware they have it. Glaucoma is also the second leading cause of blindness worldwide.

    MIGS: A New Option for Patients with Glaucoma

    Minimally invasive glaucoma surgical procedures (MIGS) have been developed to provide patients with a safer alternative to glaucoma surgery and help them reduce the burden of their medications.

    MIGS minimizes the complications associated with traditional glaucoma procedures, such as trabeculectomy, EXPRESS shunts and external tube-shunts. These long-established procedures are effective at lowering eye pressure, but have potential complications.  MIGS also accelerates the patient’s recovery time.

    “MIGS procedures have been revolutionary and, within the last few years, have opened up a menu of safer options that we can now offer our patients,” said OCB Ophthalmologist Joshua Ney, MD., a glaucoma specialist.

    In patients with most common type of glaucoma, open-angle glaucoma, intraocular pressure increases because the channels that normally drain fluid from the eye become blocked. Higher than normal pressure can damage the optic nerve, causing irreversible vision loss. In the past, glaucoma surgery was reserved for more severe cases. Now, MIGS can be offered when glaucoma is at a mild stage.

    OCB Ophthalmologist Tom Hsu, MD, points out that while MIGS procedures do not cure glaucoma, even when introduced at a mild stage, they enable patients to reduce the number of medicated drops they must use daily to keep their eye pressure under control.

    “Many patients have difficulty manipulating the drops properly and they might have as many as three different drops,” says Dr. Hsu. “A patient may have arthritis for example, and the drops require good hand-eye coordination. While patients have the best intentions, on follow up visits we may discover that eye pressure has increased due to difficulties with administering the eye drops. MIGS removes the drops from the equation and, in most cases, eye pressure is well controlled.”

    MIGS and Cataract Surgery

    Some MIGS procedures are performed during cataract surgery, using the same incisions that are used for the cataract portion of the procedure. These include implantation of tiny stents such as the iStent, which is 1 mm long, or the Cypass Micro-Stent, which is 6 mm, roughly the size of an eyelash.

    “Glaucoma patients are well informed and are aware of these devices,” says Dr. Ney. “Any patient with glaucoma who is having cataract surgery and taking a minimum of one eye drop will be evaluated to determine if they are a candidate for a MIGS implants. The MIGS procedure does not add any additional risk or recovery time to cataract surgery.”

    MIGS without Cataract Surgery

    There are also MIGS options for patients with mild glaucoma who are not having cataract surgery and for patients with more severe glaucoma who would normally be a candidate for traditional open-incision glaucoma surgery. For those patients with severe glaucoma, the XEN stent may be an option.

    “There are not many ophthalmology groups using the XEN implant because it was approved by the Food and Drug Administration in 2017 and not yet covered by insurance,” said Dr. Ney. “From what I have seen, the XEN effectively controls pressure, without the long recovery time and risks that come with trabeculectomy surgery.”

    All of OCB’s glaucoma specialists have experience with MIGS procedures. To learn more, please follow up with your OCB glaucoma specialist at your next visit. All OCB glaucoma specialists offer MIGS procedures. To learn more visit our glaucoma service pages.

    This information was originally published by Ophthalmic Consultants of Boston.

    When you first learn that your vision loss from glaucoma is irreversible, it can be overwhelming. The good news is that there are many low vision aids and blindness aids to help you live a full, independent life.

    The best way to protect your vision from glaucoma is to get your eyes checked. January is a great time to get a comprehensive dilated eye exam because it is Glaucoma Awareness Month. If you already have vision loss from glaucoma, there are many amazing low vision aids and blindness aids to help you live a full, independent life.

    As part of our work to increase awareness about glaucoma and glaucoma-related vision loss and living with glaucoma we have written a 4-part Guide to Glaucoma. Please share this Guide with friends and remember to get your eyes tested for glaucoma annually. If you do have glaucoma-related vision loss, call us at 888-211-6933 to learn how low vision aids can help you.

    In Part One of our series “A Guide to Glaucoma” we discussed what glaucoma is, the warning signs and symptoms of glaucoma and the stages of glaucoma-related vision loss.

    In Part Two of our Glaucoma Guide we discussed who’s at risk for developing glaucoma and how to prevent vision loss from this disease.

    In Part Three of our Glaucoma Guide we discussed tests and treatments for glaucoma.

    In Part Four of our Glaucoma Guide we discuss how glaucoma affects your vision and low vision and blindness aids for people with vision loss from glaucoma.

    Contact us to learn about the low vision devices that can best help you with your vision loss

    Please share this important information with your friends and family, encourage everyone you know to get a comprehensive eye exam annually.

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