Optimizing MIGS for Practice and Center Success - Scorecard - MDSpire

Optimizing MIGS for Practice and Center Success

The key is execution, understanding the clinical landscape, controlling device cost, engineering the intraoperative workflow, and scheduling/staffing with intention.

  • By

  • Mitchell C. Shultz, MD

  • July 1, 2026

  • 9 min

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Clinical Scorecard: Optimizing MIGS for Practice and Center Success

At a Glance

CategoryDetail
ConditionMinimally Invasive Glaucoma Surgery (MIGS)
Key MechanismsTechniques include microbypass stents, canaloplasty, and sustained-release drug delivery systems.
Target PopulationAdult patients with refractory primary open-angle glaucoma (POAG) who have failed prior medical and/or surgical therapy.
Care SettingAmbulatory Surgical Center (ASC)

Key Highlights

  • MIGS expands options for patients and improves OR predictability.
  • MIGS is a core capability impacting clinical outcomes and ASC economics.
  • Most MIGS cases are performed during cataract surgery with minimal operational burden.
  • Predictable techniques and favorable safety profiles make MIGS suitable for ASCs.
  • Operational efficiency is crucial for ASC profitability.

Guideline-Based Recommendations

Diagnosis

  • Capture disease severity, medication burden, and prior interventions for payer alignment.

Management

  • Utilize techniques like iStent Infinite, Hydrus Microstent, and Omni System for effective pressure lowering.

Monitoring & Follow-up

  • Monitor for iris pigmentation changes with iDose TR and Durysta implants.

Risks

  • Potential for false passage into collector channels or breakthrough into the anterior chamber with certain devices.

Patient & Prescribing Data

Adults with refractory POAG.

MIGS can be combined with cataract surgery and other interventions for enhanced outcomes.

Clinical Best Practices

  • Standardize setup and anticipate angle work to minimize scheduling disruptions.
  • Train the surgical team to ensure efficient intraoperative workflow.
  • Implement a tiered scheduling approach based on the MIGS mechanism being used.

Related Resources & Content

    Original Source(s)

    Optimizing MIGS for Practice and Center Success

    • by Mitchell C. Shultz, MD

    • July 1, 2026

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