Big Data, MIGS Are Crucial Areas of Glaucoma Treatment: AAO Panel

How to optimize patient care in glaucoma treatment was a primary topic of a session held during the American Academy of Ophthalmology (AAO) 2026 annual meeting. Experts discussed how to identify what minimally invasive glaucoma surgery (MIGS) is best for the patient and how to utilize big data to best pinpoint what the patient needs.

Big Data Can Inform Glaucoma Care

Victoria Tseng, MD, PhD, an assistant professor in residence and Jerome and Joan Snyder Chair in Ophthalmology at UCLA Stein Eye Institute, opened the session with an explanation of what big data is and how it can be used in the glaucoma space, including how it has been used in the past and how it can be used in the future.

“Big data” usually refers to data sets that consist of billions or trillions of records, or “something that can’t fit on an Excel sheet,” Tseng explained. Currently, there are several large datasets available for ophthalmologists and optometrists to choose from, primarily in datasets that are based in electronic health records. These include the AAO IRIS Registry, which is specific to ophthalmology, and the UK Biobank, which is a general dataset. The datasets can include imaging and social determinants of health through constant improvements.

Big data’s role in glaucoma care is widespread, according to Tseng. “One area where it’s been quite informative is in terms of examining risk factors for glaucoma,” she explained. These datasets have helped to determine that physical activity is associated with a lower risk of glaucoma, that diet can lower the risk of glaucoma, and that substance use can increase the chance of having higher intraocular pressure.

Gaps in care are also an area where big datasets have been helpful. Specifically, datasets that include social demographic data have helped to identify associations between areas of deprivation and the development of glaucoma.

“With the Social Vulnerability Index, there were studies that found that patients who resided in areas with greater deprivation had worse glaucoma at the time they were diagnosed and also more glaucoma surgery,” said Tseng.

Racial and ethnic disparities are also identified in these datasets, as these studies helped identify Black and Hispanic beneficiaries as having less ancillary testing and fewer visits to their eye doctor. Lastly, clinical and surgical outcomes have been identified and helped with the availability of big data. Specifically, data on rare diseases has become more robust, as data from both the country and throughout the world can help to coagulate all the information for doctors to better identify these rare diseases and use previous cases to inform treatment options.

As far as where big data can go in the future, Tseng noted a couple of areas where big data can help. She noted oculomics, which is “combining information from medical records, images, fluids, other tests, and using this to basically make the eye a window to your whole body and systemic health,” she explained. And though she noted that glaucoma is not the full body, the concept of oculomics to incorporate multimodal data into care is the goal, to go beyond just images and medical records to incorporate other types of data to put it together to personalize glaucoma care.

She also noted new models of glaucoma care as the population ages. Thinking about how to care for all of the people who will be diagnosed with glaucoma in the future, new models of care will be needed to address the influx of people who will need glaucoma care.

“Data will be really informative to incorporate these technologies; see if they’re feasible to use in new models of care that maybe doesn’t require somebody coming into the clinic to a glaucoma specialist as frequently as they do now,” said Tseng. “But we’ll really need the data to inform us how…that can help us change our care delivery in the future without compromising the quality of care.”

Identifying the Right MIGS for the Right Patient

Jella An, MD, MBA, a professor of ophthalmology for the Storm Eye Institute at the Medical University of South Carolina, followed up this presentation with an important question of how to determine the right MIGS for the patient who needs it to address their glaucoma diagnosis. An noted that MIGS is constantly evolving, with new technologies introducing new ways to approach MIGS.

For the presentation, An presented a real-world example where she had to determine what type of MIGS was needed for the patient. Her first example was a Black male who was aged 77 years and was referred for cataract surgery but also monitored for primary open-angle glaucoma. The patient also expressed difficulty staying adherent to his medication. His visual field was severe in the right eye and moderately severe in the left eye.

For this patient, An suggested that any MIGS procedure of the doctor’s choice would be appropriate for the left eye of this patient, with her specifically noting a stent-based procedure to preserve the trabecular meshwork. However, the right eye is not a classic MIGS eye and could require more than 1 procedure. For this eye, An said she did a bit of everything, including removing the lens, adding a canaloplasty, putting in a Hydrus stent, and implanting the travoprost implant. Overall, the surgeries were successful, with the patient reporting 20/25 vision.

“This is just one of the success case[s] of [a] mixed procedure that was stretch, and it was offered to a patient who was a stretch case,” said An.

Identifying the issues that the patient had was the first step to figuring out the next steps, as An confirmed with other panelists that each patient could need different forms of MIGS to address their glaucoma. Physicians should note that a patient may not be completely healed after only 1 surgery, so expanding the options to more than 1 type of MIGS to help a patient can be a key to optimizing their treatment.