Dr. Callahan is extremely patient, great at explaining things, and does not try to pressure you to take a particular course of action.
Gloria Federico
Combined Cataract Surgery and MIGS
Who Benefits from Combined Surgery
Combined cataract surgery and MIGS is not right for every patient, but it can be an excellent option when both conditions are present and the glaucoma is at the right stage. Several factors help determine whether this approach fits your situation.
If you have been diagnosed with both cataracts and glaucoma, you may be a strong candidate for combined surgery. Both conditions become more common as we age, and when a cataract is ready for removal, that is often the ideal moment to address glaucoma at the same time.
Candidacy depends on your specific glaucoma type, drainage angle anatomy, disease severity, prior eye surgeries, and target eye pressure. Certain conditions, such as active inflammation, angle-closure glaucoma, or very advanced disease requiring aggressive pressure reduction, may affect whether combined MIGS is the appropriate choice.
MIGS procedures provide modest to moderate pressure lowering, which is often well-matched to the needs of patients with early or moderate glaucoma. They are generally less appropriate when glaucoma is severe and requires a dramatic reduction in eye pressure.
- Early-stage glaucoma with minimal optic nerve damage
- Moderate glaucoma that is stable on one or more medications
- Patients with limited visual field loss whose target pressure matches MIGS capability
Many people find daily glaucoma drops inconvenient, irritating to the eye surface, or difficult to afford over the long term. If you use one or more glaucoma medications every day, combined surgery offers a real opportunity to reduce that burden.
While some patients can stop certain drops after surgery, others will still need medication. The goal is meaningful reduction in your overall treatment load, not necessarily complete elimination of drops.
Even when glaucoma is currently well controlled on drops, you may prefer to lower your reliance on medications over time. Combining MIGS with cataract surgery can be a practical way to achieve that, especially as managing a long-term medication routine becomes more complex with age.
Fewer drops can mean fewer side effects, lower out-of-pocket costs, and less risk of missed doses affecting your pressure control.
How We Evaluate Whether You Are a Candidate
A careful pre-surgical evaluation is essential before recommending combined surgery. We use several tests and a detailed review of your eye history to determine the safest and most effective plan for your specific needs.
We measure your intraocular pressure at each visit using a quick, painless test called tonometry. Tracking pressure over time shows us how well your current treatment is working and whether your pressure remains within a safe target range.
Pressure that stays above your target despite medications, or that fluctuates unpredictably, is a strong signal that adding a glaucoma intervention during your cataract surgery may improve your long-term outcome.
Visual field testing maps your peripheral, or side, vision and identifies any blind spots caused by glaucoma damage. During the test, you look into a machine and respond each time you see a flicker of light, and the computer analyzes your response pattern to determine the extent of any damage.
This information helps us stage your glaucoma and decide whether MIGS will provide sufficient pressure reduction or whether a more aggressive approach is needed.
We examine the optic nerve, the structure that carries vision signals from your eye to your brain, using a high-powered microscope and often with optical coherence tomography (OCT) imaging. OCT produces detailed, cross-sectional images that detect even subtle thinning of nerve tissue.
- Identification of nerve cupping or tissue loss consistent with glaucoma
- Baseline images used to track changes over time
- Assessment of overall nerve health to guide surgical planning
Not every cataract requires immediate surgery. We evaluate how much the clouding affects your daily activities, including driving, reading, and recognizing faces, before recommending removal.
When the cataract is ready for removal and you also have glaucoma that would benefit from treatment, that timing is ideal for combining both procedures. Aligning the timing of both conditions improves the value of a single operation.
We review your full list of glaucoma drops, how well your pressure is controlled, and any side effects you have experienced. If you are using multiple medications or struggling with adherence, MIGS becomes a more meaningful option.
We also consider your overall medical history, including conditions such as diabetes, autoimmune disorders, and blood thinner use, because these factors can affect healing and surgical risk. Any history of previous eye surgeries or injuries is equally important in our planning process.
What to Expect During and After Surgery
Knowing what happens on surgery day and during recovery helps you feel prepared and confident. Combined surgery follows a clear process, and our team guides you through every step.
You will receive specific instructions before surgery, including which medications to take or pause on the morning of your procedure and when to stop eating or drinking. Follow these instructions carefully, as they are designed for your safety.
Plan to have someone drive you home after surgery, since your vision will be blurry and you cannot operate a vehicle the same day. Comfortable, simple clothing works best, and you should leave jewelry and valuables at home.
You will lie on a reclining surgical bed while the area around your eye is cleaned and sterile drapes are placed. A specialized microscope gives us a precise, magnified view of the tiny structures inside your eye throughout the procedure.
We first remove the cloudy cataract and place the new artificial lens, then perform the MIGS step using the same incision or a nearby entry point. You remain awake during the procedure but are kept calm and comfortable with anesthesia.
Most patients receive numbing eye drops and a mild sedative through an intravenous line. You will not feel pain during surgery, though you may sense gentle pressure or hear quiet sounds from the instruments.
- Topical anesthetic drops to numb the eye surface
- Intravenous sedation to keep you relaxed and comfortable
- Injection-based anesthesia used in select cases based on individual need
Your vision will be blurry right after surgery, and you may notice halos around lights, mild redness, or a gritty sensation. These effects are normal and typically begin to improve within the first one to two days.
Rest with your head slightly elevated and wear the protective eye shield we provide, especially while sleeping, to protect the surgical site during this early healing phase.
We will prescribe antibiotic drops to prevent infection and anti-inflammatory drops to reduce swelling. Your glaucoma medications may be continued or adjusted depending on your pressure readings in the days following surgery.
- Use all prescribed drops on schedule, even if the eye feels comfortable
- Wait at least five minutes between different drop types
- Avoid heavy lifting, straining, or bending over for at least one week
- Stay out of swimming pools, hot tubs, and dusty environments until cleared by our team
Most patients return to light tasks such as reading or watching television within a day or two. Driving may resume once your vision is sufficient and we confirm it is safe, usually within a few days to a week.
Your first follow-up appointment is typically scheduled within one to two days after surgery. We check your vision, measure your eye pressure, and examine the surgical site to confirm proper healing.
Seek immediate care if you experience sudden vision loss, severe eye pain, increasing redness or discharge, marked light sensitivity, or nausea alongside eye discomfort. These symptoms are uncommon, but they require prompt evaluation to rule out complications.
Risks, Side Effects, and Realistic Expectations
Like all surgical procedures, combined cataract surgery and MIGS carries some risks. Understanding these possibilities helps you make a fully informed decision and know what to watch for during recovery.
Many patients experience mild, short-lived effects in the days following combined surgery. These are typically manageable and resolve as the eye heals.
- Temporarily blurred or fluctuating vision
- Hyphema, a small amount of blood in the front chamber of the eye
- Light sensitivity, glare, or halos around lights
- A gritty or mildly uncomfortable sensation
- Brief elevation or fluctuation in eye pressure
More serious complications are rare, but they can occur with any eye surgery. We monitor you closely after surgery to detect and address any concerns early.
- Infection inside the eye (endophthalmitis)
- Persistent inflammation or corneal swelling
- Prolonged or significant pressure elevation
- Device obstruction, malposition, or migration
- Scarring of the drainage angle
- Need for additional glaucoma surgery
MIGS procedures offer meaningful benefits, but they are not designed to replace all forms of glaucoma treatment in every patient. Pressure reduction is typically modest to moderate, not dramatic, and results vary by device, individual anatomy, and healing response.
Some patients will continue to need glaucoma medications after surgery, and some may require additional glaucoma procedures in the future if pressure rises or the disease progresses. Setting realistic expectations from the beginning helps you plan your long-term eye care with confidence.
Frequently Asked Questions
These answers address common decision points and practical concerns that go beyond what is covered in the sections above.
Adding MIGS does introduce a small number of additional risks compared to cataract surgery on its own, including a higher chance of temporary bleeding in the front of the eye and short-term pressure fluctuations. However, for patients who have both cataracts and glaucoma, the combined approach avoids the cumulative risk of two entirely separate procedures performed months apart. The overall safety profile remains favorable for most candidates. Your eye doctor will walk through the specific risks relevant to your eye anatomy and chosen MIGS technique before you make a decision.
Many patients can reduce the number of drops they use, but medication-free outcomes are not guaranteed. The amount of pressure lowering achieved depends on the specific MIGS procedure, your individual anatomy, and how your eye heals. If your pressure rises again after surgery, drops or additional treatment may be added back. The goal is to optimize your pressure control, whether that requires fewer medications or none at all.
Most MIGS procedures provide sustained pressure reduction for several years, with some patients maintaining good control for five years or longer. Over time, scarring or disease progression can gradually reduce the effect, which is one reason consistent follow-up visits are so important. If your pressure begins to rise later on, your eye doctor has additional options available, including laser treatment or further surgical intervention, to maintain safe pressure levels.
If your glaucoma is severe, with significant optic nerve damage or very high pressures that MIGS cannot adequately address, a more traditional glaucoma surgery such as trabeculectomy or a drainage tube shunt may be more appropriate. In those situations, we may recommend cataract surgery and a separate, more aggressive glaucoma procedure staged to match your needs. Every plan is individualized, and we will clearly explain why one approach fits your situation better than another.
If eye pressure remains above your target range after surgery, we have several paths forward. We can reintroduce or adjust glaucoma medications, consider a laser treatment to enhance drainage, or discuss a second procedure if necessary. Our priority is protecting your optic nerve from further damage, and we will continue to work with you until your pressure is in a safe range.
Yes. Depending on your situation, you might consider cataract surgery alone, which can produce a modest pressure reduction in some patients on its own. Selective laser trabeculoplasty (SLT) is another option that improves drainage without requiring an incision and is sometimes used before or after cataract surgery. Continuing or adjusting your current glaucoma medications is always a valid choice, and for more advanced disease, traditional filtering surgery may be the right recommendation. Some patients also prefer a staged approach, completing cataract surgery first and addressing glaucoma separately if needed. We will review all options that apply to your specific diagnosis before you make a decision.
Talk with Our Team About Your Options
At NewView Eye Center, our eye doctors are experienced in evaluating patients with both cataracts and glaucoma to determine whether combined surgery is the right path forward. We take the time to thoroughly review your eye health, explain your options clearly, and build a personalized care plan designed to protect your vision for the long term. Whether you are in the early stages of glaucoma or have been managing the condition for years, we are here to help patients throughout Northern Virginia find the most effective and convenient approach to their care. We look forward to meeting you and answering all of your questions in a thorough, unhurried consultation.
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