Ophthalmologists should incorporate MIGS sooner than later
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Minimally invasive glaucoma surgery is an important technique for ophthalmologists to learn and should be implemented into their practices sooner rather than later, according to a speaker at Real World Ophthalmology.
“Don’t wait for the perfect surgery to jump on the MIGS train,” Nina A. Goyal, MD, FACS, said. “MIGS have built upon their predecessor procedures, and it’s important to learn procedures along the way for the foundational knowledge.”
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According to Goyal, the first step is to learn gonioscopy because obtaining and maintaining an adequate view is key. Also, practice intraoperative gonioscopy during routine phaco cases to become more comfortable with the different maneuvers and to avoid corneal folds.
“If you perform cataract surgery and you see any glaucoma patients, you really need to be competent at offering MIGS to your patients,” she said. “In this day and age, if you can reduce their drops burden by even one or two drops, it is worth it, and it can be a lifestyle improvement for them.”
Goyal said it is important to have a goal IOP and know the various methods of lowering pressure. This includes considering techniques such as goniotomy, stents, bleb needling and viscocanalostomy.
She encouraged ophthalmologists to seek out opportunities to train with mentors, to learn when to stop anticoagulants, and to be willing to adapt to new techniques and face the challenges that may come with them.
“There are new technologies coming up all the time, and that pipeline is really long,” Goyal said. “Be a willing adopter and a willing adapter. But get on the MIGS train because it’s here to stay. The more you get under your belt, the more adept you will be at learning new techniques.”
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Goyal NA, et al. Top 10 things I wish I knew about MIGS (sooner!). Presented at: Real World Ophthalmology; Nov. 5, 2022 (virtual meeting).
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