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Eye Care

Minimally Invasive Glaucoma Surgery (MIGS)

Understanding Glaucoma

What is Glaucoma?

Glaucoma occurs when the optic nerve of the eye—the nerve located at the back of the eye that is responsible for sending what you see back to your brain—becomes damaged. The most common cause of this nerve damage is an increase in pressure within the eye that presses back against the nerve.

Your eyes constantly produce a special fluid that helps them maintain their shape. This fluid also needs to drain in order to maintain consistent pressure within the eyes. If the channels that drain the fluid become blocked or closed, your eyes can produce more fluid than they drain, leading to a gradual buildup of pressure over time.

This buildup of pressure can be slow and hardly noticeable at first. You may not notice anything until it begins to affect your vision. At that point, damage to the optic nerve may already have occurred, and that damage is permanent.

This is why regular eye checkups and early detection are so important. There are many treatment options that can help minimize the risk of permanent vision loss.

Specialized Glaucoma Care

Experience You Can Trust

Dr. Spaulding here at Cataract & Laser Institute is a glaucoma specialist with many years of experience diagnosing and treating glaucoma.

He will work with you to determine the best strategy for treating your glaucoma.

If surgery is needed, he is an expert in MIGS—Minimally Invasive Glaucoma Surgery—one of the newest developments in glaucoma treatment technology. You can rest assured that you are in experienced hands with Dr. Spaulding.

Advanced Glaucoma Treatment

Minimally Invasive Glaucoma Surgery (MIGS)

Minimally Invasive Glaucoma Surgery (MIGS) refers to a group of procedures developed for the treatment of mild to moderate glaucoma.

These newer treatments offer alternatives to more traditional options, which come with higher risk factors and prolonged recovery. Due to these complications, many doctors would delay treatment until symptoms became substantially worse before resorting to those older methods.

With MIGS, doctors and patients no longer need to wait, providing patients with a better quality of life by reducing the discomfort of glaucoma and improving their vision for the long term.

While the exact methods and processes of each MIGS procedure may differ, they all share a common goal: augmenting the natural drainage of the eye to help promote the flow of fluid and reduce overall eye pressure, the primary cause of glaucoma.

The differences come from how this is accomplished. Some methods use tiny implants in various ways to open up the drainage channels of the eye, while others use lasers or other tools to clear out or create new drainage channels.

Here on this page, we have more information about some of the different forms of MIGS, along with informational videos to help you learn about your options. To learn more in depth about MIGS, talk to your ophthalmologist. They will be happy to go over the different options and determine what may work best for you.

Explore Your Options

Types of MIGS Procedures

Learn more about several of the minimally invasive procedures available for managing glaucoma. Expand each section below for details and informational videos.

iStent

The iStent is a one-millimeter titanium tube that is inserted into the natural drainage channel of the eye. It aims to bypass blockages in the drainage channel and improve the flow of fluid out of the eye and reduce eye pressure. It is common to have two or maybe even three iStent devices implanted into the eye at the time of surgery.

Hydrus

The Hydrus, made of nickel and aluminum, is an eyelash-sized device that is put into the main drainage channel of the eye, the Schlemm’s Canal. The Hydrus acts as a scaffold to hold the drainage channel open and allow fluid in the eye to drain, reducing eye pressure.

ABIC

Ab-interno Canaloplasty with iTrack is a type of surgery that cleans out the main drainage channel in the eye. Ab-interno refers to the direction from which the main drainage channel is accessed during surgery, the front of the eye. The iTrack is a tiny catheter that is inserted into the drainage channel. A special gel is then injected through the catheter, opening up the drainage channel and removing any blockages. Fluid is then able to flow out of the eye, reducing eye pressure.

CPC/Cyclophotocoagulation

Cyclophotocoagulation (CPC) uses an incision-free laser probe that targets the ciliary body, the part of the eye responsible for creating fluid. This reduces the activity of the ciliary body, thus reducing the production of fluid and allowing the natural drainage of the eye to better keep up, ultimately helping reduce eye pressure.

Xen

The Xen gel stent is a 6-mm hydrophilic flexible tube made of porcine collagen-derived gelatin cross-linked with glutaraldehyde, which is non¬inflammatory and causes minimal extraocular fibrotic or vascular response to the implant material. The Xen decreases eye pressure by creating a permanent drainage shunt from the anterior chamber to the subconjunctival space through a scleral channel. The device hydrates within 1-2 minutes of contact with aqueous humor, bending and conforming to tissue. This flexibility mitigates many of the issues seen with synthetic materials such as migration, erosion and corneal endothelial damage.

GATT

GATT (Gonioscopy-Assisted Transluminal Trabeculotomy) is a modification of trabeculotomy, a procedure that has been around for more than 50 years. Traditional trabeculotomy requires a small incision to be made in the eye in order to increase fluid drainage. While this can be very effective, it requires a prolonged recovery period.

GATT, on the other hand, does not require an external incision. Instead, it uses a microcatheter that can be inserted into the eye and moved through the section of the eye responsible for drainage. This process helps remove blockages that limit drainage, allowing fluid to drain more effectively.

This allows for a quicker recovery time with similar effectiveness to traditional trabeculotomy and less risk of complications.

Durysta

Durysta is one of the newer forms of MIGS to be developed, having received FDA approval in 2020. Similar to other procedures, Durysta involves a special implant that is placed in the eye.

The unique part of Durysta is that the implant is not permanent. It is a special compound containing medication that steadily dissolves, helping reduce eye pressure over time.

This approach avoids leaving a permanent implant in the eye while providing another option for managing glaucoma and helping patients maintain their vision and quality of life.