Glaucoma Treatment MIGS
Glaucoma is a progressive disease of the eye that if left untreated can eventually lead to blindness. MIGS stands for Minimally Invasive Glaucoma Surgery.
A major risk factor for glaucoma is increased eye pressure that occurs when fluid in the eye – used to transport important nutrients to the lens – accumulates and cannot drain naturally. Over time the trapped fluid builds up, causing pressure in the eye, which can damage the optic nerve and destroy vision. Glaucoma is believed to be a genetic disease and may not appear until later in life. Besides hereditary factors, glaucoma can also be caused by a severe eye infection, a blunt eye injury or trauma, inflammatory eye conditions, or blockage of the eye’s blood vessels.
A thorough consultation is required if there is any suspicion that you might have glaucoma. The examination involves measuring the intraocular pressure (IOP) as well as evaluation of the optic nerve, specifically the cup/disk ratio which provides an indication if there has been any damage.
Since glaucoma comes with few warning signs, regular eye exams are important for detecting glaucoma early enough to allow successful treatment. A routine glaucoma exam usually includes a test to measure eye pressure and an examination of the eye, primarily the optic nerve. A visual field test may also be conducted to determine if there is any glaucoma damage, such as vision loss or blind spots in the field of vision.
Since glaucoma comes with few warning signs, regular eye exams are important for detecting glaucoma early enough to allow successful treatment. A routine glaucoma exam usually includes a test to measure eye pressure and an examination of the eye, primarily the optic nerve.
A visual field test may also be conducted to determine if there is any glaucoma damage, such as vision loss or blind spots in the field of vision.
Drops are usually the first line of treatment for Glaucoma. If the intraocular pressure cannot be reduced to an appropriate level, further drops may be added.
Laser Treatment for Glaucoma
Some cases of glaucoma, e.g. narrow angle glaucoma can benefit from a YAG peripheral iridotomy. This is where the YAG laser is used to create a small opening in the iris to allow fluid to pass through from the back of the eye to the draining area (Trabecular meshwork) at the front.
Another laser treatment is Selective Laser Trabeculoplasty (SLT) which is used to try and promote outflow of fluid from the eye.
When medical and laser treatments fail then surgery may be required.
Surgical Treatment for Glaucoma
A filtering procedure to allow fluid to drain from the eye is called a Trabeculectomy. A small opening valve is created which allows fluid to drain from the eye to the outer mucous lining covering of the eye.
A variety of microincisional glaucoma devices have recently become available. These work through a variety of mechanisms and essentially make use of a device or shunt which is implanted into the eye allowing fluid to escape by an alternate route.
These procedures have the advantage of being minimally invasive with minimal complications.
The two common MIGS procedures at Centre for Sight are Hydrus and iStent. Click on the images for more information.
Authored by Sheraz Daya MD FACP FACS FRCS(Ed) FRCOphth, Consultant Ophthalmic Surgeon & Medical Director, June 2019.
Next review due June 2020.