If your glaucoma isn’t responding to eyedrops and it’s time to consider surgery to ease the pressure building within your eye, you need to know about the latest advance for great results with less risk.

It is called MIGS, the acronym for minimally invasive glaucoma surgery, and it is the biggest development in glaucoma surgical treatment in many years.

How MIGS Works

Most of the fluid inside the eye normally drains through porous tissue called the trabecular meshwork. It is located inside the eye between the colored part (iris) and the clear “front window” of the eye (cornea). When the trabecular meshwork ages, drainage slows, and glaucoma often results from the buildup of trapped fluid. Serious cases can result in blindness.

The goal of the most common types of glaucoma surgery is to open up the drainage system and save vision. Traditional surgical procedures drain the fluid to the outside of the eye through a tiny hole or tube shunt in the thick white wall of the eye (sclera). These procedures work well but have possible complications including infection, bleeding and scarring, and they even can reduce eye pressure too much.

MIGS avoids making a hole through the sclera and instead uses an inside approach to increase the flow of eye fluid through the trabecular meshwork. This translates to MIGS procedures being faster and safer with less recovery time than older glaucoma surgeries.

There are several types of MIGS procedures. One type, ablation, opens up the trabecular meshwork with an electrocautery device (Trabectome) or a sharp blade (Goniotome) inserted through the cornea.

Another option is implanting a tiny stent into the trabecular meshwork. The stent is loaded onto the tip of a thin instrument inserted through the cornea.

Your doctor may discuss with you one or more of these stents such as the titanium iStent, the smallest device FDA-approved to be placed into the human body…Xen, a stent made from a permanent gel and about as wide as a human hair…and Hydrus, a scaffold design about the size of an eyelash that’s placed into a specific part of the drain called Schlemm’s canal.


MIGS may reduce eye pressure enough to reduce or eliminate the need for eyedrops. These drops can cause stinging and burning, and half of all patients who need them don’t use them regularly.

A MIGS procedure can be—and often is—done at the same time and through the same incision as cataract surgery.

If MIGS doesn’t reduce pressure enough, you still can have traditional glaucoma surgery at a later date.

Important: Not all eye surgeons are experienced in all types of MIGS. The best MIGS for you will depend on many factors, including your eye pressure and the procedure your surgeon is most comfortable with. Don’t hesitate to ask what kind of training your surgeon has, how many procedures of a given kind he/she has done and what kind of results patients are getting.

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