Minimally Invasive Glaucoma Surgery Princeton, Monroe Township, & Somerset, NJ

Name: Minimally Invasive Glaucoma Surgery (MIGS)
Brand: Princeton Eye Group
Rating: 3.91 (295 reviews)

Minimally invasive glaucoma surgery (MIGS) offers a less invasive surgical option for patients whose glaucoma is not adequately controlled with medications or laser treatment, but who may not require the degree of intervention provided by traditional filtering surgery. By providing meaningful pressure reduction with a favorable safety profile, MIGS can serve as an important option between non-incisional treatments and more extensive glaucoma surgery.

A Less Invasive Option When Appropriate

Glaucoma treatment is not one-size-fits-all. Many patients can maintain excellent pressure control with medications, sustained-release therapies, or laser treatment and may never require glaucoma surgery. Others may benefit from MIGS when additional pressure reduction is needed, while some patients with more advanced or difficult-to-control glaucoma may require traditional filtering surgery. For patients who need more pressure control than medications or laser treatment can provide, a MIGS procedure may offer a way to improve pressure control without the greater invasiveness of traditional filtering surgery. The goal is to match the least invasive treatment that provides adequate pressure control to each patient's individual needs.

At Princeton Eye Group, our fellowship-trained glaucoma specialists take an individualized, interventional approach to minimally invasive glaucoma surgery in Princeton, Monroe Township, & Somerset, NJ. We consider the full range of options—from medications and sustained-release therapies to laser treatment, MIGS, and traditional glaucoma surgery—and recommend the approach that best balances pressure control, treatment burden, safety, and quality of life.

What Is Minimally Invasive Glaucoma Surgery?

Minimally invasive glaucoma surgery (MIGS) refers to a family of procedures that lower intraocular pressure using microscale instruments and small incisions. A key distinction between MIGS and traditional filtering surgery is how they improve fluid drainage from the eye. Many MIGS procedures work by repairing, bypassing, or augmenting the eye's existing drainage pathways, helping aqueous fluid move more efficiently through the eye's natural drainage system. In contrast, traditional filtering procedures such as trabeculectomy and tube shunt surgery create a new pathway for fluid to leave the eye, allowing for greater pressure reduction when more substantial intervention is needed.

This distinction helps explain the role of MIGS within the spectrum of glaucoma treatment. MIGS can improve the function of the eye's existing drainage system for patients who need additional pressure control. At the same time, traditional filtering surgery remains an important option for patients who require a greater degree of pressure reduction. Many MIGS procedures can be performed through the small incision used for cataract surgery, making them particularly well-suited for patients who require both cataract removal and glaucoma treatment. Other MIGS procedures can be performed independently, depending on the specific procedure and the patient's needs.

The Benefits of Minimally Invasive Glaucoma Surgery in New Jersey

Favorable Safety Profile: Because MIGS procedures are less invasive than traditional glaucoma surgery, they generally have a favorable safety profile and a lower risk of serious complications. This can make MIGS an appropriate option for patients who need additional pressure control but may not need the more aggressive approach of traditional filtering surgery.
Reduced Medication Burden: MIGS may reduce the number of glaucoma eye drops a patient needs, helping simplify daily treatment routines, reduce medication-related side effects, and improve quality of life. The degree of medication reduction varies from patient to patient.
Improved Pressure Control: MIGS can provide additional intraocular pressure reduction when medications or laser treatment alone are not providing adequate control. For some patients, this also allows for a reduction in the number of glaucoma medications needed after surgery.
Faster Recovery: MIGS generally has a shorter and more predictable recovery than traditional glaucoma surgery. Many procedures can also be performed at the time of cataract surgery, allowing patients to address both conditions during the same surgical session.

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An Important Option During Cataract Surgery

Many MIGS procedures can be performed during cataract surgery, allowing patients to address both conditions at the same time. In glaucoma patients, adding MIGS may also help reduce the risk of postoperative intraocular pressure spikes, which can be particularly important in eyes that are more vulnerable to pressure-related optic nerve damage.

Following surgery, patients may require fewer glaucoma medications and may experience improved or more consistent intraocular pressure control. For appropriate patients, combining MIGS with cataract surgery can therefore address both the cataract and glaucoma while potentially reducing the burden and complexity of long-term glaucoma management.

Is MIGS Right for Me?

MIGS may be considered for patients whose glaucoma requires additional pressure control despite medications or laser treatment, particularly those with mild to moderate disease or those undergoing cataract surgery. It may also be an attractive option for patients who want to reduce their dependence on daily glaucoma medications.

MIGS is not appropriate for every patient. Some patients can achieve excellent long-term control without surgery, while others may have glaucoma that requires the greater pressure reduction achievable with traditional surgery. Patients with more advanced glaucoma or those who require a very low target eye pressure may benefit more from procedures such as trabeculectomy or tube shunt surgery.

The goal is not to move every patient toward surgery, but to choose the right treatment for the level of disease and the patient's individual needs. A comprehensive glaucoma evaluation at Princeton Eye Group can help determine whether medications, laser treatment, MIGS, traditional glaucoma surgery, or continued observation is the most appropriate approach.

A Range of Treatment Options

MIGS encompasses several procedures that target different parts of the eye's drainage system. Our glaucoma specialists can select the procedure that best matches each patient's anatomy, glaucoma severity, pressure goals, cataract status, and overall treatment plan.

MIGS Procedures We Offer

Microstenting procedures

Microstents such as the iStent and Hydrus can be placed in the trabecular meshwork to create a permanent bypass through the eye's natural drainage tissue, improving aqueous outflow and lowering intraocular pressure. The device is well tolerated and has an established safety and efficacy record in patients with open-angle glaucoma.

Canaloplasty

Canaloplasty is a procedure that restores the eye's natural drainage system by dilating Schlemm's canal using a microcatheter, improving aqueous outflow without creating an external filtering bleb. It offers meaningful pressure reduction with a lower risk profile than traditional filtering surgery and can be performed as a standalone procedure or in combination with cataract surgery.

Goniotomy

Goniotomy involves the surgical removal of a portion of the trabecular meshwork, the primary site of outflow resistance in open-angle glaucoma, to improve the flow of aqueous humor into Schlemm's canal. It is one of the more established MIGS techniques and can be performed using a variety of instruments, including the Kahook Dual Blade and OMNI system.

XEN Gel Stent

The XEN gel stent creates a small drainage channel from the anterior chamber to the subconjunctival space, providing a less invasive alternative to trabeculectomy for patients who require more significant pressure reduction than trabecular MIGS can provide. The XEN procedure is performed ab interno through a small corneal incision and offers a faster recovery and lower risk profile than conventional filtering surgery.

The MIGS Process What to Expect

Comprehensive Glaucoma Evaluation

Your Princeton Eye Group glaucoma specialist will assess your intraocular pressure, optic nerve health, drainage angle anatomy, and visual field to determine your stage of disease and confirm whether MIGS is the appropriate intervention.

Personalized Procedural Selection

Based on your anatomy, disease severity, and goals, your physician will recommend the most appropriate MIGS procedure and discuss whether combining it with cataract surgery is indicated.

Pre-Surgical Preparation

You will receive specific instructions regarding medications and pre-operative testing. Arrangements for a driver on the day of surgery will need to be made in advance.

Procedure Day

Most MIGS procedures are performed on an outpatient basis under local anesthesia at our affiliated surgical center, typically in conjunction with cataract surgery. The procedure itself adds only a few minutes to the overall operative time when combined with cataract removal.

Recovery

Recovery from MIGS is generally faster and more straightforward than traditional glaucoma surgery. Most patients resume normal light activities within a few days, using prescribed eye drops to support healing and manage inflammation.

Follow-Up and Monitoring

Your physician will monitor your intraocular pressure, medication use, and optic nerve health at regular follow-up appointments to assess the effectiveness of the procedure and adjust your treatment plan as needed.

Your MIGS Results and Recovery

Most patients recover quickly following MIGS, with vision stabilizing within days to weeks of the procedure. The pressure-lowering effect of MIGS is typically more modest than that of traditional filtering surgery. Still, for patients with mild to moderate glaucoma, it is often sufficient to meaningfully reduce or eliminate the need for daily eye drops. Results are monitored closely in the weeks and months following surgery, and additional treatments can be added if needed. Because MIGS is often performed alongside cataract surgery, many patients experience the combined benefit of improved vision and better pressure control from a single operative session.

Why Choose Princeton Eye Group for MIGS?

Princeton Eye Group's glaucoma program combines nationally recognized surgical expertise, an interventional treatment philosophy, and access to the full spectrum of MIGS procedures, giving patients the most current and comprehensive minimally invasive glaucoma care in New Jersey.

Fellowship-Trained Glaucoma Surgeons

Both Dr. Sarah Kuchar and Dr. Daniel Lee completed their glaucoma fellowships at Wills Eye Hospital, training under the world's leading experts in the field. Their surgical training encompasses the full range of MIGS techniques, ensuring that procedure selection is always guided by deep clinical expertise rather than familiarity with a single device.

An Interventional Approach to Glaucoma

Glaucoma is a disease that can progress gradually over time or, in some patients, more episodically. While some patients can be successfully managed with medications or laser treatment, others may benefit from a more proactive, interventional approach to help prevent further progression. Our glaucoma specialists consider laser and surgical options when they may offer meaningful advantages in pressure control, treatment burden, or long-term disease management. MIGS is an important part of this approach, providing a less invasive surgical option for appropriately selected patients.

Integrated Cataract and Glaucoma Care

Because Princeton Eye Group performs both cataract and glaucoma surgery, patients who require treatment for both conditions can have them addressed together in a single session, maximizing efficiency, minimizing risk, and reducing the overall burden of care.

Research-Driven Clinical Practice

Members of the glaucoma service at Princeton Eye Group have served as principal investigators in multiple clinical trials investigating next-generation glaucoma therapies, including studies of emerging MIGS technologies and extended-release medications. Patients benefit from a physician who is actively engaged in advancing the field and brings the latest evidence directly to his clinical practice in Princeton, Monroe Township, and Somerset.

Comprehensive Glaucoma Care Under One Roof

From MIGS and laser treatment to advanced filtering surgery, Princeton Eye Group offers the complete spectrum of glaucoma interventions, ensuring that care can be escalated or adjusted as a patient's disease evolves, without the need for outside referrals.

Minimally Invasive Glaucoma Surgery Frequently Asked Questions

What makes MIGS different from traditional glaucoma surgery?

Traditional glaucoma procedures such as trabeculectomy and tube shunt surgery create a new pathway for fluid to leave the eye, allowing for a greater degree of pressure reduction when needed. Because these procedures are more invasive, they also carry greater risks and typically require a longer recovery. MIGS procedures use microscale instruments and generally work by repairing, bypassing, or augmenting the eye's existing drainage pathways. This less invasive approach typically offers a more favorable safety profile and faster recovery. The choice between MIGS and traditional glaucoma surgery depends on the severity of glaucoma, the target eye pressure range, and the amount of pressure reduction needed to protect the optic nerve.

Can MIGS be performed without cataract surgery?

Yes, some MIGS procedures can be performed as standalone operations, while others are specifically designed to be combined with cataract surgery. Your physician will determine the most appropriate approach based on your individual clinical situation.

How much will MIGS lower my eye pressure?

The degree of pressure reduction achieved by MIGS varies depending on the specific procedure performed and individual patient factors. MIGS typically produces more modest pressure reduction than traditional filtering surgery, but it is often sufficient for patients with mild to moderate glaucoma seeking to reduce medication dependence.

Will I be able to stop taking glaucoma drops after MIGS?

Many patients achieve a meaningful reduction in the number of glaucoma medications required following MIGS, and some are able to discontinue drops entirely. Results vary depending on the procedure performed and the patient's baseline pressure. Your physician will monitor your response and adjust your regimen accordingly.

Does insurance cover MIGS?

Most MIGS procedures performed in conjunction with cataract surgery are covered by Medicare and most medical insurance plans when medically indicated. Coverage for standalone MIGS procedures varies by insurer and specific device. Our team can help verify your coverage prior to surgery.

How long does MIGS take?

When performed in conjunction with cataract surgery, most MIGS procedures add only a few minutes to the overall operative time. Standalone MIGS procedures are similarly brief. All procedures are performed on an outpatient basis, so patients go home the same day.

What are the risks of MIGS?

MIGS procedures have a significantly more favorable risk profile than traditional glaucoma surgery. Possible risks include temporary elevation of intraocular pressure, minor bleeding, device malposition, and, in rare cases, infection. Serious complications are uncommon. Your physician will review all risks and benefits in detail prior to your procedure.

How do I know which MIGS procedure is right for me?

The selection of the most appropriate MIGS procedure depends on your type and severity of glaucoma, your drainage angle anatomy, whether cataract surgery is also indicated, and your target pressure goals. Your Princeton Eye Group glaucoma specialist will evaluate all of these factors and recommend the procedure best suited to your individual situation.