Our Summary

This research paper discusses changes in surgery for glaucoma, an eye condition that can cause blindness. For over 40 years, the most common surgery for this condition has been trabeculectomy. However, a new type of surgery, called minimally invasive glaucoma surgery (MIGS), is becoming more popular. According to recent findings, more and more patients with mild to moderate glaucoma are undergoing MIGS instead of trabeculectomy. The use of implants to help drain fluid from the eye has also become more common, especially for severe glaucoma cases. The cost and availability of these implants are also affecting how often trabeculectomy is performed. The paper concludes that while trabeculectomy is still the most common surgery for glaucoma, the use of MIGS is rapidly increasing.

FAQs

  1. What is the most common surgery for glaucoma and how has it changed recently?
  2. What is minimally invasive glaucoma surgery (MIGS) and how is it being used in the treatment of glaucoma?
  3. What is the role of implants in glaucoma surgery and how are they affecting the frequency of trabeculectomy?

Doctor’s Tip

A doctor might tell a patient undergoing glaucoma surgery to follow their post-operative care instructions closely, including using any prescribed eye drops and attending follow-up appointments. It is important to monitor for any changes in vision or symptoms and report them to your doctor immediately. It is also important to avoid activities that could increase pressure in the eye, such as heavy lifting or straining. By following these instructions, patients can help ensure the best possible outcome from their glaucoma surgery.

Suitable For

Patients with mild to moderate glaucoma are typically recommended for minimally invasive glaucoma surgery (MIGS). This type of surgery is less invasive than traditional trabeculectomy and is often preferred for patients who are not responding well to medication or who are looking for a less invasive treatment option. MIGS is also recommended for patients who may not be good candidates for trabeculectomy due to other health conditions or who are looking for a quicker recovery time.

On the other hand, patients with severe glaucoma may be recommended for trabeculectomy or implant surgery. Trabeculectomy is still considered the gold standard for treating severe glaucoma and is often recommended for patients who have not responded well to other treatments or who have advanced glaucoma that requires more aggressive treatment. Implant surgery, such as the use of drainage implants, may also be recommended for patients with severe glaucoma who have not responded well to other treatments or who need more invasive treatment options.

Overall, the type of glaucoma surgery recommended for a patient will depend on the severity of their condition, their response to other treatments, and their overall health. It is important for patients to discuss their options with their ophthalmologist to determine the best course of treatment for their individual needs.

Timeline

Before glaucoma surgery:

  1. Patient is diagnosed with glaucoma through a comprehensive eye exam.
  2. Patient undergoes various treatments, such as eye drops, to manage intraocular pressure.
  3. If medications are not effective, the doctor may recommend surgery.
  4. Patient discusses surgical options with their ophthalmologist and decides on the best approach for their condition.
  5. Pre-operative tests are conducted to assess the patient’s eye health and overall fitness for surgery.

After glaucoma surgery:

  1. Patient undergoes the surgical procedure, either trabeculectomy or MIGS, to improve fluid drainage and reduce intraocular pressure.
  2. Patient may experience some discomfort, redness, and swelling in the eye immediately after surgery.
  3. Patient is prescribed medication to prevent infection and manage pain.
  4. Patient is advised to avoid strenuous activities and heavy lifting during the initial recovery period.
  5. Patient attends follow-up appointments with their ophthalmologist to monitor healing and assess the success of the surgery.
  6. Patient may need to continue using eye drops or other medications to maintain healthy intraocular pressure.
  7. Over time, the patient’s vision and eye health are monitored regularly to prevent further damage from glaucoma.

What to Ask Your Doctor

  1. What type of glaucoma surgery do you recommend for my specific case and why?

  2. What are the potential risks and complications associated with the recommended surgery?

  3. What is the success rate of the recommended surgery in terms of lowering intraocular pressure and preserving vision?

  4. What is the recovery process like after the surgery and how long does it typically take to see results?

  5. Will I need to take any medications or undergo additional treatments after the surgery?

  6. How often will I need to follow up with you after the surgery for monitoring and adjustments?

  7. Are there any lifestyle changes or precautions I should take after the surgery to protect my eyes and promote healing?

  8. What are the alternatives to surgery for treating my glaucoma and why do you recommend surgery in my case?

  9. How much experience do you have performing the recommended surgery and what is your success rate with previous patients?

  10. What is the cost of the surgery and will my insurance cover it?

Reference

Authors: Loon SC, Ang BCH, White A. Journal: Curr Opin Ophthalmol. 2025 Mar 1;36(2):146-151. doi: 10.1097/ICU.0000000000001108. Epub 2024 Nov 13. PMID: 39774269