Trends and Usage Patterns of Minimally Invasive Glaucoma Surgery (MIGS) in the US: IRIS Registry Analysis 2013-2018


Yang S-A, Mitchell W, Hall N, Elze T, Lorch AC, Miller JW, Zebardast N, Zebardast N. Trends and Usage Patterns of Minimally Invasive Glaucoma Surgery (MIGS) in the US: IRIS Registry Analysis 2013-2018. Ophthalmol Glaucoma 2021;

Date Published:

2021 Apr 05


OBJECTIVE: Understanding trends and patterns in the use of minimally invasive glaucoma surgery (MIGS) and patient profiles undergoing each procedure is important given their relative expense and unknown long-term safety and effectiveness. DESIGN: Retrospective analysis SUBJECTS: MIGS and standard glaucoma surgeries recorded in the American Academy of Ophthalmology (AAO) Intelligent Research in Sight (IRIS®) Registry. METHODS: We used the data from IRIS® Registry between 2013-2018 (inclusive) to measure annual number of MIGS and standard surgical techniques (trabeculectomy or glaucoma drainage device (GDD)) performed in the US, stratified by demographic characteristics. Secondary analyses of concurrent surgeries and of subsequent surgeries for MIGS and standard surgical technique were also conducted. MAIN OUTCOME MEASURES: Trends and sociodemographic characteristics of MIGS usage in the US. RESULTS: 203,332 eyes and 232,537 unique procedures had associated, documented International Statistical Classification of Diseases and Related Health Problems (ICD) 9/10 codes for glaucoma and were included in final analyses. Among eyes with documented glaucoma diagnoses, there was a substantial increase in annual MIGS procedures over the study period (from 7,586 in 2013 to 39,677), and a smaller decrease in standard glaucoma procedures (from 16,215 to 13,701). The proportion of iStent procedures almost tripled during the study period (from 14% to 40%), and by 2017 accounted for almost half (43.7%) of all glaucoma surgeries in the US. 21,025 (10.3%) of all eyes received multiple procedures; 7,638 (36.3%) on the same day and 13,387 (63.7%) on subsequent days. ECP and iStent were the most common concurrent procedures (55.4% of all concurrent procedures). Trabeculectomy and GDD were most commonly followed by another standard glaucoma surgery, but when followed by sequential MIGS, ECP and goniotomy were the most common procedures performed (33.0%, 21.9%, respectively). CONCLUSIONS: There was a significant increase in MIGS use over the recent six-year period despite limited evidence of their long-term safety or effectiveness, highlighting the need for trials comparing safety and outcomes of novel MIGS vs traditional surgical treatments for glaucoma.

Last updated on 05/01/2021