MIGS In Daily Practice

A Roundtable Discussion Of Nondestructive Interventional Treatments For Open-angle Glaucoma 

VIDEO SOURCE: Ellex Medical on YouTube 

Dr. Ahmed: Let’s switch gears to MIGS. MIGS procedures have exploded on the scene. There are lots of options out there. What MIGS are you using? Where do they fit into your approach?

Dr. Gallardo: I’m a proponent of the idea that every device and procedure has its place. In any one routine OR day, I perform several MIGS procedures. I evaluate each patient and try to find the procedure that I feel best fits the patient’s pathology by assessing the drainage angle via gonioscopy, stage of glaucoma, and looking at the patient’s pressure and number of medications. As a result, I use various MIGS devices and procedures for patients whose glaucoma is anywhere from mild to severe, and I try to utilize MIGS prior to doing any filtering procedure.

We’ve known for 10 or 15 years that the preservative in the drops actually damages the TM. We’re using drops to help a patient’s pressure, but at the same time, we’re damaging the system that naturally relieves the pressure.

—Mark J. Gallardo, MD

Dr. Singh: It’s a similar principle to selecting premium lenses. Which patient needs which MIGS? We never had that ability in the past, but now we can select the right MIGS for each situation. We are now able to tailor our treatment for each patient. It’s great to have options.

Dr. Ahmed: What percentage of your practice is combination cataract-MIGS surgery, versus standalone MIGS? How do you use MIGS for those situations?

Dr. Khaimi: I’m doing more combined surgery, about 60/40 or 70/30. I want to take advantage of the opportunity for patients with vision impaired by cataracts, who are on multiple drops, to be treated with a MIGS procedure that brings down their ocular pressure. I think that’s a great time to capture them. Of course, it also dramatically improves their quality of life.

Dr. Singh: For me, the numbers have changed. A few years ago, I did about 90% cataract-MIGS procedures and 10% standalone MIGS. With all of the new MIGS products available to us, including ABiC with iTrack and others, the current ability to do standalone procedures has allowed me to treat more patients earlier, especially pseudophakic patients who are not tolerating medications. Nowadays, even if the fields and nerves are stable, but the patients can’t afford the medications, can’t remember to take them, or are just not happy, I offer a MIGS procedure. Now I can tell those patients, “I’d like to discuss a procedure that is safe and efficient overall and could get rid of some of your drops.” That threshold has changed, and now I’m probably about 60/40 with more standalone MIGS than before.