Minimally-Invasive glaucoma surgery (MIGS)
About MIGS
Living with glaucoma means you may need to visit your doctor regularly so they can monitor your eye pressure. High eye pressure results in damage to the optic nerve, the part of your eye that sends images to your brain. For some glaucoma patients, medication alone is not enough to reduce eye pressure. In these instances, your doctor will recommend glaucoma surgery.
MIGS is a type of glaucoma surgery that uses microscopic equipment to lower eye pressure by draining excess fluid from the eye. Unlike traditional glaucoma surgery, MIGS is minimally invasive — it may only require a tiny incision. Many patients prefer MIGS to standard glaucoma surgery because it takes less time to perform, has a faster recovery time, and results in significantly fewer complications.
What is MIGS?
MIGS encompasses a group of surgeries designed to lower intraocular eye pressure through the use of minimally invasive surgical techniques. MIGS is often combined with cataract surgery and targets the mesh-like drainage system of the eye. These MIGS devices and procedures are generally safer than traditional glaucoma surgery, such as trabeculectomy or tube shunt surgery, with quicker recovery times:
- iStent®
- Trabectome
- CyPass Micro-Stent
- Selective Laser Trabeculoplasty
What is iStent®?
iStent® is a very small device that is implanted into the eye to improve the flow of fluid and lower intraocular eye pressure. The iStent® is implanted during your cataract surgery, so you don’t have to worry about receiving two separate surgeries! With iStent®, patients maintain a normal eye pressure and reduce their dependence on glaucoma medications.
Am I a candidate for iStent®?
If you have mild-to-moderate open-angle glaucoma and you’re preparing for cataract surgery, iStent® may be an ideal option to treat both eye conditions at the same time. If you currently manage your glaucoma symptoms with medication, the iStent® could be an effective solution for reducing or eliminating your dependence on eye drops. Talk to your doctor to see if iStent® is right for you.
How does it work?
iStent® is implanted into the eye to create a bypass between the front part of the eye and its natural drainage pathway. This allows fluids to drain normally, significantly lowering intraocular pressure. Lower IOP means less damage to the optic nerve and less vision loss.
Is The iStent® Safe?
The iStent® was the first MIGS device to receive FDA approval in 2012. Measuring only 0.3mm in height and 1mm in length, the iStent® implant is the smallest medical device ever implanted in the human body. Clinical trials concluded that iStent® surgery that took place at the same time as cataract removal surgery resulted in a significant, long-term decrease in intraocular eye pressure, as well as a reduction in the number of medications used.
What happens during surgery?
The iStent® procedure and cataract removal process are typically performed under local anesthesia. Once your eye surgeon removes your cataracts, they will insert the iStent® device using microscopic tools. After the device is implanted, you won’t see or feel it. Most patients are discharged the same day of surgery, with a light dressing or shield applied to the eye.
How much does iStent® cost?
In most cases, iStent® is covered by Medicare and the majority of private insurance companies, but only in combination with cataract surgery.
What is Selective Laser Trabeculoplasty (SLT)?
SLT is a form of laser surgery used to lower intraocular eye pressure in open-angle glaucoma patients. SLT is recommended when eye drop medications aren’t enough to lower eye pressure, or you’re tired of unwanted side effects from eye drops. SLT can also be used as an initial treatment for glaucoma. While SLT is not a cure for glaucoma, it is an FDA-approved treatment that can lower eye pressure and potentially reduce or eliminate the need for eye drop medications.
Am I a candidate for SLT?
If you have primary or secondary open-angle glaucoma and your eye pressure has not been successfully lowered through medication, you may be eligible for SLT. Patients seeking alternatives to medication and its associated side effects may also benefit from SLT as initial treatment for glaucoma. The best way to determine your candidacy is to make an appointment with your doctor.
How does SLT work?
During the SLT procedure, laser energy is applied to the drainage tissue of the eye. The laser uses minimal heat to create a chemical and biological change in the tissue, which results in increased drainage capacity and eventually, reduced intraocular eye pressure.
What’s the difference between SLT and iStent®?
SLT is a laser treatment for glaucoma, while the iStent® is an implantable device. iStent® implantation is most often recommended for patients who are preparing for cataract surgery, as it is easiest for the surgeon to “kill two birds with one stone” and insert the device directly after the cataract removal process. By contrast, cataracts are not a prerequisite for SLT — the laser procedure is a treatment option for the majority of patients with open-angle glaucoma.
How long does SLT last?
SLT lowers eye pressure by about 30%, which is comparable to most glaucoma medications (without the side effects). The decrease in eye pressure usually lasts 1-5 years or longer. The procedure can be repeated for continued benefit. If the effects of SLT wear off, some patients prefer to return to medication to control eye pressure levels.
Does Medicare cover SLT?
SLT is covered by Medicare and most private insurance companies when it is deemed medically necessary. Your doctor will determine your candidacy for SLT by examining your medical history record. You’ll receive a recommendation for SLT or other forms of glaucoma treatment based on your vision and lifestyle needs.
What are the risks of SLT?
Post-surgery eye inflammation is common, but generally mild and temporary. Your doctor may prescribe anti-inflammatory eye drops or an oral medication. There’s an approximate 5% risk of experiencing elevated eye pressure immediately after SLT. It is usually managed with glaucoma medication and often disappears after 24 hours.
