Dr. Callahan is knowledgeable, dedicated, and explains clearly. She answered all my questions with patience. Her staff is pleasant, helpful, and always kind when I called with concerns.
Debbie Baker
Minimally Invasive Glaucoma Surgery (MIGS)
Understanding MIGS
MIGS stands for minimally invasive glaucoma surgery, a category of procedures designed to lower eye pressure using very small incisions and specialized micro-instruments. These approaches represent a meaningful advance over older, more aggressive surgical methods, and they have become a well-established option for patients with mild to moderate glaucoma.
Every MIGS procedure targets the eye's drainage system in some way, either by opening blocked drainage channels, implanting a tiny device to improve outflow, or reducing the amount of fluid the eye produces. The goal in all cases is to lower intraocular pressure, which is the pressure inside the eye, to a level that protects the optic nerve from further damage.
Traditional glaucoma surgeries such as trabeculectomy require larger incisions, more extensive tissue changes, and longer recovery times. MIGS procedures involve much smaller incisions, cause less tissue disruption, and carry a lower risk of serious complications. For patients with mild to moderate glaucoma, MIGS is often a preferred first surgical step before considering more invasive options.
One of the most practical advantages of MIGS is that many procedures can be performed at the same time as cataract surgery. This combined approach allows patients to address two conditions in a single operation, with one recovery period, which is especially convenient for older adults who have both cataracts and glaucoma.
MIGS fits into a broader spectrum of glaucoma care that includes medical management with eye drops, laser treatments such as Selective Laser Trabeculoplasty (SLT) and YAG Laser Peripheral Iridotomy (YAG PI), and surgical options ranging from MIGS to more complex procedures. For patients whose pressure is not adequately controlled with drops or laser treatment, MIGS often serves as an important next step. When glaucoma is more advanced or complex, our team refers patients to a specialist for higher-level surgical care.
Goniotomy: Our Primary MIGS Procedure
Our eye doctors perform goniotomy as our primary MIGS procedure, offering patients a precise, well-supported surgical option for lowering eye pressure. Goniotomy is one of the most established minimally invasive approaches for treating open-angle glaucoma and is frequently performed alongside cataract surgery.
Goniotomy is a procedure in which a small, specially designed blade or instrument is used to open the eye's natural drainage tissue, called the trabecular meshwork. Removing or incising this tissue allows aqueous humor to flow more freely out of the eye, which reduces pressure without the need for an implanted device.
One of the instruments used for goniotomy is the Kahook Dual Blade, a precisely engineered blade that makes clean, parallel incisions through the trabecular meshwork. This approach removes the obstructed tissue efficiently while minimizing the debris that could otherwise lead to scarring. It can be performed on its own or combined with cataract surgery.
Goniotomy works with the eye's own anatomy rather than introducing a foreign implant, which many patients and eye doctors appreciate. Clinical evidence supports its effectiveness at lowering eye pressure in patients with open-angle glaucoma, and it preserves future treatment options because it does not create the extensive tissue changes associated with traditional surgery.
Goniotomy is best suited for patients with mild to moderate primary open-angle glaucoma, particularly those whose eye pressure is not adequately controlled with medications or those who are undergoing cataract surgery and want to address both conditions simultaneously. A thorough evaluation of your optic nerve, visual field, and drainage anatomy helps our team determine whether goniotomy is the right choice for you.
Benefits and Risks of MIGS
Like any medical procedure, MIGS comes with both benefits and potential risks. Understanding both sides of the equation helps you make a confident, informed decision together with your eye doctor.
Many patients who undergo MIGS are able to reduce the number of glaucoma eye drops they need each day, and some eliminate them entirely. This is an important benefit because glaucoma medications can be costly, require a strict daily routine, and sometimes cause side effects such as redness, stinging, or systemic effects from absorption into the bloodstream.
Because MIGS uses tiny incisions and causes minimal tissue disruption, recovery is generally much faster than with traditional glaucoma surgeries. Most patients are able to return to their normal daily activities within a week, rather than the several weeks or months that more invasive procedures can require.
MIGS procedures carry a significantly lower risk of serious complications compared to traditional surgeries such as trabeculectomy. The smaller incisions reduce the chance of infection, excessive scarring, or sudden pressure changes. That said, no surgical procedure is entirely without risk, and your eye doctor will review your individual risk profile before recommending treatment.
Possible complications from MIGS can include temporary inflammation, a short-term spike in eye pressure shortly after surgery, or minor bleeding inside the eye. Rare but more serious risks include infection or incomplete pressure reduction. Our team will discuss these possibilities thoroughly during your consultation so you can make a fully informed decision.
Because MIGS procedures are less invasive and do not dramatically alter the eye's anatomy, they leave the door open for additional treatments in the future. If glaucoma progresses over time, options including further laser treatment, additional MIGS procedures, or traditional surgery remain available.
Who Is a Candidate for MIGS?
MIGS is not the right treatment for every glaucoma patient, but for many it offers a safe and effective way to better control eye pressure. Candidacy depends on the type and severity of glaucoma, overall eye health, and individual factors that our eye doctors will carefully assess.
Patients who tend to be good candidates for MIGS typically have mild to moderate primary open-angle glaucoma with pressure that is not adequately controlled on medications alone. Those who struggle with remembering to take eye drops, experience side effects from their medications, or are already planning cataract surgery are also often well-suited for a MIGS approach.
Before recommending MIGS, our team will perform a detailed eye examination that includes assessment of your optic nerve, visual field testing to map any vision loss, and a careful look at the anatomy of your eye's drainage structures. This evaluation guides the decision about which approach is most likely to benefit you.
MIGS is generally not recommended for patients with advanced or severe glaucoma damage, significant scarring from previous eye surgeries, or certain types of secondary glaucoma with complex anatomy. In these situations, more aggressive traditional surgical approaches are typically needed to achieve adequate pressure control, and our team will provide an appropriate referral when necessary.
MIGS is designed to lower eye pressure and reduce the need for medications, not to cure glaucoma. Glaucoma is a lifelong condition that requires ongoing monitoring even after a successful procedure. Open, honest communication with your eye care team about your goals and concerns is an essential part of achieving the best possible outcome.
What to Expect Before, During, and After MIGS
Knowing what the MIGS process involves from start to finish can help ease any anxiety and set you up for the smoothest possible recovery. Most patients find the experience more comfortable and manageable than they expected going in.
In the days before your procedure, your eye doctor will give you specific instructions about which medications to continue or pause, whether to restrict food or drink, and what to arrange for the day of surgery. Because your vision will be temporarily blurred after the procedure, you will need a trusted adult to drive you home and stay with you for the remainder of the day.
MIGS is performed as an outpatient procedure, meaning you go home the same day. Local anesthesia is used to numb the eye completely, and mild sedation may be offered to help you stay relaxed and comfortable. The procedure itself is brief, typically taking between 15 and 45 minutes depending on whether it is combined with cataract surgery.
In the days immediately following surgery, you may notice mild discomfort, light sensitivity, or temporarily blurred vision. Prescribed antibiotic and anti-inflammatory eye drops will be part of your recovery routine to prevent infection and reduce swelling. Most patients return to everyday activities within a few days, though strenuous physical activity and swimming should be avoided until your eye doctor gives you the all-clear.
Following your aftercare instructions closely is one of the most important things you can do to support a smooth recovery and a good long-term outcome.
- Use all prescribed eye drops exactly as directed and on schedule
- Avoid rubbing, touching, or pressing on your eye
- Wear a protective eye shield at night if your eye doctor recommends it
- Avoid swimming, hot tubs, and strenuous exercise until cleared by your eye doctor
- Attend every scheduled follow-up appointment
- Contact your eye doctor immediately if you experience severe pain, sudden vision changes, or any signs of infection
These steps are straightforward, and our team will walk you through each one to make sure you feel fully prepared before you leave our office.
Even after a successful procedure, glaucoma requires lifelong attention. Regular follow-up visits allow our team to monitor your eye pressure, evaluate the health of your optic nerve, and make any necessary adjustments to your treatment plan. Consistent monitoring is the best way to ensure your vision stays protected for years to come.
Frequently Asked Questions
The following answers address some of the most common questions patients bring to us about MIGS. We encourage you to raise any additional concerns during your consultation so we can give you guidance specific to your situation.
No, MIGS and laser glaucoma treatments are different approaches. Laser procedures such as SLT use focused light energy to improve drainage without any incision, while MIGS involves a small surgical incision and a physical instrument or device. Both have a role in glaucoma management, and some patients benefit from laser treatment before moving on to MIGS if their pressure is still not well controlled.
MIGS is generally most appropriate for mild to moderate glaucoma. If your optic nerve has sustained significant damage, if your visual field loss is substantial, or if prior eye surgeries have created scarring, our eye doctors may determine that a more aggressive approach is necessary. A thorough examination and imaging of your optic nerve will help answer this question with confidence. When more complex surgical care is needed, we will refer you to an appropriate specialist.
That depends on how well your eye pressure responds to the procedure. Many patients are able to reduce or stop some of their drops, but others may still need at least one medication to keep their pressure at a safe level. MIGS is not guaranteed to eliminate medications entirely, and your eye doctor will monitor your pressure closely after surgery to determine what ongoing treatment, if any, is appropriate.
Yes. While MIGS is very commonly combined with cataract surgery because it is convenient to address both conditions at once, goniotomy and other MIGS procedures can also be performed as a standalone surgery in patients who do not have cataracts. Your eye doctor will weigh the potential benefits and any procedural considerations specific to your eye when making this recommendation.
If eye pressure remains too high after MIGS, additional steps can be taken. These might include restarting or adjusting glaucoma medications, repeating laser treatment, or proceeding to a more involved surgical procedure. Because MIGS preserves the eye's anatomy, future treatment options generally remain available. Our team will work closely with you to find the most effective path forward.
Most major insurance plans, including Medicare, cover MIGS when it is determined to be medically necessary. Coverage details vary depending on your specific plan and the procedure performed, so it is wise to verify your benefits in advance. Our team is happy to help guide you through that process.
Schedule Your Glaucoma Consultation at NewView Eye Center
If you have been diagnosed with glaucoma or have risk factors that concern you, our experienced eye doctors at NewView Eye Center are here to help you understand all of your treatment options and find the approach that is right for you. Serving patients across Northern Virginia, we combine advanced technology with personalized, compassionate care to give you the best possible chance of preserving your vision for the long term. Contact us today to schedule a comprehensive evaluation and take the next step toward protecting your sight.
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