Minimally Invasive
Glaucoma Surgery (MIGS)
MIGS represents a breakthrough in glaucoma treatment, offering safer, gentler surgical options that lower eye pressure with faster recovery and fewer risks than traditional glaucoma surgery. Our fellowship-trained glaucoma specialists use the latest MIGS techniques to protect your vision and reduce your dependence on daily eye drops.
Best For: Early Intervention & Reduced Drop Dependence
Traditional glaucoma surgeries like trabeculectomy and tube shunts are highly effective at lowering eye pressure but carry significant risks including hypotony, infection, and prolonged recovery. For many patients with mild-to-moderate glaucoma, these procedures are more aggressive than necessary. MIGS procedures bridge the gap between eye drops and traditional surgery by targeting the eye's natural drainage pathways with tiny devices or precise micro-incisions, delivering meaningful IOP reductions of 15–50% with safety profiles approaching cataract surgery alone.
The MIGS approach is especially compelling for patients who struggle with daily eye drop regimens, experience side effects from glaucoma medications, or whose disease is progressing despite medical therapy. Many MIGS procedures can be performed at the same time as cataract surgery, allowing patients to address both conditions in a single operation. The global shift toward earlier surgical intervention and away from lifelong topical therapy has made MIGS one of the fastest-growing areas in ophthalmology.
Who Is a Good Candidate for MIGS?
MIGS may be an excellent option if you have mild-to-moderate open-angle glaucoma and want to reduce your reliance on daily eye drops while protecting your vision long-term.
- Patients with open-angle glaucoma or ocular hypertension not adequately controlled with drops
- Those experiencing side effects or difficulty with daily glaucoma medication regimens
- Patients scheduled for cataract surgery who also have glaucoma (combined procedure)
- Patients whose glaucoma progression risk does not yet justify traditional filtering surgery
Meet Our Glaucoma Specialists
Fellowship-trained ophthalmologists dedicated to advanced glaucoma and cataract care
Types of MIGS Procedures We Offer
Advanced micro-surgical techniques that restore your eye's natural drainage to lower pressure safely
Trabecular Micro-Bypass Stents
Tiny micro-stents — the iStent inject in heparin-coated titanium and the Hydrus Microstent in flexible nitinol — are placed into the eye's natural drainage channel, Schlemm's canal, to improve aqueous outflow. The Hydrus Microstent spans approximately 90° of the canal, with clinical trials showing 77.3% of patients achieving significant IOP reduction at 2 years and 59% remaining medication-free at 5 years (HORIZON trial).
Canal-Based Procedures
Implant-free techniques like OMNI, ABiC (ab interno canaloplasty), KDB goniotomy, and GATT use specialized instruments to open or widen the eye's natural drainage channels. These procedures deliver comparable or greater IOP lowering without permanent implants. GATT achieves the greatest IOP reductions among canal-based MIGS, with 30–57% lowering documented in clinical studies.
XEN Gel Stent (Subconjunctival)
For more advanced glaucoma, the XEN 45 Gel Stent creates a new drainage pathway from inside the eye to beneath the conjunctiva, similar to a trabeculectomy but through a much smaller incision. The landmark GPS trial showed XEN was statistically noninferior to trabeculectomy with fewer postoperative interventions, less hypotony, and faster visual recovery.
What the Clinical Evidence Shows
MIGS has a robust and growing evidence base with multiple large randomized controlled trials demonstrating sustained safety and efficacy
Hydrus Microstent — HORIZON Trial
The largest MIGS randomized controlled trial (556 eyes, 38 centers) showed 77.3% of Hydrus patients achieved significant IOP reduction at 24 months versus 57.8% of controls. At 5 years, 59% of Hydrus patients remained medication-free, and the need for major glaucoma surgery was reduced by more than half compared to cataract surgery alone.
iStent inject — 7-Year Durability
The pivotal iStent inject trial (505 eyes, 41 sites) demonstrated 75.8% of treated eyes achieved 20% or greater IOP reduction at 24 months, with a high proportion of responders achieving medication-free status. Long-term data through 7 years confirmed sustained IOP reductions of 36–40%, with 100% of eyes maintaining same or lower IOP versus baseline and no filtering surgeries required.
XEN Gel Stent — GPS Trial
The Gold-Standard Pathway Study compared XEN to trabeculectomy in a prospective multicenter RCT. XEN was statistically noninferior, with 62.1% meeting the primary endpoint. XEN offered important practical advantages: fewer postoperative interventions (34.7% vs. 63.6%), less hypotony (23.2% vs. 50.0%), and faster visual recovery, while maintaining IOP reductions of approximately 37% at 12 months.
Clinical data from peer-reviewed randomized controlled trials, FDA filings, and published long-term follow-up studies. Individual results may vary. Discuss expected outcomes with your glaucoma specialist during your consultation.
What to Expect with MIGS
Understanding your recovery, pressure results, and long-term outlook
Rapid Recovery & Minimal Downtime
One of the greatest advantages of MIGS is the gentle recovery. Most patients experience minimal discomfort and can return to normal activities within a few days. Because MIGS procedures use tiny incisions and work within the eye's existing anatomy, there is far less tissue disruption compared to traditional glaucoma surgery. Many patients notice improved comfort quickly, especially those who were experiencing side effects from multiple eye drops.
IOP Reduction & Medication Reduction
MIGS procedures typically reduce eye pressure by 15–50%, depending on the specific technique used and the severity of your glaucoma. Many patients are able to significantly reduce or completely eliminate their glaucoma eye drops. For example, clinical trials show that 59–78% of patients who receive trabecular micro-bypass stents combined with cataract surgery become medication-free, depending on the device used.
Your glaucoma specialist will set personalized IOP targets based on your disease severity and progression risk. Regular follow-up visits are essential to monitor your pressure and ensure long-term stability.
Long-Term Outcomes & Durability
Long-term data now extends to 7–10 years for several MIGS devices, demonstrating sustained IOP and medication reductions over time. The Hydrus Microstent 5-year data showed a reduction by more than half in the need for subsequent major glaucoma surgery. The iStent has documented IOP reductions sustained through a full decade with no filtering surgeries required — the longest MIGS follow-up published.
While MIGS may not eliminate the need for all future glaucoma treatment, it can significantly delay or prevent the need for more invasive procedures and protect your vision for years to come.
MIGS Device Comparison
How the leading MIGS procedures compare in effectiveness and approach
| Procedure | Mechanism | IOP Reduction | Key Advantage |
|---|---|---|---|
| Hydrus Microstent | Trabecular bypass & canal scaffold | ~34% | Largest RCT evidence; 5-year data |
| iStent inject | Dual trabecular micro-bypass | ~29% | 7-year durability; high medication freedom |
| OMNI System | 360° viscodilation + trabeculotomy | ~34% | Dual-mechanism; no permanent implant |
| KDB Goniotomy | Excisional goniotomy | ~25% | Only canal-based procedure with RCT |
| GATT | 360° ab interno trabeculotomy | ~37% | Greatest IOP lowering; cost-effective |
| ABiC | 360° viscodilation of Schlemm's canal | ~36% | Cleanest safety record; 6-year data |
| XEN Gel Stent | Subconjunctival filtration | ~39% | Noninferior to trabeculectomy; safer profile |
Your MIGS Journey
From evaluation to recovery, here is what to expect every step of the way
Comprehensive Glaucoma Evaluation
Your journey begins with a thorough glaucoma evaluation at our office. Dr. Shakarov or Dr. Shields will measure your intraocular pressure, assess your optic nerve health, perform visual field testing, and review your current medication regimen. Together you will discuss your treatment goals and determine which MIGS procedure — or combination approach with cataract surgery — is the best fit for your condition.
Day of Surgery
MIGS procedures are typically performed in an outpatient surgical center, often combined with cataract surgery when appropriate. The MIGS portion of the procedure usually adds only a few minutes to the overall surgical time. You will receive numbing drops so you feel no pain, and many patients also receive mild sedation to help them relax. Your surgeon uses specialized microsurgical instruments and a gonioscopy lens to precisely access the eye's drainage system.
Recovery & Follow-Up
Most patients experience minimal discomfort and can return to light activities within a day or two. You will use prescription eye drops for several weeks to prevent infection and reduce inflammation. Your glaucoma specialist will monitor your eye pressure closely in the weeks following surgery and adjust your medication regimen as needed. Many patients are able to reduce or stop some of their glaucoma drops within the first few months after MIGS.
Cost and Insurance Considerations
Insurance Coverage for MIGS
Most MIGS procedures are covered by Medicare and major private insurance plans when performed in conjunction with cataract surgery for patients with documented glaucoma. Coverage for standalone MIGS procedures (without cataract surgery) may vary depending on the specific device and your insurance plan. Recent changes in Medicare reimbursement have affected coverage policies, so we verify your benefits before scheduling surgery.
Our team will work with your insurance provider to determine your specific coverage and any out-of-pocket costs before you proceed.
The Value of Early Intervention
Glaucoma is a progressive disease, and the damage it causes to your optic nerve is irreversible. By intervening earlier with MIGS rather than waiting for disease progression to justify more invasive surgery, many patients can preserve more of their vision long-term. When you also factor in the reduced cost of fewer daily medications, fewer office visits for medication adjustments, and the improved quality of life from not managing multiple eye drop schedules, MIGS can be a sound investment in your eye health.
Frequently Asked Questions
Common questions about minimally invasive glaucoma surgery answered by our glaucoma specialists
What is MIGS and how is it different from traditional glaucoma surgery?
Can MIGS be performed at the same time as cataract surgery?
Will MIGS eliminate my need for glaucoma eye drops?
How long does recovery take after MIGS?
Which MIGS procedure is right for me?
How long do the results of MIGS last?
What are the risks of MIGS?
Can MIGS be performed as a standalone procedure without cataract surgery?
Find Out If MIGS Is Right for You
Schedule a glaucoma evaluation with Dr. Shakarov or Dr. Shields to discuss your treatment options and explore whether minimally invasive glaucoma surgery can help protect your vision.
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