At NewView Eye Center, serving patients throughout Northern Virginia, we offer minimally invasive glaucoma surgery, known as MIGS, as part of a comprehensive approach to managing glaucoma.
MIGS procedures use microscopic tools and tiny incisions to improve how fluid drains from the eye, lowering eye pressure with less risk and faster recovery than traditional glaucoma surgery. For many patients, MIGS offers a meaningful way to protect their vision and reduce the burden of daily eye drop medications.
Certain factors increase the likelihood of developing glaucoma. Knowing your risk can help you and your eye doctor decide how closely to monitor your eye health over time.
Because glaucoma so often develops without early warning signs, routine comprehensive eye exams are the most reliable way to detect it before serious damage occurs.
Glaucoma is a group of eye diseases that damage the optic nerve, which connects the eye to the brain and is essential for vision. It is one of the leading causes of permanent blindness worldwide, and it often causes no noticeable symptoms in its early stages, making regular eye exams critically important for catching it in time.
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Most forms develop when fluid inside the eye, called aqueous humor, does not drain properly. As fluid builds up, pressure rises, compressing and damaging the optic nerve and causing irreversible vision loss that typically begins with peripheral, or side, vision.
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By far the most common form. The eye's drainage channels gradually become less efficient, pressure slowly rises, and vision loss progresses so quietly that most people have no idea anything is wrong until significant damage has occurred.
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This less common form occurs when the drainage angle between the iris and the cornea becomes suddenly blocked. Pressure can spike within hours, causing eye pain, headache, nausea, blurred vision, and halos around lights — a medical emergency.
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Some cases develop as a result of other conditions or circumstances, including eye injuries, prolonged use of steroid medications, diabetes, or previous eye surgery. Identifying and addressing the underlying cause helps guide treatment.
Our eye doctors perform goniotomy as our primary MIGS procedure, one of the most established minimally invasive approaches for treating open-angle glaucoma. A small, specially designed blade or instrument opens the eye's natural drainage tissue, called the trabecular meshwork, so aqueous humor can flow more freely out of the eye and pressure comes down without an implanted device.
One of the instruments used for goniotomy is the Kahook Dual Blade, which makes clean, parallel incisions through the trabecular meshwork and removes the obstructed tissue efficiently while minimizing the debris that could otherwise lead to scarring. Because goniotomy works with the eye's own anatomy rather than introducing a foreign implant, it preserves future treatment options and can be performed on its own or combined with cataract surgery.
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.
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.
Following your aftercare instructions closely matters: 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, attend every scheduled follow-up appointment, and contact your eye doctor immediately if you experience severe pain, sudden vision changes, or any signs of infection.
Your eye doctor will give you specific instructions about which medications to continue or pause and whether to restrict food or drink. Because your vision will be temporarily blurred afterward, arrange for a trusted adult to drive you home and stay with you for the rest of the day.
MIGS is performed as an outpatient procedure, so you go home the same day. Local anesthesia numbs the eye completely and mild sedation may be offered. The procedure is brief, typically taking between 15 and 45 minutes depending on whether it is combined with cataract surgery.
Mild discomfort, light sensitivity, or temporarily blurred vision are common in the first days. Prescribed antibiotic and anti-inflammatory drops prevent infection and reduce swelling, and most patients return to everyday activities within a few days.
Even after a successful procedure, glaucoma requires lifelong attention. Regular follow-up visits let our team monitor your eye pressure, evaluate the health of your optic nerve, and make any necessary adjustments to your treatment plan.
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. Expand each item to learn more.
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, 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.
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. Good candidates typically have mild to moderate primary open-angle glaucoma with pressure that is not adequately controlled on medications alone, struggle with remembering or tolerating their eye drops, or are already planning cataract surgery.
Before recommending MIGS, our team performs 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 drainage structures. MIGS is generally not recommended for advanced or severe glaucoma damage, significant scarring from previous eye surgeries, or certain types of secondary glaucoma — and our team will provide an appropriate referral when a more aggressive approach is needed.
It is also worth setting expectations early: MIGS is designed to lower eye pressure and reduce the need for medications, not to cure glaucoma, which remains a lifelong condition requiring ongoing monitoring.
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.
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