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    What advent of MIGS means for earlier glaucoma intervention


    On the other hand, compared with medical treatment, the patients treated with surgery showed lower mean diurnal IOP, lower peak IOP, and less IOP fluctuation with fewer spikes, Sit et al. reported in 2008 in Surv Ophthalmol. Similar findings emerged even when surgery was the primary therapy, Musch et al reported in 2009 in Ophthalmology.

    Yet, out of more than 3 million people with glaucoma in the United States, 500,000 are being treated with lasers and 120,000 with trabeculectomy and tube shunts, Dr. Ahmed said, citing Market Scope. The use of trabeculectomy is in decline, and while tube shunt use is rising, the numbers are still low, he added, citing a 2015 study by Arora et al. in Ophthalmology.

    That sets the stage for MIGS, which are minimally traumatic with high safety and rapid recovery, said Dr. Ahmed.

    The interventional glaucoma approach could combine MIGS with cataract surgery, he said. About 15% to 20% of the 3.7 million patients undergoing cataract surgery in the United States every year have glaucoma, he pointed out, citing the Centers for Medicare and Medicaid Services as well as a 2012 study by Tseng et al. in JAMA.

    "MIGS is to phaco as toric lenses are to IOLs," he said.

    In addition, interventional glaucoma could make use of sustained-release drug delivery to lower IOPs while modulating wound healing. It. And it could take advantage of microstenting bleb surgery, said Dr. Ahmed.

    "We're changing our attitude," he concluded. "We're enabled by what's available to us and what's coming in the future."

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