IGS 2026: Navigating MIGS and other modern glaucoma procedures

Andrew Tatham, MD, MBA, FRCOphth, FEBO, discussed the evolving role of minimally invasive glaucoma surgery (MIGS) in glaucoma management at the 2nd International Glaucoma Symposium, held on 31 January 2026 in Mainz, Germany.¹ His presentation covered how MIGS compares with traditional surgeries, patient selection, adoption barriers, and future developments, with an emphasis on clinical practicality and patient-centred outcomes. Tatham is consultant ophthalmologist at Princess Alexandra Eye Pavilion in Edinburgh, Scotland.

Tatham highlighted safety as MIGS’ principal advantage, stating they have “a much better safety profile compared to traditional surgery.” Although trabeculectomy remains highly effective, its risk profile has historically limited early intervention. MIGS allow earlier treatment with “fewer complications” and “a faster visual recovery,” and they can be combined with cataract surgery. He noted, however, that MIGS produce a more modest pressure-lowering effect and “are not really a competitor to the more traditional surgery,” serving instead as an additional option for earlier-stage disease.

Evaluating patient selection for MIGS

Regarding patient selection, Tatham emphasised the presence of visually significant cataract as the most important factor. MIGS can be added efficiently to standard phacoemulsification, offering greater independence from medications, slower visual field loss, and potential delay of more invasive surgery. Other considerations include glaucoma severity, target intraocular pressure, age, comorbidities, and anticoagulant use. He observed that the expanding range of devices means “there is a device for most patients.”

Tatham also discussed limitations in broader MIGS adoption. Many eligible patients with mild to moderate glaucoma undergoing cataract surgery do not receive MIGS. Barriers include the technical demands of intraoperative gonioscopy and uncertainty in device selection. Training and mentorship remain crucial, especially for surgeons trained before MIGS became widely available. He emphasised the need for clearer guidance on patient selection and cited a growing body of evidence—randomised trials, meta-analyses, Cochrane reviews, and guidelines from the American Glaucoma Society and European Glaucoma Society—that support MIGS’ important role.

Looking ahead, Tatham called glaucoma surgery “a really exciting field,” anticipating advances in imaging, drug delivery, artificial intelligence, and genomics. He highlighted aqueous angiography, which may allow visualisation of outflow pathways and more precise device targeting, similar to coronary angiography. He concluded that MIGS’ most important benefit is on patient quality of life, by reducing medication burden, improving adherence, and potentially lowering the need for more invasive interventions.

Reference

1. Tatham W. Micro-invasive glaucoma surgery (MIGS) and other modern glaucoma procedures. Presented at: 2nd International Glaucoma Symposium; 31 January 2026; Mainz, Germany.