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    MIGS: Expanding realm of glaucoma

    Success requires picking right patient, setting proper expectations, learning technique



    Microinvasive glaucoma surgery creates a new paradigm for the role of glaucoma surgery and is within the skillset of cataract and cornea surgeons.



    AtlantaCataract surgeons and cornea specialists have been important in the development of microinvasive glaucoma surgery (MIGS), and they have an important role to play in its future, according to Reay H. Brown, MD.

    “When the first MIGS device was approved, the question arose of whether it should only be implanted by glaucoma specialists,” said Dr. Brown, in private practice, Atlanta Ophthalmology Associates. “However, that was a debate that never got off the ground.”

    More in this issue: What dying wishes or regrets might ophthalmologists have?

    Cataract and cornea surgeons should care about MIGS because it is within their skillset and offers a chance for them to safely help glaucoma patients who need cataract surgery but not a trabeculectomy or tube surgery. Moreover, cataract and cornea surgeons have an amazing record of innovation, and glaucoma needs your innovative spirit, he noted.

    Speaking about combined MIGS and cataract surgery, Dr. Brown explained that by strict definition, MIGS is performed through an ab interno incision and is not destructive or ablative. Based on its safety and efficacy, MIGS creates a new paradigm for the role of surgery in glaucoma management.

    “MIGS introduces a new way of thinking about glaucoma surgery,” he said. “In the past, surgical intervention was considered for the 5% of patients who were on 4 or more medications. However, with MIGS, surgery is no longer a last resort for candidates failing maximal medical treatment with an elevated IOP and visual field progression.

    Cheryl Guttman Krader
    Cheryl Guttman Krader is a contributor to Dermatology Times, Ophthalmology Times, and Urology Times.

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