COMMENTARY

Out With the Old, in With the New: The Best of AAO 2013

American Academy of Ophthalmology 2013

Roger F. Steinert, MD; Eric D. Donnenfeld, MD; Richard A. Lewis, MD

Disclosures

November 25, 2013

In This Article

Launching the MIGS Era

Dr. Lewis: The patient who needs glaucoma surgery has also been handicapped in the past by surgeries that essentially were 100 years old. We have been making a hole in an eye since the early 1900s. It is exciting in glaucoma that the microinvasive glaucoma surgery(MIGS) device -- the iStent® from Glaukos -- is approved. It's a wonderful, relatively safe procedure. It doesn't add a lot of time to the cataract surgery. At least in my own study, in which I looked at my first 50 patients, I was impressed by the pressure reduction, the reduction in medications, and the safety of this device.

This is launching the MIGS era, when we are going to have canal-based devices, suprachoroidal-based devices, and some that will be like a conventional trabeculectomy, but will be ab interno and avoid all the incisions and sutures. It is the dawn of a new era that's very exciting for us.

Dr. Donnenfeld: This expands glaucoma therapy beyond the glaucoma specialist, because for the first time, as a cataract surgeon, I feel comfortable with the safety and efficacy of these new procedures. We were a little bit concerned that the iStent would not have the efficacy that was necessary to make this a viable treatment. Now we are doing studies, and Rick referenced his own patients. We have looked at our patients. We have done some large studies, and some will be presented in the next few years that show that the pressure reduction is significantly beyond what was expected. We are getting great pressure reduction with minimal risk to the patient. The risk associated with a trabeculectomy vs the risk associated with the iStent is orders of magnitude less. This is the safest glaucoma surgery, other than lasers, that we will ever have.

Dr. Steinert: Definitely.

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