MIGS update

It is with great pleasure that I am writing this editorial for the June issue of EuroTimes, which has a special focus on Glaucoma. Glaucoma is the second most common cause of blindness worldwide and as ophthalmologists we are constantly searching for new procedures to tackle the condition. In our cover story, we focus specifically on MIGS and we examine how the popularity of minimally invasive glaucoma surgery has risen dramatically over the past few years. As with all procedures, we need to exercise caution with this procedure. As compared with trabeculectomy, the reasons for the success of MIGS are the low variability of the surgical protocols, the more comfortable postoperative period, the quick recovery of vision, the supposed lower incidence of complications. We should also note that the reported complications may be the same as those of trabeculectomy when a sudden drop in IOP takes place. On the other hand, MIGS appears to lower IOP at a lesser extent and for a shorter time than trabeculectomy. It is much too early to draw conclusions and precise indications; however, MIGS might change glaucoma surgery from a single and sometimes dramatic procedure into multiple yet safer procedures titrating intraocular pressure. It must also be pointed out that MIGS is an expensive procedure and may not be available to all surgeons. In my own country, Italy, MIGS is rarely reimbursed in public hospitals but this situation may change in future years. If the reimbursement situation can be changed, I believe MIGS will be the standard of care. The short surgical times in the procedure will also allow more surgeries, thus facing the increase in the demand for glaucoma care due to the increased life span of an increasingly older European population. In this issue of EuroTimes, you can also look at other developments in the treatment of glaucoma. Dr Soosan Jacob has written an excellent article on the different MIGS techniques and also the devices that are currently available for surgeons who choose to practice MIGS. We also have a very interesting commentary from Dr David Garway-Heath, who notes that the next 40 years are likely to see advances in the diagnosis of glaucoma using technologies that are now in their infancy. I am sure you will enjoy reading this month’s magazine and urge you, your families, colleagues and friends to stay safe.