G360 2024: Combined MIGS for better IOP efficacy?

Shan C. Lin, MD, sat down with Ophthalmology Times to discuss his Glaucoma 360 presentation on combined minimally invasive glaucoma surgery and its impact on achieving improved intraocular pressure (IOP) efficacy. He shares some of the highlights here with Group Editorial Director Sheryl Stevenson.

Video Transcript

Editor's note: This transcript has been edited for clarity.

Sheryl Stevenson: We are joined today by Dr. Shan Lin, who is among the faculty at this year's Glaucoma 360 conference. So excited to learn more about your presentation this year. Can you tell us about 'Combined MIGS: Better IOP Efficacy?'

Shan C. Lin, MD: Hi, Sheryl. I'm excited to be able to talk about the question for many of us who do glaucoma surgeries together with cataract surgeries or even by themselves, whether doing more than one MIGS [minimally invasive glaucoma surgery] is more effective. Basically, they're just putting in one MIGS. And so now there's been studies that are starting to come out that are combining more than one MIGS together with cataract surgery. And basically, the answer is yes, actually doing more than one MIGS is more effective at lowering the intraocular pressure and having a higher success rate...in meeting the criteria of 20% eye-pressure lowering or greater.

Early examples were whether to put more than one iStent. And with the original iStent as well as with the subsequent iStent versions, putting in more than one... that is, two is better than one in terms of lowering intraocular pressure. And in fact, there's some studies to show that three is better than two and of course then two is better than one.

And there are now studies that compare and look at whether doing just a single MIGS versus doing an additional MIGS is more beneficial. For example, doing a Hydrus stent, which is in some ways similar to an iStent — it is a trabecular stent to help outflow. And doing that in combination with canaloplasty actually increases the efficacy. You have a lower intraocular pressure by doing both procedures as opposed to just the Hydrus.

So basically, the message for the audience is if you're able to and if you have the skills and the patient is somebody who is appropriate for that, then perhaps doing two MIGS at the time of cataract surgery will help that glaucoma patient even more.

Stevenson: Anything else to add regarding some further research?

Lin: Yeah, and so I know that future studies are going to look at this. Many centers are already looking at this in terms of doing small clinical trials to see if mixing different MIGS is going to be more helpful so we'll have larger studies in the future to answer the question a little bit more definitively, but the several preliminary studies indicate that adding additional MIGS is going to increase the efficacy of the procedures.