Cornea and External Disease

The Synergy of MIGS and Cornea Specialists: Advancing Glaucoma Treatment and Improving Quality of Life

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Over the past 10 years, minimally invasive glaucoma surgery (MIGS) has emerged as an effective and innovative treatment option for patients with glaucoma. Its integration with cataract surgery has made it an attractive choice for ophthalmologists, including cornea specialists, who seek to enhance patient outcomes.

Himani Goyal, MD, a cornea specialist at NYU Langone Medical Center, NYU Grossman School of Medicine, said MIGS presents a unique opportunity to address multiple aspects of glaucoma treatment simultaneously. By effectively lowering intraocular pressure (IOP), MIGS may reduce the need for medications, alleviate ocular surface disease, and improve the patient’s quality of life.

The Benefits of MIGS
Corneal disorders can significantly impact a patient’s quality of life, causing discomfort, blurred vision, sensitivity to light, and pain. As cornea specialists focus on improving patients’ visual comfort, incorporating MIGS may offer an opportunity to address glaucoma effectively while also considering the cornea’s well-being.

Cornea specialists have a vested interest in maintaining healthy corneas for their patients. One of the major challenges faced by patients with glaucoma is that the long-term use of IOP-lowering topical medications can adversely impact the ocular surface, leading to corneal disorders and vision problems. These drugs can lead to dry eyes, allergic conjunctivitis, dermatitis, and limbal stem cell loss, causing discomfort, reduced vision, and quality of life. MIGS provides a new approach to glaucoma treatment, which may help preserve corneal health and improve overall visual comfort and outcomes.

“MIGS is effective. It gives our patients a better quality of life in terms of having the freedom to not have to remember to take a medication and not have to deal with the side effects of those medications,” said Dr Goyal, adding, “Decreasing the use of chronic topical preserved eye drops is truly one of the best treatments for the cornea.”

Dr Goyal emphasized that the direct benefit for the cornea surface when patients can come off of preserved eye drops is significant.

“I don’t think that we realize how great MIGS is for the cornea until you give these patients 3 to 6 months off of their drops. Their surface needs that much time to recover, and the patients look and feel so much better” she said.

Integrating MIGS into Practice
MIGS allows cornea specialists to expand their scope of practice and offer glaucoma care. This integration of treatments can provide a more holistic approach to eye care and increase patient satisfaction.

“MIGS is not the only option for glaucoma treatment, but I am making the argument that it may be the best option. Minimally invasive glaucoma surgery, along with selective laser trabeculoplasty, and other procedure-based treatments for glaucoma may offer better consistent IOP control and quality of life as first-line treatments for glaucoma over topical medications by sparing our patients of the burden of hourly dosing and the side effects of ocular surface disease.”

Adopting MIGS may present a learning curve for cornea specialists unfamiliar with the procedure. However, the techniques involved are relatively straightforward and can be learned through training opportunities at conferences and hands-on experience with our surgical representatives. With practice, cornea specialists can master MIGS procedures.

“I think there is definitely a learning curve to incorporating MIGS, but that should be expected,” said Dr Goyal. “Learning MIGS is within the skillset of cornea specialists. It just comes down to familiarizing yourself with a different part of the eye versus cornea surgery or cataract surgery.”

One of the unique advantages of MIGS is its integration with cataract surgery. The procedure can be seamlessly combined with cataract extraction, making it an efficient and convenient option for both patients and surgeons.

“The idea is that you’re not invading any other space. Since you’re already in that space, there is no increased risk of infection. MIGS are straightforward angle surgeries, not involving the manipulation of conjunctiva,” said Dr Goyal.

Incorporating MIGS into the practice of cornea specialists can have a transformative impact on patients’ lives. By offering an effective alternative to traditional IOP-lowering medications and combining it with cataract surgery, we can provide comprehensive eye care and improved patient outcomes. The potential to treat glaucoma, reduce medications, and improve corneal health all at once makes MIGS an invaluable addition to the armamentarium of cornea specialists, ultimately contributing to the betterment of patients’ vision and overall quality of life.