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MIGS is a category of newer glaucoma procedures that use micro-incisions and micro-devices to lower intraocular pressure. Compared with traditional glaucoma surgeries like trabeculectomy or tube shunts, MIGS carries a significantly lower risk profile, faster recovery, and can often be performed at the same time as cataract surgery. MIGS is appropriate for patients with mild to moderate open-angle glaucoma who want to reduce their dependence on glaucoma drops or need additional pressure control beyond what drops alone provide.
The iStent inject W (manufactured by Glaukos) is the smallest medical device implanted in the human body. During cataract surgery, Dr. Collett places two tiny titanium stents into the trabecular meshwork - the eye's natural drainage structure. The stents bypass areas of resistance and allow aqueous humor to drain more efficiently, lowering intraocular pressure. The procedure adds only a few minutes to the cataract surgery itself. Most patients see reduced reliance on glaucoma drops within weeks of the procedure.
Durysta (bimatoprost implant, by AbbVie/Allergan) is a dissolvable micro-implant that delivers a sustained-release dose of bimatoprost directly inside the eye. A single in-office injection provides pressure-lowering medication for approximately 4 months per implant. Durysta is ideal for patients who have trouble remembering drops, have dry eye that worsens with preserved drops, or simply prefer not to rely on daily medication. The injection itself takes a few minutes and can be done in-office without surgery.
MIGS is not a cure for glaucoma. Glaucoma is a chronic condition that is managed, and MIGS is one tool for pressure management. You'll continue seeing Dr. Collett for regular glaucoma monitoring (visual field testing, OCT, IOP checks).
Drops are first-line therapy for most glaucoma patients. They work well for many people. For others, drops become a daily burden: two or three medications, multiple times per day, often causing dry eye, redness, or lash/iris pigmentation changes. Adherence drops over time - studies consistently show 30-40% of patients stop their drops within a year. MIGS offers an alternative or supplement: reduce the drop burden by achieving pressure control through a device or sustained-release implant rather than daily medication. Dr. Collett will review your specific pressures, drop regimen, and disease progression to recommend whether drops, MIGS, or a combination is right for you.
The most common MIGS indication is a patient who has both glaucoma and a visually significant cataract. Combining iStent with cataract surgery is convenient (single trip to the surgery center), covered by Medicare and most commercial insurers, and carries outcome data showing meaningful pressure reduction in many patients. The cataract recovery and MIGS recovery overlap, so there is effectively no added post-op burden from the MIGS portion.
iStent is added to your cataract surgery. After the cataract is removed and the IOL is implanted, Dr. Collett uses a specialized gonioscopy view of the angle to place the two micro-stents into the trabecular meshwork. The procedure adds only a few minutes. Durysta is performed in the office, usually in a standard exam room: the eye is numbed, a small injector places the implant inside the eye, and you go home minutes later.
When MIGS is combined with cataract surgery, recovery follows the cataract timeline: drops for 2 to 4 weeks, activity restrictions for the first week, and a few post-op visits over the first month. Durysta recovery is minimal - a few hours of mild irritation and a few days of antibiotic drops.
Most Medicare plans and major commercial insurers cover MIGS when clinically indicated (glaucoma diagnosis, documented progression or inadequate drop control). Durysta is similarly covered under medical benefits. We verify coverage before scheduling and discuss any out-of-pocket considerations with you directly.
Minimally Invasive Glaucoma Surgery - a category of micro-incision, micro-device procedures that lower intraocular pressure with less risk than traditional filtering surgery.
Yes. iStent combined with medically-indicated cataract surgery is covered by Medicare and most major commercial insurers.
Some MIGS devices are approved stand-alone; others are FDA-approved only in conjunction with cataract surgery. Durysta is an in-office injection that does not require surgery. Dr. Collett will confirm which options apply to you.
When combined with cataract surgery, MIGS recovery mirrors cataract recovery - about 2 to 4 weeks of drops and a few post-op visits. Durysta recovery is minimal.
Typical published outcomes range from 20-30% pressure reduction for iStent, varying by individual anatomy and disease severity. Durysta provides drop-equivalent pressure control for approximately 4 months per implant.
iStent is a permanent implant and continues to work as long as the drainage pathway remains open. Durysta lasts approximately 4 months per implant and can be repeated. Glaucoma is a chronic condition that requires ongoing monitoring regardless of which treatment is chosen.
Call 281-800-1585 or request an appointment online. See also our glaucoma treatment hub. Learn more about iStent at glaukos.com and Durysta at durysta.com.
©Red Barn Media Group 2026