He ranked procedures for glaucoma according to the levels of IOP they can achieve, from highest to lowest: phacoemulsification, internal MIGS, the external (subconjunctival) MIGS and trabeculectomy.
A patient who tolerates medication and has ocular hypertension or mild-to moderate glaucoma and a target IOP above 15 mm Hg might benefit from glaucoma surgery if cataract surgery created the opportunity, he said.
Patients who have trouble adhering to medication and have an IOP above the target level despite medical treatment could be candidates for laser trabeculoplasty, internal MIGS or subconjunctival MIGS, said Dr. Ahmed.
Those with fast progression might be especially good candidates for subconjunctival MIGS, he said. If the target IOP is very low, patients might go directly to traditional filtering surgery.
Dr. Ahmed is a consultant to Glaukos among many other ophthalmic device and drug companies.