Optometrists who have cataract patients with mild-to-moderate glaucoma should make a point of discussing minimally invasive glaucoma surgery (MIGS) procedures for these reasons:

• Ocular health improvements/reduced medication need. In a study published in 2020, my colleagues and I found that patients who underwent implantation of one or two trabecular micro-bypass stents at the time of cataract surgery saw clear and objective improvements in their ocular surface health, along with significant reductions in IOP and the number of medications needed.¹
• Better vision-better life. New data shows improved vision-related quality of life following MIGS implantation.²
• Similar risk. Based on an FDA trial, “the overall safety profile of the MIGS group was favorable and similar to that in the control group throughout the 2-year follow-up.”³
• Receptive patients. I have found that when I educate patients about the aforementioned benefits of MIGS, they are grateful to hear about this option. It is a straightforward conversation: I remind them that, at my discretion as an eye care provider, it is very likely that by having the combined procedure, we will be able to reduce the number of drops that they are currently taking, decreasing their dependence on multiple daily drops. For the O.D,’s part, this has the potential to make for better patient compliance to medication overall.

I believe MIGS present a great opportunity for optometrists to be advocates for their patients’ ocular health and overall quality of life. OM

REFERENCES

1. Schweitzer JA, Hauser WH, Ibach M, et al. Micro-bypass stent(s) implantation (iStent or iStent inject) with phacoemulsification. Ophthalmol Ther. 2020;9(4):941-53. doi: 10.1007/s40123-020-00290-6.
2. Samuelson TW, Singh IP, Williamson BK, et al. Quality of Life in Primary Open-Angle Glaucoma and Cataract: An Analysis of VFQ-25 and OSDI From the iStent inject Pivotal Trial. Am J Ophthalmol. 2021 Mar 15;229:220-229. doi: 10.1016/j.ajo.2021.03.007.
3. Samuelson TW, Sarkisian Jr. SR, Lubeck DM, et al. Prospective, Randomized, Controlled Pivotal Trial of an Ab Interno Implanted Trabecular Micro-Bypass in Primary Open-Angle Glaucoma and Cataract: Two-Year Results. Ophthalmology. 2019;126(6):811-21. doi: 10.1016/j.ophtha.2019.03.006.