MIGS needs to be considered for glaucoma patients undergoing cataract surgery
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Key takeaways:
- MIGS with cataract surgery is effective, safe and cost-effective.
- Considering MIGS for each patient with glaucoma undergoing cataract surgery should be the standard of care.
Considering minimally invasive glaucoma surgery alongside cataract surgery should be the standard of care for cataract surgeons, according to a presenter at the American Glaucoma Society meeting.
“The point is not that we necessarily should offer MIGS for every patient with glaucoma undergoing cataract surgery, but it really should be considered in the context of the patient’s individual situation,” Ian Conner, MD, PhD, said.
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According to Conner, the primary goals when performing MIGS with cataract surgery are to better control IOP and reduce medication burden.
Previous studies found angle-based implant MIGS procedures are safe and effective, with no significant difference in complications between phacoemulsification alone and phaco with device implantation.
Importantly, Conner said that MIGS is cost-effective. For example, in a study, patients with cataracts who underwent phacoemulsification and MIGS showed a “very high quality of life year compared to the cost” compared with those who underwent phacoemulsification alone or received medications alone.
Common barriers that cataract surgeons face in adopting MIGS regularly into practice include discomfort with surgical gonioscopy, reimbursement concerns and added procedure time.
“What we find is that in experienced hands, any of these procedures typically take 5 minutes or less,” he said.
When selecting which MIGS procedure is right for each patient, surgeons should assess the patient’s demographics, the type and severity of glaucoma, cataract and anticoagulant statuses, and the need to minimize medications for each patient.
“Offering MIGS with cataract surgery is not yet the standard of care, but it probably should be,” Conner said.
References:
- Ahmed IIK, et al. Ophthalmology. 2020;doi:10.1016/j.ophtha.2019.04.034.
- Ahmed IIK, et al. Ophthalmology. 2022;doi:10.1016/j.ophtha.2022.02.021.
- Gedde SJ, et al. Ophthalmology. 2021;doi:10.1016/j.ophtha.2020.10.022.
- Rowson AC, et al. J Clin Med. 2022;doi:10.3390/jcm11226833.
- Sood S, et al. Ophthalmol Glaucoma. 2021;doi:10.1016/j.ogla.2021.09.006.
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Conner I. Is it “standard of care” to offer MIGS with cataract surgery? Presented at: American Glaucoma Society meeting; March 2-5, 2022; Austin, Texas.
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