Glaucoma can be treated with medications, laser or surgery.
The first line of treatment consists of either IOP-lowering drop medications or laser. However, many patients suffer from refractory high IOP or glaucoma progression despite maximum tolerated medical treatment. In these cases, surgery is the only option left to achieve satisfactory IOP control.
Traditionally, filtration surgery such as trabeculectomy and aqueous tube shunts are considered the gold standard for the surgical treatment of glaucoma. Although the long-term efficacy of such procedures is well studied, they are also associated with postoperative complications, some of which might be sight-threatening. These procedures are very invasive, with eye tissue dissected and sutured back. The procedures are also time consuming and the post-op periods hold major risks. Although these complications are relatively infrequent, they lead most surgeons to delay glaucoma surgery until all other, less invasive treatment options (medications and laser treatment) have been exhausted and the patient has definitive, worsening glaucoma.
More recently, growing evidence supports the use of minimally invasive glaucoma surgery (MIGS) to achieve the target IOP (at which glaucoma remains stable). These have been demonstrated to result in various degrees of IOP-lowering effect (depending on the specific type of procedure). MIGSs are becoming increasingly popular among glaucoma surgeons as a primary surgical procedure in patients requiring additional IOP control. All current MIGS are used ab-internally, requiring skilled subspecialized glaucoma surgeons. Furthermore, placement of these devices requires an operating room, meaning that the surgeon has to book the patient for a surgery in the operating room, which can be very costly for the health care system. The surgery also takes time and requires specialized training; that said, not all ophthalmologists have access to the devices.