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Making the move to MIGS


When weighing the decision to adopt minimally invasive glaucoma surgery (MIGS) into their practice, several advantages may support surgeons’ rationale, according to Richard A. Lewis, MD.

Sacramento, CA-When weighing the decision to adopt minimally invasive glaucoma surgery (MIGS) into their practice, several advantages may support surgeons’ rationale, according to Richard A. Lewis, MD.

 “MIGS-defined as a minimally invasive procedure performed through an ab interno incision-is changing how we manage glaucoma,” said Dr. Lewis, a glaucoma specialist in private practice, Sacramento, CA. “We know that glaucoma is a spectrum of disease, and that one procedure will not be effective for each different type.

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“Thus, there is a need for different approaches to manage the range of conditions glaucoma represents, and MIGS is the first effort to be more specific,” he continued.

Explaining the advantages of MIGS, Dr. Lewis said it fits with an evolving truism for all glaucoma surgery in that it strives for greater safety. Compared with filtering and tube surgery, MIGS causes less tissue trauma, has fewer complications, and allows for earlier intervention while not precluding the opportunity for other types of glaucoma surgery.

Another major advantage of MIGS is that it focuses on the target tissue that is the root of the problem in Schlemm’s canal. In addition, it coincides with the concept that glaucoma is a surgical disease.

“The simplicity of treating glaucoma with surgery and the benefit of having a surgical cure as an alternative to a lifetime of medical treatment with its issues of compliance, cost, and side effects cannot be denied,” Dr. Lewis said. “If we had a surgical procedure that was safe and simple, I don’t believe anyone would opt not to use it.

NEXT: Beginning the process



“Up until the present, the safety element has been the missing factor in an acceptable surgical solution,” he added.

MIGS procedures also do not necessitate any major capital investment for the surgery center, and there is a favorable reimbursement attached to it, explained Dr. Lewis.

Beginning the process

Developing expertise with MIGS is also relatively easy, although that is not to say there is not a learning curve, Dr. Lewis cautioned.

In order to understand the procedure and develop skills, Dr. Lewis said surgeons need to read about it, take training courses, consult with experienced colleagues, and practice.

He recommended watching videos of their own procedures and those performed by other surgeons, learning from differences in technique, and their colleagues’ approaches for managing complications. In addition, he emphasized making education an ongoing process.

“Learning should not end once you have implemented MIGS into your practice,” Dr. Lewis said. “Surgeons need to continue to read, take skills transfer courses, and attend user group discussions.”

Surgeons should also recognize that success with MIGS is not a one-person effort, but requires the commitment and contributions of ancillary personnel.

“An important consideration when introducing a new technique, which is often ignored, is the need to involve your staff, especially your surgery techs and the surgery scheduler,” Dr. Lewis said.

NEXT: Conclusion


He also recommended having educational materials available for patients, including brochures and animation videos that explain the procedure.



Dr. Lewis is a consultant to several companies that market or are developing products for MIGS and for medical treatment of glaucoma.

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