What is Minimally Invasive Glaucoma Surgery (MIGS)?
Minimally Invasive Glaucoma Surgery, also called MIGS, refers to a range of implants, devices and techniques that all aim to reduce the pressure in the eye with less surgical risk than the more established procedures (for example trabeculectomy). MIGS can help to optimise glaucoma control and / or reduce the number of glaucoma drops a patient takes to treat their glaucoma. NICE published guidance in support of MIGS in 2017.
The below features distinguish MIGS from traditional glaucoma surgery:
- Minimally invasive (most MIGS leaves the conjunctiva intact)
- High safety profile and rapid recovery
- Frequently combined with cataract extraction (less risk as there’s no need for a separate admission, anaesthetic and intra-ocular surgery)
- Provides more modest intraocular pressure lowering than trabeculectomy
What is iStent?
iStent implantation is a minimally invasive glaucoma surgery (MIGS) that increases drainage from the eye to lower eye pressure. The iStent device, which is 0.36mm in length and width, can slow down damage to visual fields in the long term, and can also allow patients to reduce the number of drops they take for glaucoma. Taking just a few minutes, the procedure is most often performed at the end of cataract surgery. This offers glaucoma patients an important additional opportunity to protect against glaucoma damage at the same time as having cataract surgery.
Who can benefit from iStent?
iStent implantation is approved to treat moderate to advanced open-angle glaucoma in people who are already using medication to reduce high pressure in the eye.
The procedure may not be suitable for everyone with glaucoma. Professor Muhtaseb will always discuss his patients’ specific needs and recommend the best course of action during consultations.
Professor Muhtaseb offers the procedure at the following hospitals in South Wales:
- Cardiff Bay (Nuffield)
- Sancta Maria Hospital, Swansea
- St Joseph’s Hospital, Newport
Cataract and MIGS Glaucoma Surgery FAQs
The procedure may not be suitable for everyone with glaucoma. It is suitable for use in those patients who have a type of glaucoma called open angle glaucoma. Professor Muhtaseb will always discuss his patients’ specific needs and recommend the best course of action during consultations.
To find out more, call our office.
Many of the minimally invasive glaucoma surgeries (MIGS) can be combined with cataract surgery. Your ophthalmologist may recommend a MIGS at the time of cataract surgery to either lower eye pressure or to reduce medication burden.
Yes, it is. In fact, it is often very important to treat your cataract if you also have glaucoma. If you have glaucoma and develop a cataract, not only will you experience reduced quality of vision but it may become difficult for the glaucoma specialist to monitor and treat your glaucoma effectively. This is because the cataract can hinder the view of the optic nerve inside your eye, making it more difficult to take OCT images of the optic nerve and visual field tests less reliable. All of these are important aspects of glaucoma management.
By treating both the cataract and glaucoma concurrently, MIGS minimises the need for multiple surgeries, and utilises the opportunity presented by cataract surgery to help optimise glaucoma control.
Both cataracts and glaucoma are more likely to occur as we get older. Many people over 60 may have both.
Here is a breakdown of symptoms:
Cataract:
- Blurred or foggy vision
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Difficulty seeing the writing on television or the action in a sporting fixture
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Difficulty reading, or needing brighter lights to read
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Shadowing or ghosting of the vision
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Glare or dazzle from lights, such as when driving at night
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Difficulty recognising people’s faces
- Open angle glaucoma does not cause symptoms until advanced loss of visual field has occurred. This is often called “tunnel vision”.
- It is not possible to reverse the loss of visual field from glaucoma, which is why early detection and treatment is so important.
- Treatment is aimed at lowering eye pressure and preventing visual field loss.
- Open angle glaucoma is picked up at routine testing with the optician and may be more likely to occur if you have certain risk factors.
- One of the strongest risk factors is a family history of glaucoma and opticians will carefully monitor for glaucoma if that is the case.
- Many opticians will offer all patients a scan of the optic nerve (Optic Disc OCT) and visual field testing to look for early signs of glaucoma that should be referred to a specialist for assessment and treatment.
Following the surgery some patients may be able to reduce or eliminate their use of glaucoma medications, while others may still require a level of medication to control their intraocular pressure. Generally it takes 1 to 3 months following surgery to assess the effects of MIGS and consider reducing the number of glaucoma medications.
Adding MIGS to cataract surgery has no effect on which lens you choose. Glaucoma patients can have cataract surgery with standard monofocal or more advanced increased range of focus lenses, as well as toric lenses. Multifocal lenses are not advised in the presence of glaucoma.
Professor Muhtaseb will explain all the options available to glaucoma patients during a consultation.
Download Professor Muhtaseb's cataract guide
Most people have cataract surgery without knowing about all the options they actually have surrounding cataract surgery. Unfortunately, most people only find this out after having cataract surgery. The information in this Wales Cataract Guide could save you frustration and worry. Simply click the button below to give us your email and we’ll send you this life changing guide:
Hear from our patients
With over 6300+ surgeries performed hear from just a few of my happy patients.
It’s been incredibly liberating to wake up in the morning and be able to see without reaching for my glasses.
I can go any anywhere and see anything near and far. I can see now as well as I could when I was 18 years of age which is incredible and I’m looking forward to clear vision for the rest of my life.
“No. 1 – My advice would be do it. No. 2 – See Mohammed if you can. I made the decision to not go down the NHS route because I wanted to see the best consultant – probably in the UK… It was absolutely worth it… because you can’t really put a price on your sight.”
“I don’t wear glasses at all now. I don’t need them. I was impressed by his professionalism, his calmness. He explained everything clearly and in layman’s language… I would say to anyone considering treatment: just do it. Don’t be afraid of it. It’s painless and it works.”
“I can’t speak highly enough of (Prof Muhtaseb). Nothing was too much trouble, you could phone anytime, day or night. I wish I had done it when I first started wearing reading glasses and just gone to Prof Muhtaseb then and got it done. I would do it all over again, but do it much faster.”
“I would definitely recommend the professor. I think his approach is perfect! If you have any anxieties at all – just check with someone who’s had the procedure done. I had no pain at all. I expected a little bit of discomfort – but no pain, that was good. It’s life-enhancing and that’s not something you can put clearly enough. I didn’t realise how green the trees were! It’s lovely!”
Enjoy a life free from cataracts, glasses and contact lenses in three easy steps
Talk to us
Request your consultation online or call us on 02922 550 201 and we’ll guide you towards an initial assessment.
Meet your consultant
I’ll see you before treatment to ensure you’re a good candidate and treat you at one of my facilities in South Wales or Bristol.
Revitalise your eyes
I’ll supervise your aftercare as you begin to experience a life free of cataracts and glasses and contact lenses.
Learn more about eye conditions and eye treatments
Terrified of Cataract Surgery? 10 Things Patients Are Scared Of.
“I’m not sure this is the right time to do this”
“I’d like to think about it”
Educate yourself further about MIGS by reading the links below
Glaucoma UK – Minimally invasive glaucoma surgery options available in the UK
This 6-page guide provides you with the benefits of the iStent procedure, as well as the risks and alternatives. Click here for more information.
We are proud to be a part of these professional bodies
Prof Mohammed Muhtaseb, FRCOphth
Consultant Cornea, Cataract and Refractive Surgeon
Based in South Wales, he is one of the very few ophthalmologists working in the UK who is a fellowship-trained specialist in Cornea, Cataract and Refractive Surgery. He holds full specialist registration with the General Medical Council and was appointed as a Consultant in the NHS in 2006.