Ophthalmology Times: MIGS replacing trabs
- Ophthalmology Times Europe highlighted a long-running shift in glaucoma surgery: surgeons are doing more minimally invasive glaucoma surgeries, or MIGS, while trabeculectomy volumes keep falling in U.S. and European practice. - In U.S. Medicare data cited in the coverage, trabeculectomies fell from about 50,000 a year in 1994 to under 20,000 by 2012, while tube shunts rose above 12,000 annually. - The shift tracks a broader move toward safer, earlier interventions, even as trabeculectomy still delivers the lowest eye pressure for advanced disease (europe.ophthalmologytimes.com).
Glaucoma surgery is moving away from trabeculectomy, the old standard, toward minimally invasive glaucoma surgery in patients who do not need the very lowest eye pressure. (europe.ophthalmologytimes.com) (eyewiki.org) Glaucoma damages the optic nerve when pressure inside the eye stays too high. Treatment starts with drops or laser, and surgery is used when those steps do not lower pressure enough. (eyewiki.org) (thelancet.com) Trabeculectomy works by creating a new drainage route and a fluid reservoir, called a bleb, under the eye’s surface. It can lower pressure more than other operations, but it also brings risks including wound leaks, infection, low pressure, and longer recovery. (europe.ophthalmologytimes.com) (eyewiki.org) Minimally invasive glaucoma surgery takes a different approach. These procedures usually work through the eye’s existing drainage pathways or reduce fluid production, with less tissue disruption and fewer bleb-related problems. (europe.ophthalmologytimes.com) (cms.gov) The Ophthalmology Times Europe piece traces the shift back before MIGS arrived. Cleveland Clinic glaucoma surgeon Ang Li said Medicare data showed trabeculectomy falling from about 50,000 cases a year in 1994 to below 20,000 by 2012. (europe.ophthalmologytimes.com) Over that same period, tube shunts such as the Baerveldt implant and Ahmed valve gained ground because surgeons saw them as more controlled and safer, even if they did not always lower pressure as much as trabeculectomy. (europe.ophthalmologytimes.com) Then came the next turn. MIGS entered practice after the Food and Drug Administration approved the iStent in 2012, and later U.S. data showed these newer procedures taking a growing share of glaucoma operations. (ophthalmologyglaucoma.org) (reviewofoptometry.com) One IRIS Registry analysis covered 232,537 glaucoma procedures from 2013 through 2018 and found MIGS use rising, especially in open-angle and normal-tension glaucoma. Standard surgery remained more common in angle-closure and secondary glaucoma. (advances.massgeneral.org) A separate Medicare analysis found total glaucoma surgeries climbed 176.66% from 80,151 in 2011 to 221,602 in 2021, while trabeculectomies fell 58.5% from 32,145 to 13,345. (iovs.arvojournals.org) (ophthalmologytimes.com) The shift is not absolute. The American Academy of Ophthalmology’s 2025 Europe overview said MIGS has entered the mainstream, but trabeculectomy still stays essential for advanced glaucoma and for patients who need very low target pressure. (aao.org) That leaves surgeons with a more layered playbook than they had a decade ago: drops and laser first, MIGS earlier for many mild-to-moderate cases, and trabeculectomy or tube implants when the pressure goal is lower and the disease is more severe. (eyewiki.org) (aao.org)
