G360 2025: The newest in MIGS and what it means for comanagement

Shan Lin, MD, is the co-research director at the Glaucoma Center of San Francisco. At the Glaucoma 360 meeting, he discussed the new generation of minimally invasive glaucoma surgeries (MIGS). These include trabecular procedures like the CyPass which removes part of the trabecular meshwork, suprachoroidal stents like the iStent, and scleral-based procedures like Xen. There are also new minimally invasive filtration surgeries like the Preserflo MicroShunt. Lin notes that the introduction of prostaglandin eye drops and SLT laser have greatly improved glaucoma management. The new MIGS procedures allow for further delaying the need for more invasive filtering surgeries. Lin believes the field of glaucoma will continue to see evolutionary development of new MIGS.

Another area of potential progress is in neuroprotection. While an earlier trial of memantine did not pan out, Lin is optimistic that new neuroprotective agents are on the horizon as research into the underlying mechanisms of glaucoma advances. Beyond medications and surgery, Lin discusses other potential therapies. Exercise, a healthy diet, and certain supplements like nicotinamide and citicoline show promise in clinical studies.

Lin emphasizes the importance of collaboration between ophthalmologists and optometrists as the population of glaucoma patients grows. Optometrists are often the first point of contact and can help get patients to the right specialist for treatment.