What is Minimally Invasive Glaucoma Surgery?

The goal of treatment for glaucoma is to lower the pressure inside the eye. This in turn decreases the stress on the optic nerve which carries the information of sight from the eye to the brain. The optic nerve is being damaged in glaucoma, causing vision loss. There are various treatment options to lower eye pressure, we can either decrease the amount of fluid the eye makes inside or increase the drainage of fluid from inside the eye. This goal can be accomplished with medications, laser, or surgery.

Over the past 5-10 years there has been a revolution in glaucoma surgery, specifically Micro (or Minimally)-Invasive Glaucoma Surgery, commonly called MIGS. The MIGS revolution has allowed us to change our approach to surgical glaucoma for many patients. Traditional glaucoma surgery has some vision threatening risks. The main theme and priority of MIGS is patient safety. While no surgery is without risk, MIGS provide improved safety while usually providing mild-to-moderate eye pressure lowering.

MIGS can be thought of in a few broad categories, either enhancing fluid outflow using the eye’s inherent drainage system (GATT, Kahook Dual Blade Goniotomy, Trabectome, iStent), shunting fluid to the outside of the eye (XEN Gel Stent) or decreasing production of fluid within the eye (ECP).

Currently Dr. Velotta performs iStent Inject or Omni canaloplasty MIGS. For istent Inject 2 or 3 tiny stents (tubes) are placed in the drainage system of the eye to facilitate lowering of eye pressure. Omni canaloplasty involves injecting a clear gel into the drainage system to open the area further to improve drainage and lower pressure inside the eye. Most patients have been able to stop taking at least one of their glaucoma medications after this surgery due to pressure lowering effects of the procedure.

While MIGS procedures will not replace or eliminate traditional glaucoma surgery, they have greatly decreased the number of patients who require these more invasive surgeries to control their eye pressure.