The management of glaucoma is continuously evaluated throughout the life of a glaucoma patient. Treatments are adjusted based on the progression of the disease. Effective management can significantly delay the time from one method of management to another.
Drops or SLT
MIGS
Trabeculectomy
Tubes
In most cases, glaucoma can be controlled with drops or laser. For some people though, the eye pressure cannot be effectively controlled, and surgical intervention is required. The traditional glaucoma surgeries (trabeculectomy and glaucoma drainage devices) are usually very effective, but they carry risks of blurred or even loss of vision, due to infection or a haemorrhage in the eye, low pressure and failure. As a result, even until today, some ophthalmologists delay glaucoma surgery, by using maximum medical treatments which can cause a number of topical and systemic side effects. This also results in worsening of their glaucoma. However, over the past few years, there is a plethora of novel surgical procedures and devices, claiming that they can reduce the eye pressure safely with minimal risk. The term MIGS is used to include all these surgical innovative techniques.
Why iStent
In my opinion, a MIGS procedure should satisfy the following criteria:
- Must be a good alternative to current surgical options
- Carry very low risk
- Minimal additional equipment required
- Sparing conjunctiva for future trabeculectomy or tube surgery
- Be cost effective
The device that fulfills all the above conditions is the istent, which is usually combined with cataract surgery.
The iStent is one of the smallest medical devices that is implanted on the human body. It is a tiny one millimetre long titanium tube which safely lowers eye pressure by creating a permanent bypass in the trabecular meshwork. National Institute of Clinical Excellence have approved it. The implantation adds about 15 minutes to a cataract surgery and is performed under local anaesthesia. I will arrange to see you frequently after surgery to ensure the effectiveness of the treatment.
What is PreserFlo
PresFlo is a new MIGS device that is effective in lowering eye pressure. Like iStent, it is usually performed with cataract surgery. However, PreserFlo is a thin tube that allows the passage of aqeuous from inside the eye to under the conjunctiva.
Why iStent
In my opinion, a MIGS procedure should satisfy the following criteria:
- Must be a good alternative to current surgical options
- Carry very low risk
- Minimal additional equipment required
- Sparing conjunctiva for future trabeculectomy or tube surgery
- Be cost effective
The device that fulfills all the above conditions is the istent, which is usually combined with cataract surgery.
The iStent is the smallest medical devices that is implanted on the human body. It is a tiny one millimetre long titanium tube which safely lowers eye pressure by creating a permanent bypass in the trabecular meshwork. National Institute of Clinical Excellence have approved it. The implantation adds about 15 minutes to a cataract surgery and is performed under local anaesthesia. I will arrange to see you frequently after surgery to ensure the effectiveness of the treatment.
What is PreserFlo
PresFlo is a new MIGS device that is effective in lowering eye pressure. Like iStent, it is usually performed with cataract surgery. However, PreserFlo is a thin tube that allows the passage of aqeuous from inside the eye to under the conjunctiva.
Experience & Expertise
I was one of the first glaucoma surgeons that started using it in the West Midlands more than 5 years ago and my personal data shows reduction of eye pressure of around 25 % in mild to moderate glaucoma in 80% of patients. Many of my patients are very pleased as their number of drops was reduced by at least one, while others avoided advanced surgery such as trabeculectomy. The risk profile of the istent is excellent, as there are no additional complications compared to cataract surgery alone.
However, as this field is evolving rapidly, I m following the technological advances and study the data for all the other devices available. I m keen to embrace new devices, if they prove to be safe and effective. As part of the glaucoma expert community, I strive to innovate and identify which of these procedures will benefit my patients the most.
