Minimally invasive glaucoma surgery (MIGS) is an umbrella term encompassing multiple types of glaucoma treatments that utilize microscopic incisions and devices. Glaucoma is primarily a disease of high intraocular pressure. Therefore, the goal of each of these treatments is to lower internal eye pressure, and in turn, avoid or lessen any damage to the optical nerve.
Fortunately, minimally invasive glaucoma surgeries can be done at most stages of glaucoma. They have consistently shown fewer post-surgery complications and are widely considered to be safer overall than traditional glaucoma surgery.
At Solomon Eye Physicians and Surgeons, we provide a variety of these procedures to our Greenbelt and Bowie, MD area patients, depending on their type and stage of glaucoma. Read on to learn a little more and then contact us to schedule a comprehensive glaucoma evaluation to find out if you are a candidate for MIGS.
Best Candidates for MIGS
The most suitable candidates for MIGS are those patients who have mild to moderate glaucoma and have not been able to achieve glaucoma relief through prescription eye drops or medications. Patients should also be over the age of 18.
There are many types of glaucoma, each of which may range from mild to severe. Therefore, every glaucoma patient should receive individualized care and tailored treatment plans. If you are interested in undergoing MIGS, the board-certified ophthalmologists at Solomon Eye Physicians and Surgeons will first need to perform a thorough exam and evaluation to determine if MIGS will be best for you.
MIGS Treatment Options
For those patients who are good candidates for MIGS, Solomon Eye Physicians and Surgeons is proud to offer several options. Each of our MIGS procedures utilizes the most advanced technology and can be performed as standalone treatments or in combination with cataracts surgery. They are all typically performed as outpatient treatments with either local or general anesthetic so there is little to no discomfort.
iStent – At less than 0.5 mm, the iStent is the smallest medical implant device in use and was approved for glaucoma treatment by the FDA in 2012. When the iStent is implanted, it is able to create a tiny channel that allows more built-up fluid to drain away from the eye.
The iStent implantation is extremely quick and simple and is done in a matter of moments. The iStent device is so tiny that it is implanted via a 2 mm incision. Your ophthalmologist will insert the device carefully into the trabecular meshwork, ensure that it is firmly in place, and then place special drops in your eye. The incision is self-healing, and your intraocular pressure will start to decrease within weeks.
Canaloplasty – The canaloplasty is a very common and effective procedure to lower intraocular pressure in patients with open-angle glaucoma. The focus of a canaloplasty is to internally widen the Schlemm’s Canal, which is part of the natural drainage system in your eye. This canal surrounds the iris and sits between the trabecular meshwork and the sclera. Depending on the method chosen by your surgeon, the canal can be accessed either through a small scleral incision or through a surgical flap, similar to the flap made for LASIK, but a little deeper. The timing of a canaloplasty varies by patient and by surgeon but can last from about 45 minutes to two hours.
OMNI™ Glaucoma System – The OMNI Glaucoma System is a state-of-the-art surgical device that can be used to perform two separate MIGS procedures – a canaloplasty and a goniotomy – either during the same session or as standalone options. The revolutionary design of the OMNI device allows access to the Schlemm’s Canal and trabecular meshwork (TM) through a single, very small incision in the sclera (the white of the eye). A specialized, microscopic catheter is introduced into this canal, where it releases a safe, sterile gel all the way around. The catheter and the gel both work to enlarge the inside of the canal so that fluid can move through more easily.
Goniotomy – The goniotomy has traditionally been used to treat congenital and juvenile glaucoma but is now commonly performed to treat open-angle glaucoma and ocular hypertension in adults. To improve the flow of intraocular fluid and lower internal eye pressure, a goniotomy involves the excision of a tiny strip of the trabecular meshwork and the creation of a pin-prick hole in the wall of the Schlemm’s Canal.
Kahook Dual Blade Goniotomy – The Kahook Dual Blade has an innovative, 4-tools-in-1 design that streamlines the goniotomy procedure. First, your surgeon will create a tiny scleral incision. The Kahook Dual Blade is inserted through this incision, and its specialized tip enters the trabecular meshwork (TM), creating the opening for its gradually widening “ramp,” which gently enlarges this opening. At the appropriate depth, the tip pierces the Schlemm’s canal, and a safety feature, called a “foot plate,” rests against the outside wall of the Schlemm’s canal to protect against further perforation. The dual blades create precisely aligned incisions in the TM, and the surgeon then gently turns the device so that the blades excise a precise strip of the tissue. The KDB goniotomy is an outpatient procedure that only takes about 10 –15 minutes.
"Every staff member had a welcoming smile and treated myself and others with the utmost respect! One of the nicer eye doctors I've been to. Even had some nice art around the lounge!!"- J.W. / Yelp / Nov 20, 2019
"I went to their office in Greenbelt and they treat you with respect and very professional way."- B.T. / Facebook / Oct 31, 2019
"ICL surgery went extremely well. I initially went to Lasik but my eyes were too weak (-12.5 eye presecription with astigmatism), a little older than some at 49 and my corneas too thin. They recommended me to Dr. Solomon, and I am very grateful that they did. From my initial exam to post surgery Dr. Solomon and his staff have been exceptional. I had some eye prescription stability issues with the initial visit, so I had to where my glasses for a week, once my prescription stabilized, I had the surgery and then had issues with eye pressure. After a few eye visits and some additional eye drops I could not be more pleased with the results being able to see everything so clearly without any contacts or reading glasses."- R.T. / Google / Oct 26, 2019
"ICL surgery went extremely well. I did have some eye pressure issues after surgery but the office gave me medicine to relieve the pressure and follow up appointments all free of charge. I couldn't be more pleased with the results. My eye prescription was -12.5 with astigmatism, now I see 20/20 without any type of lenses. Not bad for a 49 year old. I highly recommend Dr Solomon and his staff for your eye care."- R.T. / Google / Sep 29, 2019
"Would recommend to everyone. My wife and I have been patients of Steve Solomon and then Johnathan Solomon for years. We both have had cataract surgery which has been wonderful and life changing. Office staff super helpful. Jasmine G is a real asset. If we could give them ten stars we would!!!"- J.D. / Google / May 14, 2019
What to Expect with MIGS
MIGS procedures are generally done on an outpatient basis and are usually completed relatively quickly, with some lasting only about 10 minutes and others just an hour or two. Your eyes will be fully numbed before the procedure, and if necessary, you may be given a general anesthetic. Once your eyes are numb, we will gently place a special device that keeps you from blinking or moving your eyes. After this point, each MIGS procedure is slightly different. After the procedure, most patients have very little to no discomfort, which should only last a day or two. Depending on the specific MIGS performed, your pupils may be dilated or constricted with special eye drops, and your vision will be temporarily blurred from the procedure. Therefore, you will need to have someone drive you home to recover.
MIGS is minimally invasive, so each procedure has relatively little downtime afterward. Most patients are able to return to work or other daily activities within 2 – 5 days. When your procedure is complete, we will discuss your aftercare instructions with you to ensure you fully understand how to care for your eyes as they heal. Solomon Eye Physicians and Surgeons requires all MIGS patients to return for a series of follow-up appointments. This is because it is very important that we closely monitor your eye pressure through the healing period.
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Fight Back Against Glaucoma
Minimally invasive glaucoma surgery (MIGS) represents a wonderful trend of advancement in glaucoma treatment. As recently as ten years ago, traditional glaucoma surgery was the only option for late-stage glaucoma patients. Now, we are able to safely and effectively reduce glaucoma symptoms and vision loss with much less discomfort and downtime. Contact Solomon Eye Physicians and Surgeons today to find out if MIGS can work for you.