FEATURE EWAP MARCH 2023 17 by Liz Hillman Editorial Co-Director Procedural classifications of MIGS: How to understand, group the options W hen the term MIGS (microinvasive glaucoma surgery) was first coined more than a decade ago, there were only a few options in the space, and they were often referred to by their brand name, not the mechanism of action. Since then, however, the MIGS space has grown significantly with many options addressing the same outflow pathway. As such, it might be time to start talking about MIGS in terms of procedural categories. “The MIGS space has expanded throughout the years,” said Brian Francis, MD. “There are some novel mechanisms that are being introduced, but there are also a lot of procedures in the same space. I think it makes sense to talk about the mechanism of action rather than the name of the procedure itself.” As Robert Noecker, MD, put it, “we’re at critical mass” with multiple entries available in each space, so “it only makes sense to talk about these in categories now.” “It wasn’t as important before because there were only a couple of things to think and talk about and everyone was on the same page. Now many companies offer multiple strategies and operate in different parts of the MIGS spectrum. It’s important to do this to reduce confusion and help sort out the technologies,” Dr. Noecker said. Dr. Noecker said MIGS has followed a similar trajectory to Contact information Francis: bfrancis@doheny.org Noecker: noeckerrj@gmail.com This article originally appeared in the December 2022 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. A. Canaloplasty performed with iTrack to viscodilate and open Schlemm’s canal with illuminated catheter. B. Hydrus in place in the canal with adjacent area of goniotomy visible (white area visible is back of Schlemm’s canal). C. Endoscopic view of ciliary processes with ECP laser-treated white processes visible. D. Gonioscopic view of TrabEx performing goniotomy. Source (all): Robert Noecker, MD A C B D
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