MIGS moves earlier in practice

Glaucoma surgery is moving earlier in the disease course, with minimally invasive glaucoma surgery increasingly paired with cataract operations instead of being held for last. (ophthalmologytimes.com) (europe.ophthalmologytimes.com) Glaucoma damages the optic nerve when pressure inside the eye stays too high, and the main treatment target is lowering that pressure, called intraocular pressure. Traditional operations such as trabeculectomy can lower pressure strongly, but they create a drainage bleb and carry more tissue disruption and complication risk. (aao.org) (europe.ophthalmologytimes.com) Minimally invasive glaucoma surgery, or MIGS, uses smaller internal approaches to improve the eye’s natural fluid outflow or reduce fluid production. Ophthalmology Times reported that surgeons now use those procedures earlier because they generally offer a better safety profile and faster visual recovery than older filtering surgery. (ophthalmologytimes.com 1) (ophthalmologytimes.com 2) That earlier-use argument has been building for years. In a Glaucoma 360 lecture covered by Ophthalmology Times, Ike Ahmed, MD, said the arrival of MIGS opened the door to “interventional glaucoma,” a more proactive strategy that combines earlier procedures, lower pressure targets, and less reliance on daily drops. (ophthalmologytimes.com) Recent meeting coverage shows the idea becoming routine practice rather than a niche pitch. At IGS 2026, Gus Gazzard, MD, said MIGS can be added efficiently to standard phacoemulsification cataract surgery and may give patients greater independence from medications while delaying more invasive surgery. (europe.ophthalmologytimes.com) The planning is changing too. Inder Paul Singh, MD, told Ophthalmology Times that surgeons should decide the non-refractive goal before a cataract list starts: whether the case is meant to hit a target pressure, reduce drop burden, or stabilize disease. (ophthalmologytimes.com) That matters because cataract surgery is no longer treated as a separate lane from glaucoma care. Singh said “cataract is just an excuse to take care of the glaucoma now,” describing a shift in which the cataract operation becomes the moment to add a pressure-lowering procedure. (ophthalmologytimes.com) The evidence base is still mixed by device and by patient selection. An American Academy of Ophthalmology review of trabecular MIGS combined with cataract surgery found these procedures reduce intraocular pressure compared with cataract surgery alone, while also comparing different safety profiles and patient factors that may favor one option over another. (aaojournal.org) Surgeons also say MIGS is not a replacement for every advanced case. Ophthalmology Times’ 2026 coverage noted that trabeculectomy remains highly effective when very low pressure is needed, even as MIGS expands options for mild-to-moderate disease and earlier intervention. (ophthalmologytimes.com) The result is a different treatment ladder: fewer years of waiting on drops alone, more combined cataract-and-glaucoma procedures, and a narrower role for older surgery as first choice. (ophthalmologytimes.com) (europe.ophthalmologytimes.com)