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Recent Advances in MIGS

Technology and ophthalmology go hand in hand. New advances are now occurring more frequently than ever before, allowing us to serve our patient bases more efficiently than ever before. 

Recent advances in MIGS devices have created a more viable and less-invasive option than traditional, penetrating glaucoma surgeries to assist in lowering intraocular pressure in glaucoma patients.

What are MIGS?

MIGS procedures work by using microscopic equipment and tiny incisions. While this reduces the incidence of complications, some degree of efficacy is also traded for increased safety. They are becoming popular options for the following reasons:

  1. Safety: Although there are no long-term studies available at this time, MIGS are considered safer than traditional trabeculectomy or tube shunt surgeries.   
  1. The shorter surgery time for patients: MIGS procedures are generally faster than trabeculectomy and tube shunt surgeries, and shortened surgical time can be significant for the safety of the patient. 

Understanding iStents

One commonly used example of a MIGS procedure is the iStent. iStents are a micro-bypass stent (single bypass system) placed into Schlemm's canal. They improve outflow by creating a patent bypass between the anterior chamber and Schlemm's canal. The inserter has a secure, rotatable grip and reacquisition capability to facilitate manipulation and micro-targeted placement into the canal.

iStents are made of a surgical grade non ferromagnetic titanium. They're heparin-coated to promote self-priming and facilitate outflow. Each iStent measures 1 mm x 0.33 mm and is available in two orientations, one for the right eye and one for the left.

Who is a candidate for iStent?

We recommend iStents to patients ready for cataract extraction who could benefit from a reduction in IOPL. In general, patients who are already on ocular hypotensive medications are good candidates. The iStent is inserted during the cataract surgery and does not affect post-operative care. 


We do not advise iStents for patients with angle-closure glaucoma, neovascular glaucoma, and patients with retrobulbar tumor, thyroid eye disease, and Sturge-Weber Syndrome. Patients with other conditions that may cause elevated episcleral venous pressure are also poor candidates for iStents.  


Dr. Cohen will evaluate each patient personally, ensuring that whatever is best for your patient is the procedure that gets done. You can have confidence that when you send your patients to Cohen Eye Institute, they will always have the latest technologies available at their disposal. Dr. Cohen's passion for new innovation is what motivates him to continuously improve.


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