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Glaucoma Physician

Article

What Holds Back MIGS

From the Editor: The reluctance of some surgeons to adopt MIGS may stem from cognitive biases that overemphasize short-term risks like hyphema over long-term benefits.

Nathan M. Radcliffe, MD
Glaucoma Physician November 1, 2025 Page(s): 1

Clinical Scorecard: What Holds Back MIGS

At a Glance

CategoryDetail
ConditionGlaucoma
Key MechanismsMinimally Invasive Glaucoma Surgery (MIGS) techniques aim to reduce intraocular pressure (IOP) with a favorable safety profile.
Target PopulationPatients with glaucoma requiring surgical intervention.
Care SettingOphthalmology clinics and surgical centers.

Key Highlights

  • MIGS offers significant IOP reduction with excellent safety.
  • Hyphema is a common adverse event impacting patient vision early post-surgery.
  • Cognitive biases may hinder surgeon adoption of MIGS despite long-term benefits.
  • Interventional lasers and drug delivery methods may reduce hyphema risk.
  • Surgeons can benefit from reframing risks associated with surgical interventions.

Guideline-Based Recommendations

Diagnosis

  • Assess intraocular pressure and visual field loss to diagnose glaucoma.

Management

  • Consider MIGS for patients needing surgical intervention for glaucoma.

Monitoring & Follow-up

  • Regular follow-up to evaluate IOP and visual function post-MIGS.

Risks

  • Be aware of hyphema as a potential complication of MIGS.

Patient & Prescribing Data

Patients with glaucoma considering surgical options.

MIGS procedures may be underutilized due to perceived short-term risks.

Clinical Best Practices

  • Educate patients on the risks and benefits of MIGS.
  • Utilize shared decision-making models to address patient concerns.
  • Encourage surgeons to recognize cognitive biases affecting surgical decisions.

References