Combined Cataract Surgery and MIGS
Schedule
Today
Who Benefits from Combined Surgery
Not everyone with cataracts and glaucoma is a candidate for combined surgery, but many patients are. The decision depends on the stage of your glaucoma, the health of your drainage angle, your current pressure targets, and several other factors that we evaluate together.
If you have been diagnosed with both conditions, combined surgery may offer an efficient path to better vision and improved pressure control at the same time. Both cataracts and glaucoma become more common with age, so it is not unusual for patients to develop them together.
Certain types of glaucoma, such as angle-closure glaucoma or cases with active inflammation, may not be suited to combined MIGS. Very advanced disease that requires aggressive pressure lowering may also call for a different surgical approach. We will assess your specific situation carefully before making a recommendation.
MIGS procedures are best suited for mild to moderate glaucoma. They provide a meaningful reduction in eye pressure, but the amount of lowering they achieve is generally moderate rather than dramatic.
- Early-stage glaucoma with minimal optic nerve damage
- Moderate glaucoma that is stable on current medications
- Cases where limited visual field loss has been detected
- Target pressures that are achievable with the expected effect of the chosen MIGS procedure
If your target pressure requires a more dramatic reduction than MIGS can reliably provide, we will discuss whether a traditional glaucoma surgery is a better fit.
If you use one or more glaucoma drops daily, combined surgery may help you reduce or simplify that regimen. Many patients find that drops are inconvenient, expensive, or irritating to the surface of the eye over time.
MIGS offers a way to lower pressure without relying entirely on medications. While some patients still need drops after surgery, the number is often reduced.
Even when glaucoma is well controlled with drops, some patients prefer to reduce their reliance on daily medications over the long term. Combining MIGS with cataract surgery can support that goal.
Fewer medications can mean fewer side effects, lower costs, and less concern about missed doses. This benefit is meaningful for many patients who value simplicity in their daily routine.
How We Determine If You Are a Candidate
Candidacy for combined surgery requires a thorough evaluation of your eye health from several angles. We use a combination of measurements, imaging, and a review of your medical history to determine whether this approach is right for you.
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.
If your pressure stays above your target despite medications, or if we see fluctuations that could threaten the optic nerve, adding a MIGS procedure during cataract surgery may provide better long-term control.
Visual field testing maps your peripheral, or side, vision to detect blind spots caused by glaucoma damage. You look into a testing machine and respond to small lights, and a computer analyzes the pattern of your responses.
The results help us understand how far glaucoma has progressed and whether the pressure lowering that MIGS can deliver will be enough to protect your nerve going forward. Severe visual field loss may point toward a more aggressive surgical approach.
We examine your optic nerve directly using a specialized microscope and typically take high-resolution images using optical coherence tomography, or OCT. These scans reveal thinning of the nerve fiber layer and allow us to track changes over time.
- Detection of optic nerve cupping, which refers to an enlargement of the central hollow in the nerve
- Baseline imaging to compare against future scans
- Assessment of overall nerve health before we proceed with any surgery
Not every cataract needs immediate removal. We evaluate how much the lens cloudiness is affecting your daily activities, such as safe driving or comfortable reading, before we recommend surgery.
When the cataract is ready for removal and you also have glaucoma, that timing creates an ideal opportunity to combine both procedures and address two conditions at once.
We review every glaucoma drop you use, how consistently you are able to take them, and whether your pressure is well controlled. If you use multiple drops or find the regimen difficult to maintain, MIGS becomes a more appealing addition to your cataract surgery.
Understanding your medication history also helps us predict how much additional pressure lowering you may need and which MIGS approach is most likely to achieve that goal.
Your overall health history plays a role in determining surgical risk and expected healing. We ask about conditions such as diabetes, autoimmune diseases, and blood-thinning medications, as well as any prior eye surgeries or injuries.
- History of other eye procedures or eye trauma
- Current medications, particularly blood thinners
- Chronic health conditions that may affect healing
- Allergies to anesthesia or eye drop ingredients
Risks, Side Effects, and Limitations
Like all surgical procedures, combined cataract and MIGS surgery carries some risks. Most side effects are mild and temporary, but it is important to understand the full range of possibilities so you can make an informed decision.
Many patients experience mild, short-lived side effects in the first days to weeks after surgery. These typically improve as your eye heals and rarely require additional treatment.
- Blurred or fluctuating vision in the early healing period
- Hyphema, which is a small amount of blood in the front chamber of the eye
- Light sensitivity and halos or glare around lights
- A gritty or foreign-body sensation in the eye
- Temporary fluctuations in eye pressure
More serious complications are uncommon, but they can occur with any eye surgery. We monitor you closely at every follow-up visit to detect and address any concerns early.
- Endophthalmitis, which is a serious infection inside the eye requiring urgent treatment
- Persistent inflammation or corneal swelling
- Significant or prolonged spikes in eye pressure
- Device obstruction, malposition, or movement from the original placement site
- Peripheral anterior synechiae, which refers to scar tissue that can block the drainage angle
- Choroidal effusion or hemorrhage, which involves fluid or bleeding behind the retina
- The need for additional glaucoma surgery if pressure is not adequately controlled
MIGS offers meaningful benefits for the right patients, but it is important to understand what these procedures can and cannot accomplish. Pressure reduction is typically moderate rather than dramatic, and results vary by device, anatomy, and individual healing response.
Some patients will continue to need glaucoma medications after surgery, and others may require additional treatment in the future if pressure rises or the disease advances. Setting realistic expectations before surgery leads to greater satisfaction with the outcome.
Recovery and Follow-Up Care
Recovery from combined surgery is similar to cataract surgery alone in many ways, though your follow-up visits will also monitor eye pressure and glaucoma status. Following our instructions closely during recovery is one of the most important things you can do to support a good outcome.
Your vision will likely be blurry immediately after surgery, and you may notice halos around lights or mild redness in the eye. These effects typically improve within the first day or two as healing begins.
Mild discomfort, a gritty sensation, and light sensitivity are normal early on. Resting with your head slightly elevated and wearing the protective eye shield we provide, especially while sleeping, helps protect your eye during this initial phase.
We will prescribe antibiotic drops to prevent infection and anti-inflammatory drops to reduce swelling inside the eye. Depending on your pressure readings, we may also continue or adjust your glaucoma medications.
- Use all drops exactly as prescribed, even if your eye feels comfortable
- Wait at least five minutes between different types of eye drops
- Wash your hands before touching the drop bottle or your eye area
- Keep a written schedule if you are managing multiple drop types
Avoid heavy lifting, bending at the waist, or straining for at least one week after surgery, as these activities can temporarily raise eye pressure. Swimming, hot tubs, and dusty or dirty environments should be avoided until we clear you, which is typically one to two weeks after the procedure.
Most patients return to light activities such as reading or watching television within a day or two. Driving is permitted once your vision has stabilized and we confirm it is safe, often within a few days to one week.
Your first follow-up appointment typically occurs 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 as expected.
Additional visits over the following weeks and months allow us to monitor pressure trends and adjust your treatment if needed. Long-term success depends on consistent monitoring and maintaining pressure within a safe range.
Serious complications after surgery are rare, but certain symptoms should never be ignored. Contact our office immediately or seek urgent evaluation if you notice any of the following.
- Sudden or significant decrease in vision, or new floaters and flashes of light
- Severe eye pain or a sudden headache
- Pain that worsens alongside worsening vision and does not improve day to day
- Increasing redness, swelling, or discharge from the eye
- Extreme light sensitivity or a cloudy, hazy appearance to your vision
- Nausea or vomiting accompanied by eye discomfort
Frequently Asked Questions
These answers address common questions that go beyond what is covered in the sections above, including guidance on decision-making, realistic expectations, and what to do if things do not go as planned.
Adding MIGS does introduce some additional risks compared to cataract surgery by itself, though the overall safety profile remains favorable for appropriately selected patients. The most notable added risks include a higher chance of temporary bleeding in the front of the eye, short-term eye pressure fluctuations, and device-related complications such as malposition. The specific risk profile depends on which MIGS technique we use and the unique characteristics of your eye. We review all of this with you in detail before you decide whether to proceed.
Many patients can reduce the number of drops they use after combined surgery, but complete elimination of medications is not guaranteed for everyone. The amount of pressure lowering varies by device, technique, and individual healing. We monitor your pressure closely at follow-up visits and adjust your medications based on what your optic nerve requires, not on a standard formula.
Most MIGS procedures provide sustained pressure reduction for several years, though durability varies considerably by device type, individual anatomy, and how the eye heals over time. Some patients maintain good pressure control for five years or longer, while others may experience a gradual rise in pressure as scarring or disease progression occurs. Regular follow-up appointments are the most reliable way to detect any changes early and adjust treatment before the optic nerve is harmed.
If your eye pressure remains above your target after surgery, there are several next steps available. We may add or increase glaucoma medications, consider a laser treatment to improve drainage further, or discuss a secondary glaucoma procedure if the situation calls for it. An elevated pressure after surgery does not mean the combined approach failed, it simply means we need to adjust the treatment plan to reach your goal. Protecting the optic nerve remains the priority at every stage.
There are meaningful alternatives depending on your glaucoma type, severity, and overall eye health. Cataract surgery alone can modestly lower eye pressure in some patients, particularly those with angle-closure glaucoma. Continuing or modifying your current glaucoma drops is always an option, as is selective laser trabeculoplasty, a procedure that uses laser energy to improve drainage through the eye's natural meshwork. For advanced glaucoma, traditional surgeries such as trabeculectomy or a tube shunt may offer more robust pressure lowering. Some patients also choose a staged approach, having cataract surgery first and then addressing glaucoma separately afterward if needed. We will review all suitable options with you at your evaluation.
In many cases, yes. Premium lens implants, including extended depth-of-focus lenses that reduce reliance on reading glasses, can be used during combined cataract and MIGS surgery. However, because glaucoma can affect visual quality and contrast sensitivity, we carefully assess whether a premium lens is likely to meet your expectations before recommending one. The final decision depends on the health of your optic nerve, the stage of your glaucoma, and the realistic visual outcomes we can anticipate for your individual situation.
Talk to Our Team About Your Options
If you have been diagnosed with both cataracts and glaucoma, our specialists are here to help you understand whether combined surgery is the right path forward for you. We take the time to thoroughly evaluate your eye health, explain every option in plain language, and build a treatment plan around your specific goals and needs. Our team is committed to protecting your vision and making your care as straightforward and comfortable as possible. We look forward to seeing you and answering every question you have.
