EyeWorld India March 2021 Issue

EWAP MAR C H 2021 51 GLAUCOMA D epending on what you define as a microinvasive glaucoma surgery (MIGS), you might think it first became available several decades ago with endocyclophotocoagulation (ECP), but many define the MIGS era beginning with the iStent (Glaukos), the first ab interno trabecular microbypass device approved by the FDA in 2012. Since then there has been a steady stream of new devices and procedures classified as MIGS that have entered the market, and some are still in development. Though nearly a decade has passed since the more formal MIGS era began, are there still hurdles facing the IOP-lowering procedures? According to three glaucoma specialists EyeWorld spoke with, the short answer is yes. 1. Comparing it to trabeculectomy Amy Zhang, MD, said one major hurdle is that MIGS are often still compared to trabeculectomy. “Some say MIGS would be a replacement for trabeculectomy. I don’t think that should be the approach one takes with MIGS. I think by Liz Hillman Editorial Co-Director Hurdles facing MIGS Contact information Huang: lindayhuangmd@gmail.com Patrianakos: tpatrianakos@yahoo.com Zhang: amydz.@med.umich.edu This article originally appeared in the December 2020 issue of EyeWorld . It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. it should be thought of as a bridge to possibly better IOP control,” she said. “I don’t think the gold standard in terms of trabeculectomy pressure lowering can be replaced by one MIGS device. That’s one of the biggest challenges, understanding where MIGS would fit in.” 2. Surgeon adoption Thomas Patrianakos, DO, thinks the biggest hurdle facing MIGS is still surgeon comfort. “Just like with any new procedure that’s out there, there’s a learning curve, and there will be complications that occur,” he said, explaining that the perception of getting over that learning curve and handling complications is still needed for MIGS acceptance by surgeons. He also advised surgeons to not be put off by early complications. “Reach out to colleagues doing the procedures, and you’ll be surprised that they probably had that same complications happen,” he said. 3. Approved for specific indications Linda Huang, MD, addressed the hurdle of many MIGS being approved by the FDA for only certain types or severities of glaucoma and/or in combination with cataract surgery. “This may limit the use of certain types of procedures even though patients may still benefit from them. For example, iStent or Hydrus [Ivantis] is not approved in patients who are pseudophakic, even if the device may be effective in lowering the patient’s pressure,” Dr. Huang said. Operating with the Omni Surgical System (Sight Sciences). Source: Linda Huang, MD