Proficiency, flexibility help match patients with appropriate MIGS device
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WAIKOLOA, Hawaii — With several good MIGS options, the choice often comes down to matching the procedure with the patient, according to a presentation at Hawaiian Eye 2022.
John Berdahl, MD, said devices such as the Hydrus microstent (Ivantis/Alcon) and the iStent (Glaukos) have shown efficacy in reducing IOP and medications in patients with glaucoma.
“So, how do you choose?” Berdahl said. “I always ask myself the question, ‘What would I want if it was my eye?’”
One thing that helps, Berdahl said, is the quality of data provided by recent studies such as HORIZON, which includes outcomes of up to 5 years. In the study, researchers randomly assigned 556 eyes to receive the Hydrus microstent or no additional treatment after phacoemulsification.
After 5 years, 66% of patients who received the microstent required no medications compared with 46% of patients who underwent cataract surgery alone. Patients in the microstent group also had a greater reduction in medication-free IOP.
When starting MIGS procedures, Berdahl said surgeons need to consider a few factors. First is determining which patients are candidates.
“It’s currently indicated for mild to moderate glaucoma,” he said. “We’re not restricted by what we’re able to do by the label, but we are restricted on what we may get paid for.”
Second is being proficient but flexible when it comes to choosing a device.
“There isn’t an algorithm,” Berdahl said. “My advice to you, if you’re getting into the MIGS space, is to choose the one that resonates with you and get really good at it. Once you have visualization down, broaden out into other procedures, so you can do your best job at matching the procedure to the patient, not trying to force the patient into the procedure that you’re good at.”
In a disease that includes both medical and surgical treatments, Berdahl said MIGS plays an important role in glaucoma.
“We want to balance efficacy and safety,” he said. “MIGS has filled a huge gap.”
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Berdahl J. MIGS devices. Presented at: Hawaiian Eye 2022; Jan. 15-21, 2022; Waikoloa, Hawaii.
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