The rise in popularity of MIGS was highlighted in a recent study of surgical trends in glaucoma, which found that while specialists continue to perform the bulk of the traditional procedures—tube shunts and trabeculectomies—a large portion of MIGS procedures are performed by non-specialists.

The retrospective, observational study analyzed the use of laser and incisional surgeries and whether they were conducted by glaucoma specialists or non-specialists.

The researchers found that the number of patients undergoing any glaucoma procedure increased by 10.6% during the study period. The number of traditional incisional surgeries increased by 11.7%, and MIGS procedures increased by almost 4.5-fold, from 13,705 in 2012 (the first year MIGS codes were available), to nearly 60,000 in 2016. Each of these increases was statistically significant.

The researchers also noted that during the study period, specialists performed more than 75% of all the trabeculectomy and drainage implant procedures. Non-specialists performed between 22% and 63% of MIGS procedures (Table 1).

The researchers concluded that a large shift in practice took place between 2008 and 2016, from traditional incisional surgery to MIGS. “These results highlight the importance of training residents in performing MIGS procedures and managing these patients perioperatively,” they wrote in their paper. The researchers also suggested further studies be undertaken to analyze what this shift in care might mean for costs and outcomes.

Table 1. Percentage of MIGS Procedures Performed by Non-Specialists

Procedure % Performed by Non-Specialists
Endocyclophotocoagulation 22.0%
iStent (Glaukos) insertions 25.2%
 Goniotomy 56.9%
 Canaloplasty 62.8%

Rathi S, Andrews CA, Greenfield DS, et al. Trends in glaucoma surgeries performed by glaucoma subspecialists vs. nonsubspecialists on Medicare beneficiaries from 2008 through 2016. Ophthalmology. 2021;128(1);30-8.