Minimally Invasive Glaucoma Surgery Offers Quality of Life Improvements in Patients With Glaucoma: Christine Funke, MD

Christine Funke, MD, a glaucoma specialist at Barnet Dulaney Perkins Eye Center in Phoenix, Arizona, discussed how minimally invasive glaucoma surgery (MIGS) has been able to offer her patients better quality of life in treating their glaucoma when compared with traditional surgeries.

This transcript has been lightly edited for clarity; captions are auto-generated.

Transcript

How is MIGS different than traditional surgery for glaucoma?

We can go into it a little more too, because the traditional surgeries, they're pretty tough on the eye. They are higher risk for complication, even long post-op. Traditional surgeries are considered trabeculectomies and tube shunt surgeries. Those are the things that have been around for a long time. Basically we're trying to just make brand new drainage pathways in the eye, which comes with major hardware or more invasive procedures. And with those 20% to 30% risk of complications, that's a pretty high number to tell patients about. If they are at end stage disease, they are going blind without this procedure, then it's something that I'm willing and think is worth the discussion. But now that we have all these other techniques and options, when we talk about minimally invasive glaucoma surgery, the risk is well under 1% of some sort of issue. I hardly talk about, at this point, adverse effects of minimally invasives, because they just are pretty few and far between, especially as you get more and more well-versed at doing them surgically, you become very confident surgically. The more you do, of course, the better you are. You start to feel this confidence and you're like, "I don't really see a lot of negatives here as to why we wouldn't be trying this procedure."

The rate of recovery, quality of life with minimally invasive glaucoma surgery, I think to as similar to no change. Your quality of life should remain the same. Yes, you're going to recover for a week or so, but your quality of life should remain the same or improve. And that's something that's so exciting to see that we can't say with traditional glaucoma surgery. I don't have any patients who are like, "Oh, I'd do that again." They're usually more like, "Oh, I don't ever want to do that again." With minimally invasives, they're very happy to go for another round. If they've had an eye stent, say, in the past with cataract surgery, and it did beautifully for 5 years, and now we're starting to see their pressure creep up again. They say, "Hey, I can place another couple stents here, or I can place an eye dose here. I can do X, Y and Z, and we can get you back under control." There's not many patients who say, no. I probably hear ["no" more] often about the idea of adding backdrops, because they've been there, they've gotten off of them, and they don't want to return to that.

I think the quality-of-life discussion is probably what's so fun that's on the table that hasn't been before for us as glaucoma surgeons and as general ophthalmologists. All of this is very adaptable to anybody who does eye surgery, which is nice as well. But it's the quality-of-life discussion that's exciting, of getting people to save their vision, getting to slow down the progression of disease, being able to do this also much earlier to prevent horrible end stage blindness, or even just a lot of problems and issues with quality of life because of low vision. We have so many options now that can prevent all of that later stage disease, and we're improving quality of life.

As much as I do of the more challenging glaucoma surgeries, because they're never going away, I've done less and less of them. But I can't say that I'm improving people's quality of life by doing them. I may be saving the vision, and long term they're better off than without it, but I can't say, "I'm excited to tell you need a tube shunt surgery." That never comes out of my mouth. When I say, I'm excited to do a minimally invasive glaucoma surgery for you, I think this is really going to help things and make you better. Get you off a drop, make your eye feel better, make your dry eye better, whatever it may be. That's an exciting discussion. That's where I think the difference in quality of life you can talk about because there's no quality-of-life discussion with the traditional surgeries, and there's a lot of quality-of-life discussion with what we're doing now [with] all of the newer techniques.