What Is MIGS Surgery for Glaucoma? A Patient-Friendly Guide
If you’ve been diagnosed with glaucoma, you may have heard your eye doctor mention MIGS as a possible treatment option. But what exactly is MIGS surgery for glaucoma, and how does it differ from traditional glaucoma surgery?
MIGS, or minimally invasive glaucoma surgery, refers to a group of procedures designed to help lower eye pressure with less tissue disruption than some traditional glaucoma surgeries.
For some people with glaucoma, MIGS may help reduce their dependence on glaucoma medications or provide additional pressure control. However, MIGS is not appropriate for every patient or every type and stage of glaucoma.
In this guide, we’ll explain what MIGS is, how it works, who may benefit from it, what to expect, and how it compares with other glaucoma treatments.
What Is MIGS Surgery for Glaucoma?
MIGS stands for minimally invasive glaucoma surgery.
It is a group of surgical procedures used to lower intraocular pressure (IOP) in people with glaucoma. High eye pressure can damage the optic nerve, which is responsible for sending visual information from the eye to the brain.
Unlike traditional glaucoma surgeries that may involve creating a larger new drainage pathway, many MIGS procedures use small instruments or implants to improve the eye's natural ability to drain fluid.
The goal is to improve the flow of aqueous humor, the clear fluid produced inside the eye, and lower pressure within the eye.
MIGS procedures are generally designed to be less invasive than traditional glaucoma surgeries, but they are still surgical procedures and carry potential risks.
How Does MIGS Work?
To understand MIGS, it helps to understand how fluid normally leaves the eye.
The eye continuously produces aqueous humor. This fluid flows through the front portion of the eye and normally drains through a structure called the trabecular meshwork into the eye's drainage system.
In glaucoma, the drainage system may not allow fluid to leave the eye efficiently. As fluid builds up, pressure inside the eye can increase.
Over time, elevated eye pressure can contribute to damage to the optic nerve.
Depending on the specific MIGS procedure, surgery may:
- Improve access to the eye's natural drainage pathway
- Bypass areas where fluid encounters resistance
- Create an alternative pathway for fluid to leave the eye
- Use a small device or implant to improve drainage
By helping fluid leave the eye more effectively, MIGS can lower intraocular pressure.
Who May Be a Candidate for MIGS?
MIGS isn't automatically recommended for everyone with glaucoma.
Your ophthalmologist will consider several factors before recommending a procedure, including:
- The type of glaucoma you have
- The severity of your glaucoma
- Your current eye pressure
- How well your glaucoma medications are working
- Your optic nerve health
- Your visual field results
- Your overall eye health
- Whether you are undergoing cataract surgery
- Your treatment goals
MIGS is commonly considered for certain patients with mild to moderate open-angle glaucoma, although the appropriate procedure depends on the individual.
For some patients, MIGS may be performed at the same time as cataract surgery.
Your ophthalmologist can determine whether MIGS is appropriate based on your individual diagnosis and treatment needs.
What Are the Different Types of MIGS?
MIGS is not one single procedure. It describes a category of minimally invasive glaucoma procedures.
Different MIGS procedures work in different ways.
1. Trabecular MIGS
Some MIGS procedures target the trabecular meshwork, which is part of the eye's natural drainage system.
The procedure may remove or bypass tissue that is restricting fluid outflow. This can allow aqueous humor to reach the eye's natural drainage channels more easily.
2. MIGS With a Small Implant
Some procedures use a tiny implant or stent to help maintain a pathway for fluid drainage.
These implants are designed to improve aqueous humor outflow and lower intraocular pressure.
3. Canal-Based Procedures
Some MIGS techniques work with the eye's natural drainage canal, called Schlemm's canal.
The goal is to improve access to the natural drainage system and help aqueous humor leave the eye.
4. Suprachoroidal or Subconjunctival Approaches
Other minimally invasive procedures use different pathways to help fluid leave the eye.
The best approach depends on factors such as your glaucoma type, eye anatomy, pressure level, and previous treatments.
Because MIGS includes several different procedures, your doctor can recommend the technique that best fits your individual situation.
Is MIGS the Same as Traditional Glaucoma Surgery?
No.
MIGS and traditional glaucoma surgery both aim to lower eye pressure, but they use different surgical approaches.
Traditional procedures such as trabeculectomy or glaucoma drainage device surgery can create or use alternative drainage pathways to provide substantial pressure reduction.
MIGS procedures are generally designed to be less invasive and may have a different risk and effectiveness profile.
This doesn't mean MIGS is always better.
Patients with more advanced glaucoma or very high target pressure requirements may need a more traditional glaucoma procedure.
The appropriate treatment depends on the patient's condition.
Can MIGS Be Done During Cataract Surgery?
In some cases, yes.
Certain MIGS procedures can be performed at the same time as cataract surgery.
This can be convenient for patients who have both cataracts and glaucoma because the surgeon can address both conditions during the same surgical session.
However, not every MIGS procedure is appropriate for every cataract patient with glaucoma.
Your ophthalmologist will evaluate your glaucoma, cataract, eye anatomy, and treatment goals before recommending combined surgery.
What Are the Benefits of MIGS?
One potential benefit of MIGS is that it may lower eye pressure while using a less invasive surgical approach than some traditional glaucoma procedures.
Depending on the procedure and the patient, potential benefits may include:
- Lower intraocular pressure
- Reduced dependence on glaucoma medications
- A minimally invasive surgical approach
- The ability to combine certain procedures with cataract surgery
- Potentially faster recovery than some traditional glaucoma surgeries
However, results vary from person to person.
MIGS is intended to help manage glaucoma—it does not reverse existing optic nerve damage.
What Is Recovery Like After MIGS?
Recovery depends on the specific MIGS procedure you undergo.
Your ophthalmologist will provide detailed postoperative instructions, which may include using prescription eye drops and avoiding certain activities temporarily.
You may experience some temporary symptoms such as:
- Mild irritation
- Redness
- Blurry vision
- Light sensitivity
- Mild discomfort
Your doctor will monitor your eye pressure and healing during follow-up visits.
Because different MIGS procedures have different recovery periods, it's important to follow the specific instructions provided by your surgeon.
Are There Risks With MIGS?
Like any surgery, MIGS has potential risks.
The risks depend on the specific procedure but may include:
- Temporary changes in eye pressure
- Bleeding inside the eye
- Inflammation
- Infection
- Vision changes
- The need for additional glaucoma treatment
- Failure to achieve the desired reduction in eye pressure
Your ophthalmologist should explain the potential benefits and risks of the specific MIGS procedure being considered for you.
Does MIGS Cure Glaucoma?
No.
MIGS does not cure glaucoma or restore optic nerve damage that has already occurred.
Glaucoma is a chronic eye disease that requires ongoing monitoring and management.
The purpose of MIGS is to help control intraocular pressure and reduce the risk of further glaucoma damage.
Some patients may still need glaucoma medications or other treatments after surgery.
Regular eye examinations remain important even after a successful MIGS procedure.
MIGS vs. Glaucoma Eye Drops
Eye drops are one of the most common treatments for glaucoma.
Depending on the medication, glaucoma drops may reduce the amount of fluid produced by the eye or improve fluid drainage.
While eye drops can be effective, some patients have difficulty using them consistently or experience side effects.
MIGS may be considered when medication alone isn't providing adequate pressure control or when reducing the number of medications is an important treatment goal.
However, MIGS does not necessarily eliminate the need for eye drops.
Your ophthalmologist can help determine whether medication, laser treatment, surgery, or a combination of treatments is appropriate.
MIGS vs. Laser Treatment for Glaucoma
Laser treatment is another option for some people with glaucoma.
One example is selective laser trabeculoplasty (SLT), which uses laser energy to improve fluid drainage through the eye's natural drainage system.
SLT is performed in an office setting and does not involve placing an implant inside the eye.
MIGS, on the other hand, involves a surgical procedure and may involve an implant or modification of the eye's drainage pathway.
The best option depends on your glaucoma and how your eyes respond to treatment.
How Do I Know if MIGS Is Right for Me?
The best way to determine whether MIGS is appropriate is to have a comprehensive glaucoma evaluation.
Your ophthalmologist may review:
- Your eye pressure
- Optic nerve appearance
- Visual field testing
- OCT imaging
- Your glaucoma diagnosis and stage
- Current medications
- Previous glaucoma treatments
- Overall eye health
From there, your doctor can explain your treatment options and discuss whether MIGS could help you reach your target eye pressure.
Take the Next Step in Glaucoma Care
If you've been diagnosed with glaucoma, you don't necessarily have to rely on one treatment option.
Depending on your condition, glaucoma management may include medication, laser treatment, MIGS, traditional glaucoma surgery, or a combination of approaches.
At MiVision Eye Care, we can evaluate your eyes, monitor your glaucoma, and discuss treatment options based on your individual needs.
If you're wondering what MIGS surgery for glaucoma is or whether you may be a candidate, schedule an eye evaluation to discuss your options.
Don't wait for glaucoma to affect your vision. Early diagnosis, regular monitoring, and appropriate treatment can help protect your sight.