DECEMBER 2020 | EYEWORLD | 121
G
Contact
Huang:
lindayhuangmd@gmail.com
Patrianakos:
tpatrianakos@yahoo.com
Zhang: amydz.@med.umich.edu
burden. In addition to potentially lowering the
amount of drops needed, Dr. Zhang said the vi-
sual outcomes of phaco combined with a MIGS
procedure are better than phaco combined with
trabeculectomy. What's more, cataract surgery
causes inflammation and can cause a trabe-
culectomy to fail when done in combination.
"When you do MIGS with cataract sur-
gery, it tends to have a better outcome visual
outcome than phaco plus trabeculectomy," Dr.
Zhang said.
5. Intraoperative gonioscopy
Learning intraoperative gonioscopy is essential
for most MIGS procedures.
"It's important if you're going to do any of
this that you're comfortable with intraoperative
gonioscopy," Dr. Patrianakos said.
Dr. Zhang advised ophthalmologists to start
practicing visualization of the angle through in-
traoperative gonioscopy on all of their standard
cataract surgeries.
6. Financial hesitations
Equipment concerns could be a barrier to some
physicians bringing certain MIGS options into
their practice. Some MIGS are only single-use,
single-packs, Dr. Zhang said, while others re-
quire a unit to be purchased for multiple uses.
Some MIGS are also less likely to be
covered by insurance compared to traditional
glaucoma surgery, according to Dr. Huang.
Dr. Zhang said she doesn't think patient
perception is too much of a barrier to MIGS. In
her practice, if she recommends a MIGS proce-
dure, patients are usually on board. She said she
sets honest expectations for them, explaining
that they might not take the patient completely
off medications but could reduce the medication
Glaucoma pipeline update
Dr. Huang gave a quick update on what's in
the pipeline for glaucoma that she's looking
forward to. PRESERFLO (Santen, formerly
the InnFocus Microshunt), an ab externo
subconjunctival MIGS similar to the XEN Gel
Stent (Allergan), is anticipated. The iStent
infinite (Glaukos), which Dr. Huang said will
have three stents in a standalone procedure
for severe and refractory glaucoma, is also
expected. Additionally, there are some drug-
eluting implantable devices that may benefit
glaucoma patients in the future, she said.
Relevant disclosures
Huang: Sight Sciences
Patrianakos: None
Zhang: None
Dr. Huang operates with the Omni Surgical System (Sight Sciences).
Source: Linda Huang, MD
