Combined Cataract Surgery and MIGS
Understanding Combined Cataract Surgery and MIGS
Combined cataract and MIGS surgery builds on a standard cataract procedure by adding a specialized step to improve fluid drainage inside the eye. Understanding how these two parts work together helps you know what to expect and why this approach benefits certain patients.
Minimally invasive glaucoma surgery is performed during the same operation as cataract removal, typically using the same small corneal incisions already made for the cataract portion. During the glaucoma step, your surgeon inserts a tiny device or creates a microscopic drainage pathway to help fluid exit the eye more easily.
This improved drainage lowers the pressure inside your eye, called intraocular pressure, which is the primary goal of glaucoma treatment. MIGS devices are designed to be gentle on eye tissue and cause less trauma than older, more invasive glaucoma surgeries.
The cataract portion of your surgery remains the same: the cloudy natural lens is removed and replaced with a clear artificial lens called an intraocular lens. The MIGS portion adds only a few extra minutes to the total procedure time.
Because glaucoma is addressed during the same operation, your post-surgery eye drop routine may include additional anti-inflammatory medications for a short period. Your follow-up schedule will also monitor both your vision clarity and your eye pressure readings.
Several MIGS devices and approaches are approved and commonly used during combined surgery. Each works through a different mechanism to improve fluid drainage and lower eye pressure.
- Trabecular bypass stents that create a pathway through the drainage meshwork of the eye
- Goniotomy or trabeculotomy procedures that remove or open tissue blocking the drainage angle
- Canaloplasty or viscodilation techniques that widen the eye's natural drainage canal
- Suprachoroidal approaches that create an alternate drainage route between layers of the eye
- Subconjunctival microshunts for controlled fluid outflow in select cases
Your surgeon will recommend a specific device based on your type of glaucoma, the anatomy of your drainage angle, and how much pressure reduction you need. Not every option is appropriate for every patient or glaucoma type.
Scheduling one surgery instead of two saves time, reduces your total recovery period, and limits the number of days away from work or daily activities. It also avoids the stress and added cost of two separate surgical events.
- One recovery period with one set of restrictions
- Potentially fewer glaucoma medications needed long term
- Lower cumulative surgical risk compared to two separate procedures
- Simultaneous improvement in both vision clarity and eye pressure control
Not all patients achieve complete freedom from glaucoma medications, and some may still require future glaucoma treatment as the disease progresses over time.
Who Benefits from Combined Cataract and MIGS Surgery
Not everyone with cataracts and glaucoma is the right candidate for combined surgery. Several factors help determine whether this approach is the best fit for your situation.
If you carry diagnoses of both cataracts and glaucoma, you may be a strong candidate for combined surgery. Many people develop cataracts with age, and glaucoma also becomes more common after age sixty.
Candidacy depends on your specific type of glaucoma, the anatomy of your drainage angle, how advanced the disease is, your target eye pressure, and any prior eye surgeries. Certain conditions, such as angle-closure glaucoma, active inflammation, or very advanced disease requiring aggressive pressure lowering, may affect whether combined MIGS and cataract surgery is appropriate for you.
MIGS procedures work best when glaucoma is in an early or moderate stage, because these devices provide modest to moderate pressure reduction rather than dramatic lowering. This level of control is often enough when the disease has not yet caused severe damage.
- Early-stage glaucoma with minimal optic nerve damage
- Moderate glaucoma that is stable on current medications
- Patients whose visual field loss remains limited
- Target pressures that match what the chosen MIGS procedure can reliably achieve
If you already use one or more glaucoma drops every day, combined surgery may help reduce or eliminate some of those medications. Many patients find daily drops inconvenient, expensive, or irritating to the surface of the eye.
MIGS offers a way to help control pressure without relying as heavily on drops. While you may still need some medication after surgery, the burden is often lighter for eligible patients.
Even if your glaucoma is currently well-controlled on drops, you may prefer to lower your dependence on medications over the years ahead. Combining MIGS with cataract surgery can help work toward that goal at a time when surgery is already planned.
Fewer medications can mean fewer side effects, lower out-of-pocket costs, and less worry about missed doses affecting your eye pressure over time.
Most candidates for combined surgery are adults over sixty, but age alone does not qualify or disqualify you. Your surgeon will also evaluate your general health, any other eye conditions, and your ability to tolerate a slightly longer procedure.
- Good overall health with stable chronic conditions
- No active eye infections or severe uncontrolled inflammation
- Realistic expectations about the degree of pressure reduction
- Willingness to attend regular follow-up visits after surgery
How We Determine Whether You Are a Candidate
A thorough evaluation is required before recommending combined surgery. We use several tests and a detailed review of your health history to make the most informed recommendation for your situation.
We measure your intraocular pressure at every visit using a quick, painless test called tonometry. Tracking your pressure over time helps us understand how well your current treatment is working and whether additional intervention is warranted.
If your pressure stays above your target level despite medications, or if we notice fluctuations that could harm the optic nerve, adding MIGS to your cataract surgery may provide better long-term control.
Visual field testing maps your peripheral, or side, vision to detect any blind spots caused by glaucoma. During the test, you look into a machine and press a button each time you see a point of light, and a computer analyzes the pattern of your responses.
Results help us stage your glaucoma and confirm whether a MIGS device will provide enough pressure lowering for your situation. Severe visual field loss may require a more aggressive surgical approach than MIGS alone.
We examine your optic nerve using a specialized microscope and often capture high-resolution images with a technology called optical coherence tomography, or OCT. These images reveal thinning of nerve tissue and help us track changes over time.
- Detection of optic nerve cupping or thinning that signals glaucoma damage
- Baseline imaging to compare with future scans
- Assessment of overall nerve health before planning surgery
Not every cataract requires immediate surgery, so we evaluate how much cloudiness affects your daily life. If vision is still adequate for safe driving and reading, we may recommend waiting.
We also review every glaucoma drop you use, how well your pressure is controlled, and whether you experience any side effects from your current regimen. This information helps us predict how much additional pressure lowering you may need and which MIGS approach is most likely to help.
Your overall medical history matters because certain conditions can affect healing or increase surgical risk. We ask about diabetes, autoimmune diseases, blood thinners, and any previous eye surgeries or injuries.
- History of other eye surgeries or eye trauma
- Current medications, including blood thinners and supplements
- Chronic conditions such as diabetes or arthritis
- Known allergies to anesthesia or eye drop ingredients
What to Expect During Combined Surgery
Knowing what happens on the day of surgery helps reduce anxiety and allows you to prepare well. The combined procedure is performed as an outpatient surgery, and you return home the same day.
You will receive detailed instructions about which medications to take or skip on the morning of surgery and when to stop eating or drinking beforehand. Your surgeon may also prescribe specific preoperative eye drops depending on their protocol.
Arrange for someone to drive you home afterward, since your vision will be blurry and driving is not safe on the day of surgery. Wear comfortable clothing and leave jewelry and valuables at home.
You will lie comfortably on a reclining surgical table while the area around your eye is cleaned and covered with a sterile drape. A surgical microscope helps your surgeon see the very small structures inside your eye throughout the procedure.
First, the cloudy cataract is removed through a small incision and replaced with a clear artificial lens. Then, using the same or a nearby incision, your surgeon places the MIGS device or creates the drainage pathway. You remain awake throughout but are kept relaxed with sedation.
Most patients receive numbing eye drops combined with a mild sedative delivered through an intravenous line to keep you calm and comfortable. You will not feel pain during the procedure, though you may sense light pressure or hear quiet sounds from the instruments.
- Topical anesthetic drops numb the surface of the eye
- Light intravenous sedation helps you remain relaxed
- Some cases may require an injection-based anesthetic depending on your anatomy and the surgeon's judgment
Cataract surgery alone typically takes fifteen to twenty minutes. Adding the MIGS portion extends the total time by only a few minutes, so the entire combined procedure usually finishes in under thirty minutes.
After surgery, you rest briefly in a recovery area while the sedation wears off, and then you go home the same day with no overnight hospital stay required.
Risks, Side Effects, and Limitations
Like any surgical procedure, combined cataract and MIGS surgery carries potential risks. Understanding these helps you make an informed decision alongside your surgeon.
Many patients experience mild and short-lived side effects in the first days or weeks after surgery. These effects are usually manageable and improve as the eye heals.
- Blurred or fluctuating vision during the early healing phase
- Hyphema, meaning a small amount of blood visible in the front chamber of the eye
- Light sensitivity and halos or glare around lights
- A gritty or foreign-body sensation
- Temporary elevation or fluctuation of eye pressure
Although rare, more serious complications can occur with any eye surgery. We monitor you closely after the procedure to detect and address any issues as early as possible.
- Infection inside the eye, known as endophthalmitis
- Persistent inflammation or swelling
- Corneal swelling or, in susceptible eyes, risk of corneal decompensation
- Significant or prolonged eye pressure spikes
- Device obstruction, malposition, or migration
- Peripheral anterior synechiae, a condition in which the iris adheres to the drainage angle
- Need for additional glaucoma surgery if pressure is not adequately controlled
MIGS procedures provide meaningful benefits for the right candidates, but it is important to understand what they can and cannot achieve. Pressure reduction with MIGS tends to be modest to moderate rather than dramatic.
Results vary based on the specific device used, individual eye anatomy, and how each eye heals after surgery. Some patients will continue to need glaucoma medications, and others may require additional glaucoma procedures in the future if pressure rises or the disease progresses.
Recovery and Follow-Up Care After Combined Surgery
A smooth recovery depends on following your post-operative instructions carefully and attending all scheduled follow-up appointments. Most patients recover well and notice meaningful improvements in both vision and eye pressure control.
Your vision will be blurry immediately after surgery, and you may notice halos around lights or mild redness. These effects typically improve quickly over the first day or two as healing begins.
Mild discomfort, a gritty feeling, and light sensitivity are normal during this early phase. Resting with your head elevated and wearing the protective shield provided to you, especially while sleeping, helps protect your eye.
We prescribe antibiotic drops to prevent infection and anti-inflammatory drops to reduce swelling. Depending on your pressure readings after surgery, your glaucoma medications may be continued, adjusted, or temporarily stopped.
- Use all drops exactly as prescribed, even if your eye feels comfortable
- Wait at least five minutes between different types of drops
- Wash your hands thoroughly before touching the bottle or the area around your eye
- Keep a written schedule if tracking multiple drops feels difficult
Avoid heavy lifting, bending over, or straining for at least one week after surgery, since these activities can temporarily raise eye pressure. Swimming, hot tubs, and dusty or dirty environments should also be avoided until your surgeon clears you, which typically happens one to two weeks after surgery.
Most patients return to light activities such as reading or watching television within a day or two. Driving is permitted once your vision is clear enough and your surgeon confirms it is safe, often within a few days to a week.
Your first follow-up visit typically takes place within one to two days after surgery. We check your vision, measure your eye pressure, and examine the surgical site to confirm that healing is progressing well.
Additional visits occur over the following weeks and months to monitor pressure trends and adjust medications as needed. Long-term success depends on keeping your pressure within a safe range and watching for any signs of glaucoma progression.
Serious complications are rare, but certain symptoms require urgent evaluation. Contact our office immediately or seek emergency eye care if you notice any of the following.
- Sudden decrease in vision, or new floaters and flashes of light
- Severe eye pain or a significant headache
- Worsening pain combined with worsening vision that does not improve from one day to the next
- Increasing redness, swelling, or discharge from the eye
- Marked light sensitivity or a cloudy or hazy appearance to your vision
- Nausea or vomiting accompanied by eye discomfort
Frequently Asked Questions
These answers address common questions about combined cataract and MIGS surgery that go beyond the details already covered above.
Adding MIGS does introduce some additional risks that are not present with cataract surgery alone, including a higher chance of temporary bleeding in the front of the eye and short-term pressure fluctuations. However, the overall safety profile remains favorable for most well-selected patients, and the benefit of avoiding a second surgery later often outweighs those added risks. The specific risk level depends on the MIGS technique chosen and your individual eye anatomy. Your surgeon will walk through all of this with you before you make a decision.
Most MIGS devices provide sustained pressure reduction for several years, though exact durability varies by procedure, device type, and how an individual eye heals. Some patients maintain good control for five years or more, while others may see a gradual rise in pressure over time due to scarring or disease progression. This is why consistent follow-up is so important, because early detection of rising pressure allows your care team to respond before optic nerve damage worsens.
Prior eye surgery does not automatically rule out combined cataract and MIGS surgery, but it does affect the evaluation process. Previous procedures can alter the anatomy of the drainage angle or affect how the eye heals, which may limit which MIGS devices or techniques are suitable. Your surgeon will carefully review your surgical history and examine your eye before making any recommendation.
If eye pressure remains above your target after surgery, several options are available. Your surgeon may add or adjust glaucoma medications, consider selective laser trabeculoplasty to improve drainage further, or discuss a second glaucoma procedure if the situation calls for it. The response is always tailored to your specific pressure readings and optic nerve health, with the goal of protecting your vision over the long term.
If combined surgery is not right for you, other paths are available. Cataract surgery alone can modestly lower eye pressure in some patients, and continuing or adjusting glaucoma eye drops is always an option. Selective laser trabeculoplasty can also improve drainage without surgery. For advanced glaucoma, traditional filtering procedures such as trabeculectomy or a tube shunt may be more appropriate. Some patients choose a staged approach, with cataract surgery first and a separate glaucoma procedure later if needed. Your surgeon will review which alternatives best fit your individual situation.
After combined surgery, your care may be co-managed between your surgical team and your regular eye care provider. Routine pressure checks, visual field testing, and optic nerve imaging should continue on the schedule recommended by your surgeon. It is important that all members of your care team communicate so that your glaucoma management remains consistent and well-coordinated as you heal and your eye stabilizes.
Schedule a Consultation at EyeCare Consultants of NJ
If you have been diagnosed with both cataracts and glaucoma, our team at EyeCare Consultants of NJ is here to help you understand all of your options. We provide expert evaluations at our offices in Edison and Woodland Park, New Jersey, and we are committed to creating a personalized plan that protects your vision and supports your long-term eye health. We look forward to being a trusted part of your care.
Dr. Kayserman was gentle, efficient and provided extremely valuable information which was comforting to me. I felt better after seeing her and am looking forward to additional visits.
Lina N.
I had cataract surgery done by Dr. Jai. The process went very smoothly. Aside from the follow up visits in the office after the surgery, Dr. Jai called several times to check how I was doing.
Madesa Espana
Dr. Arnett has provided excellent medical attention for my retina eye surgery and has a very professional and positive bedside manner. I would highly recommend him.
R. T
My family and I have been patients of Dr. J for many years. Friendly staff who takes care of us. Highly recommend
Sunil Ramakrishnan
Dr. Arnett is very kind
Shirly