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
Clinical Scorecard: Optimizing MIGS for Practice and Center Success
At a Glance
Category Detail
Condition Minimally Invasive Glaucoma Surgery (MIGS) Key Mechanisms Techniques include microbypass stents, canaloplasty, and sustained-release drug delivery systems. Target Population Adult patients with refractory primary open-angle glaucoma (POAG) who have failed prior medical and/or surgical therapy. Care Setting Ambulatory 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
