Binkhorst Lecture: Right time for MIGS

Boston-Interventional glaucoma is the new horizon for patients. Microinvasive glaucoma surgery (MIGS)-a term coined by Iqbal Ike K. Ahmed, MD-will allow for early intervention in patients with glaucoma and be safe and more effective than the medications and laser procedures used for so long with less efficacy.

In his delivery of the Binkhorst Lecture during the ASCRS Opening General Session, Dr. Ahmed-assistant professor, University of Toronto and clinical assistant professor, University of Utah, Salt Lake City-described the work in progress with various glaucoma devices, whose designs are still evolving.

With the realization that phacoemulsification lowered IOP, the cataract procedure was combined with a trabecular micro-bypass device (iStent, Glaukos) to explore the duration of the effect of phacoemulsification compared with combined phacoemulsification and the stent. The results indicated that the device effectively lowered the number of medications that patients required after surgery.

MIGS research, Dr. Ahmed continued, is thinking outside the box and finding ingenious ways to access aqueous outflow. One of which is gonioscopic targeting of aqueous veins-which Dr. Ahmed referred to as “superhighways”-to determine where to place stents to re-establish aqueous outflow in damaged veins.

Numerous studies are ongoing in the United States and internationally of various stenting devices-such as the trabecular micro-bypass device, CyPass Microstent, Transcend Medical; and the Hydrus II, Ivantis-with more than 1,000 patients with glaucoma participating. Implantation of single and multiple devices at strategic locations are being investigated.

When considering the spectrum of treatments for glaucoma, MIGS falls between medications and lasers, and should prove to be safer and more efficacious than the previous go-to interventions, he noted.

“MIGS is the future of treatment for glaucoma,” Dr. Ahmed said. “This approach will allow early intervention and decrease glaucoma progression. This is the new horizon for patients.

“Interventional glaucoma is not just about IOP, it is about the patient and the quality of their lives,” he continued. “MIGS is an idea whose time has come. It makes sense. Nothing will stop this.”

For more articles in this issue of Ophthalmology Times’ Conference Brief, click here.