Advertisement

PentaVision

Glaucoma Physician

Article

Why Do Half of Cataract Surgeons Avoid MIGS?

From the Editor: Despite patient acceptance and expanding options, surgeon hesitation remains a major barrier to broader MIGS adoption.

By: Nathan M. Radcliffe, MD
Glaucoma Physician March 1, 2026 Page(s): 1

Clinical Scorecard: Why Do Half of Cataract Surgeons Avoid MIGS?

At a Glance

CategoryDetail
ConditionGlaucoma in patients undergoing cataract surgery
Key MechanismsMinimally invasive glaucoma surgeries (MIGS) and emerging glaucoma treatments including laser trabeculoplasty, drug-delivery platforms, and automated trabeculotomy
Target PopulationGlaucoma patients undergoing cataract surgery
Care SettingOphthalmology surgical settings, specifically cataract surgery procedures

Key Highlights

  • Nearly half of glaucoma patients undergoing cataract surgery do not receive concomitant glaucoma treatment including MIGS.
  • Surgeon hesitation to adopt MIGS is influenced by discomfort with gonioscopy, preference to refer glaucoma care, and past complications.
  • Emerging treatments such as direct selective laser trabeculoplasty, intraocular lens drug-delivery systems, and automated femtosecond laser trabeculotomy may increase glaucoma treatment accessibility.

Guideline-Based Recommendations

Diagnosis

  • Utilize gonioscopy skills for angle assessment when considering MIGS.
  • Consider alternative diagnostic approaches compatible with emerging non-gonioscopic treatments.

Management

  • Offer MIGS concomitantly with cataract surgery to glaucoma patients when appropriate.
  • Consider emerging glaucoma treatments such as direct selective laser trabeculoplasty and sustained drug-delivery platforms for patients or surgeons uncomfortable with gonioscopy.
  • Employ second-generation canaloplasty devices to minimize complications like hyphema.

Monitoring & Follow-up

  • Monitor for complications post-MIGS, including bleeding and hyphema.
  • Evaluate patient response to sustained drug-delivery implants and laser trabeculoplasty.

Risks

  • Recognize that complications from MIGS may lead to surgeon reluctance to continue these procedures.
  • Be aware of bleeding risks associated with angle surgery; alternative treatments may reduce this risk.

Patient & Prescribing Data

Glaucoma patients undergoing cataract surgery

Patients generally accept MIGS when offered; surgeon choice is a major factor in treatment avoidance.

Clinical Best Practices

  • Educate and train surgeons in gonioscopy to increase comfort with MIGS procedures.
  • Incorporate emerging glaucoma treatments that do not require gonioscopic skills to broaden treatment options.
  • Address surgeon concerns and past negative experiences with MIGS to improve adoption rates.
  • Consider patient preference and acceptance, which is generally favorable toward MIGS.

Related Resources & Content