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Interventional Glaucoma

Interventional Glaucoma Management 
Intervening earlier, together, to preserve vision and prevent end-stage crisis management. A collaborative referral pathway designed around you and your patient.
Refer a Patient
Our Approach

Treating Glaucoma earlier, together

Interventional glaucoma shifts the treatment paradigm from reactive, traditional models towards preventative, proactive intervention. Our goal is to establish effective therapy sooner, in partnership with referring doctors, to mitigate future progression and avoid end-stage crisis management.

Patients have the best chance of preserved vision when treatment halts progression before significant damage occurs. That is the framework we apply to every referral and every co-management relationship.

Referral Criteria

When should a patient be referred to MHEI?

Any of the clinical scenarios below may warrant referral for interventional glaucoma evaluation.

Refer a Patient
Noncompliance or intolerance to current medications
  • Responded to PGA but could not tolerate the topical side effects
  • Physical or cognitive limitations that make drop instillation difficult
  • Coexisting ocular surface disease
Higher risk of progression
  • Drance hemorrhage
  • Strong family history
  • Secondary glaucoma
A cataract that may qualify for surgery
Combined phaco–MIGS consideration allows a single intervention to address both lens opacity and IOP control.
Traditional therapy is failing
  • Progressive structural or functional changes
  • Lifestyle-limiting drop compliance (e.g., shift work, frequent travel)
  • Patient needs further IOP control despite established topical therapy
Angle closure
Patients with narrow or occludable angles who may benefit from LPI or other angle-based interventions.
Newly diagnosed, not yet on therapy
When the referring clinic does not perform SLT, we can initiate first-line laser therapy and return the patient to you for ongoing care.
Interventional Glaucoma Procedures

The Right Intervention at the Right Stage

Recommendations by Stage and IOP Goal

Explore each procedure in our interventional glaucoma toolkit. Treatment is tailored to disease stage, target pressure, and patient-specific factors.

SLT
initial therapy
Durysta
Early / Moderate
iDose
iStent Infinite
MIGS
Canaloplasty
Goniotomy
MIBS
Failing Tm
Initial Therapy · Laser

SLT

Selective Laser Trabeculoplasty

First-line therapy for newly diagnosed POAG, pseudoexfoliation/PXG, and high-risk ocular hypertension. Also recommended as the next step prior to adding medications for patients already on topical therapy.

1st-line therapy
POAG · PXG · OHTN
In-clinic
Laser-based

Ideal Candidates:

  • Newly diagnosed POAG
  • Pseudoexfoliation/PXG
  • High-risk OHTN

Supplemental When:

  • Very high starting pressure (>30 mm Hg)
  • Advanced disease at diagnosis
  • Very low starting pressure (<16 mm Hg)
  • PDS/PDG: role depends on active pigment shedding (LPI may apply)
Early/Moderate · Sustained-Release

Durysta

Dissolvable bimatoprost implant placed in the anterior chamber. For patients with an open angle who are candidates for PGA therapy, they may be phakic or pseudophakic.

−5 to −8
mm Hg reduction
24.5
mean baseline IOP
(pre-treatment/washout)
3 months
FDA-approved duration

Real-World Durability:

  • 50% of patients require a restart of meds or further intervention by 6 months
  • 74% reached 12 months without additional intervention in a separate study

Setting:

  • Implanted in the clinic or Ambulatory Surgery Center
  • Same indications/contraindications as topical PGA
  • Requires an open angle
Early/Moderate · Sustained-Release

iDose TR

Titanium travoprost-eluting implant anchored to the scleral wall in the anterior chamber. Longer-duration therapy for patients seeking drop independence.

6.6 to −8.4
mm Hg from baseline
24
mean baseline IOP
(pre-treatment/washout)
2 years
FDA-approved duration

Considerations:

  • May be visible to the patient or others
  • Anchored in the anterior chamber — permanent placement

Setting:

  • Implanted in Ambulatory Surgery Center
MIGS · Trabecular Microbypass

iStent Infinite

Three trabecular microbypass stents. It can be performed as a standalone MIGS procedure or combined with cataract surgery.

76%
of eyes achieved ≥20% IOP reduction (standalone)
3 Stents
Trabecular microbypass

Standalone Indication:

  • Patients who have failed prior surgical intervention (including SLT)

With Phaco:

  • Mild-to-moderate POAG based on visual field
  • Currently on topical medications

Contraindications / Non-Covered:

  • Traumatic or uveitic glaucoma
  • Narrow or closed-angle glaucoma
  • Glaucoma suspect, OHTN
  • Pseudoexfoliation, pigmentary glaucoma
MIGS · Canal-Based

Canaloplasty

Viscodilation of Schlemm's canal using OMNI, ABiC, Streamline, and Via360. It may be performed alone or supplemented with 90–180° goniotomy and can be standalone or combined with cataract surgery, but it is a better option for those earlier in the disease.

28%
IOP reduction
Any stage
Of glaucoma

Outcomes:

  • Typically achieves mid-upper teens; lower teens with continued medication

Contraindications:

  • Neovascular glaucoma (NVG)
  • Chronic angle closure or narrow angles
  • Previous MIGS implants in the same quadrant
  • Higher rate of post-op hyphema formation
MIGS · Angle-Based

Goniotomy

Strips 90–360° of trabecular meshwork from Schlemm's canal using GATT, Kahook Dual Blade, OMNI, or BANG. Performed at any stage of disease, standalone or combined.

28–46%
IOP reduction (range)
Any stage
Of glaucoma

Outcomes:

  • Typically achieves mid-upper teens; lower teens with continued medication
  • Can be performed standalone or combined with phaco

Considerations:

  • Higher rate of post-op hyphema formation
Failing Trabecular Meshwork

MIBS

Microinvasive Bleb-Forming Surgery

Creates a subconjunctival bleb space that bypasses the trabecular meshwork. Examples include the XEN gel stent and the Aqualumen filtering procedure. Can be combined with phaco.

56%
IOP reduction (range)
Low teens
target IOPs

Indications:

  • Patients who have failed previous surgeries or medications

Advantages:

  • Faster recovery than traditional filtering surgeries
  • Lower complication rates
  • Less invasive technique

Reducing End-Stage Glaucoma Surgery Through Interventional Care and Collaboration

Severe or refractory disease may still require tube shunts or trabeculectomy — but our goal, through interventional methodology, is to reduce the need for end-stage intervention. Between each step, medications serve as a bridge and supplemental therapy. This is where collaborative care benefits the patient most.

Refer a Patient
Your Referral Partners

Meet our glaucoma specialists

 Refer a Patient

Zachary Vest, MD

Cataract & Glaucoma Surgeon

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Marshall J. Huang, MD

Cataract & Glaucoma Surgeon

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Collaborative Care

Co-Management, Your Way

Every clinic and practitioner has different preferences for co-managed care. Our approach is shaped around the preferences of each referring provider.

Select the option that fits your practice, and we'll follow your lead.

Submit Your Preferences Now
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