Combined Cataract Surgery and MIGS: Treating Two Conditions at Once
What Is Combined Cataract Surgery and MIGS?
Combined cataract surgery with MIGS addresses two distinct problems during one carefully planned operation. Understanding how each part works helps you feel confident going into your evaluation.
During the cataract portion of the procedure, your surgeon removes the cloudy natural lens inside your eye and replaces it with a clear artificial lens called an intraocular lens (IOL). This restores sharpness and brightness to your vision. The procedure uses a very small incision and is one of the most commonly performed surgeries in medicine.
Minimally invasive glaucoma surgery is performed during the same operation, typically through the same small incision used for cataract removal. Your surgeon inserts a tiny device or creates a microscopic pathway to help fluid drain more easily from your eye.
By improving drainage, MIGS lowers intraocular pressure (the pressure inside your eye), which is the primary goal of any glaucoma treatment. These techniques are designed to be gentle on eye tissue and cause significantly less trauma than traditional glaucoma surgeries.
Several different MIGS techniques and devices may be used during combined surgery, and each works through a slightly different mechanism to improve fluid drainage.
- Trabecular bypass micro-stents that create a pathway through the eye's natural drainage meshwork
- Goniotomy or trabeculotomy, which removes tissue that blocks proper drainage
- Canaloplasty or viscodilation to open the eye's internal drainage canal
- Suprachoroidal approaches that redirect fluid between layers of the eye
- Subconjunctival microshunts for controlled outflow in carefully selected cases
Dr. Sarah Anis, our cataract and glaucoma surgeon, will recommend a specific approach based on your type of glaucoma, your eye anatomy, your target pressure, and the health of your optic nerve. Not every technique is appropriate for every patient.
Scheduling one surgery instead of two saves time, reduces your total recovery, and lowers the cumulative risk associated with multiple procedures. For patients managing both cataracts and glaucoma, the combined approach offers real practical benefits.
- One operation instead of two separate surgeries
- A single recovery period with one set of post-operative instructions
- Potential to reduce or eliminate daily glaucoma eye drops
- Lower overall surgical risk compared to two staged procedures
It is important to note that not all patients achieve medication freedom after combined surgery, and some may still need ongoing glaucoma treatment.
Who Is a Good Candidate for Combined Surgery?
Combined cataract surgery with MIGS is not the right choice for every patient, but for many people it offers a meaningful advantage. Candidacy depends on several factors that we assess together during your consultation.
If you carry diagnoses of both cataracts and glaucoma, you may be an excellent candidate for combined surgery. Both conditions become more common with age, so it is not unusual for them to occur together.
Eligibility depends on your specific type of glaucoma, the anatomy of your drainage angle, the severity of your disease, and your individual pressure goal. Angle-closure glaucoma, certain secondary glaucomas, active inflammation, or very advanced disease requiring aggressive pressure lowering can affect whether MIGS is the right fit for your situation.
MIGS procedures tend to work best when glaucoma is in its early or moderate stages. The pressure lowering these devices provide is typically modest to moderate, which is often enough when significant optic nerve damage has not yet occurred.
- Early-stage glaucoma with minimal optic nerve damage
- Moderate glaucoma that is stable on medications
- Patients whose visual field loss remains limited
- Target eye pressures that align with the expected effect of the chosen MIGS technique
If you currently use one or more glaucoma drops every day, combined surgery may help reduce your dependence on those medications. Many patients find daily drops inconvenient, costly, or irritating to the surface of their eyes.
MIGS offers a way to help control pressure from the inside, reducing the load on your daily medication routine. Some patients still need drops after surgery, but often fewer than before.
Even if your glaucoma is currently well controlled on drops, you may prefer to lower your dependence on medications over the years ahead. Fewer medications mean fewer side effects, lower costs, and less risk of missed doses, which are real concerns for long-term glaucoma management.
Combining MIGS with an already-planned cataract surgery is a natural opportunity to work toward that goal without adding a separate procedure.
How We Evaluate Whether Combined Surgery Is Right for You
Our evaluation process is thorough and personalized. We use several diagnostic tools to understand the full picture of your eye health before making any recommendation.
We measure 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 and whether additional intervention is needed.
If your pressure remains above your individual target despite medications, or if we see fluctuations that could harm your optic nerve, combining MIGS with cataract surgery may offer better long-term control.
Automated visual field testing maps your peripheral (side) vision to detect any blind spots caused by glaucoma damage. You look into a machine and respond each time you see a small flash of light, and the computer creates a detailed map of your visual field.
These results help us understand the stage of your glaucoma and whether the pressure lowering a MIGS procedure provides will be sufficient. More severe visual field loss may point toward a more aggressive surgical approach.
We examine your optic nerve using a specialized microscope and take high-resolution images with optical coherence tomography (OCT), a non-invasive scan that reveals the microscopic structure of the nerve tissue. These images help us detect early thinning and track any changes over time.
- Color stereoscopic optic nerve photography to document nerve appearance
- OCT imaging to measure nerve fiber layer thickness
- Baseline imaging to compare against future scans
Gonioscopy is a painless examination that uses a special lens placed gently on the eye to let us look directly at the drainage angle, the area inside your eye where fluid exits. Most MIGS procedures target this angle, so understanding its anatomy is essential before choosing the right technique.
This examination also helps us identify what type of glaucoma you have, including whether it is open-angle, angle-closure, or a secondary form such as pseudoexfoliative or pigmentary glaucoma.
We evaluate how much the cataract is affecting your daily life, including your ability to drive safely, read comfortably, and perform other activities that matter to you. Not every cataract requires immediate surgery.
When the cataract is causing meaningful vision problems and you also have glaucoma, that is often the ideal time to combine procedures. We align the timing to serve both conditions well.
Your overall health history plays a role in surgical planning. We review any prior eye surgeries, systemic conditions like diabetes or autoimmune disease, and medications such as blood thinners that could affect healing or surgical risk.
- History of previous eye surgeries or eye injuries
- Current medications, including anticoagulants
- Chronic health conditions that may affect recovery
- Allergies to anesthesia or eye drop ingredients
What to Expect During and After Combined Surgery
Knowing what happens on the day of surgery and during recovery helps reduce anxiety and sets you up for the best possible outcome. Here is what the experience typically looks like.
Before your procedure, we will give you detailed instructions about which medications to continue or pause on the morning of surgery and when to stop eating or drinking. Your surgeon may also prescribe preoperative eye drops depending on your specific protocol.
Plan to have someone drive you home afterward, since your vision will be blurry and you will not be able to drive on the day of surgery. Wear comfortable clothing and leave jewelry and valuables at home.
You will lie comfortably on a reclining surgical bed while the area around your eye is cleaned and covered with sterile drapes. A surgical microscope allows your eye doctor to see the delicate structures inside your eye with precision.
First, your surgeon removes the cloudy cataract through a small incision and inserts the new artificial lens. Using the same or a nearby incision, the MIGS device is then placed or the drainage pathway is created. You remain awake throughout but are kept calm and comfortable with anesthesia. The combined procedure typically takes under thirty minutes.
Your vision will be blurry immediately after surgery, and mild redness, light sensitivity, or a gritty feeling is normal in the first day or two. Rest with your head elevated and wear the protective eye shield we provide, especially while sleeping.
You will use antibiotic drops to prevent infection and anti-inflammatory drops to reduce swelling. Continue all prescribed drops exactly as directed, even when your eye feels fine. Most patients return to light activities like reading or watching television within a day or two.
Avoid heavy lifting, bending over, or straining for at least one week after surgery, since these can temporarily raise eye pressure. Swimming, hot tubs, and dusty environments should be avoided until we specifically clear you, which is typically one to two weeks after the procedure.
Driving is permitted once your vision is stable and we confirm it is safe, often within the first week. We will guide you clearly at each follow-up visit.
Your first follow-up appointment usually occurs within one to two days of surgery. We check your vision, measure your eye pressure, and examine the surgical area to make sure healing is progressing well.
Additional visits over the following weeks and months allow us to monitor pressure trends and adjust your glaucoma medications if needed. Long-term success depends on keeping pressure in a safe range and detecting any early signs of progression.
Serious complications after combined surgery are rare, but certain symptoms should never be ignored. Contact our office or seek urgent eye care right away if you experience any of the following.
- Sudden decrease in vision or new floaters or flashes of light
- Severe eye pain or a significant headache
- Pain that worsens each day rather than improving
- Increasing redness, swelling, or discharge from the eye
- Marked light sensitivity or a hazy or cloudy appearance to your cornea
- Nausea or vomiting accompanied by eye discomfort
Understanding the Risks and Limitations
Like all surgical procedures, combined cataract surgery with MIGS carries risks that deserve open discussion. We believe informed patients make better decisions and recover with greater confidence.
Most side effects after combined surgery are mild and resolve on their own as your eye heals. These are expected parts of the recovery process for many patients.
- Blurred or fluctuating vision in the days following surgery
- Hyphema, a small amount of blood in the front chamber of the eye that typically clears on its own
- Light sensitivity, glare, or halos around lights
- A mild foreign-body or gritty sensation
- Temporary eye pressure changes during healing
Although uncommon, more serious complications can occur with any eye surgery. We monitor you closely at every follow-up visit so that any concerns can be addressed quickly.
- Infection inside the eye, known as endophthalmitis, which is rare but requires urgent treatment
- Persistent inflammation or corneal swelling
- Significant or prolonged elevation of eye pressure
- Device obstruction, migration, or malposition
- The need for an additional glaucoma procedure in the future
MIGS procedures provide meaningful but modest to moderate pressure reduction. Results vary depending on the device or technique used, your individual eye anatomy, and how your eye heals over time.
Some patients will continue to need glaucoma drops after combined surgery, and others may require additional glaucoma treatment in the future as the disease progresses. Setting realistic expectations before surgery leads to greater satisfaction with the outcome.
Frequently Asked Questions
These answers address common questions that go beyond the explanations provided above, to help you think through your decision and know when to reach out to us.
Adding MIGS to cataract surgery does introduce some additional risk, though the overall safety profile remains favorable for most eligible patients. You may have a somewhat higher chance of temporary bleeding in the front of the eye, short-term pressure fluctuations, or mild inflammation compared to cataract surgery by itself. The specific risk profile depends heavily on which MIGS technique is chosen and your individual anatomy. Discussing your full risk picture with Dr. Sarah Anis before surgery ensures that you can weigh the benefits against those risks for your specific situation.
Many patients reduce the number of drops they need, but not everyone can stop medications entirely. Because the amount of pressure lowering varies by technique and individual response, we monitor your pressure closely after surgery and adjust your regimen accordingly. If your pressure rises over time, we may restart or add medications rather than leaving the nerve unprotected. Think of MIGS as a tool that can lighten the medication burden rather than a guaranteed replacement for all drops.
Most MIGS devices provide sustained pressure reduction for several years, and some patients maintain good control for five years or longer. Over time, however, scarring around the device or natural disease progression can cause pressure to rise again. The durability of the effect varies from person to person, which is one reason regular follow-up visits matter so much even when things appear to be going well. Catching a gradual rise in pressure early gives us far more treatment options.
Advanced glaucoma with significant optic nerve damage or very high pressures generally calls for a more powerful pressure-lowering procedure than MIGS can provide. In those cases, we may recommend a traditional filtering surgery such as a trabeculectomy or a tube shunt implant to achieve the degree of pressure control needed to protect what vision remains. For some patients with moderately advanced disease, the decision requires careful judgment, and we will be transparent about what MIGS can realistically accomplish for your specific stage of the disease.
If your eye pressure remains above your target after combined surgery, we have several paths forward. We can add or increase glaucoma medications, consider selective laser trabeculoplasty (SLT) to stimulate additional drainage, or discuss a second glaucoma procedure if conservative measures are not sufficient. The decision depends on how far above target your pressure is and how much optic nerve tissue remains to be protected. Our goal at every stage is to keep your pressure low enough to preserve the vision you have.
Yes, several options remain available. Cataract surgery alone can modestly lower eye pressure in some patients and may be the right first step. Continuing or adjusting your current glaucoma medications is always an option, and SLT laser treatment can be added to improve drainage without surgery. For more advanced glaucoma, trabeculectomy or tube shunt surgery offers stronger pressure control. Some patients prefer a staged approach, addressing the cataract first and then reassessing glaucoma treatment separately. We will walk through every suitable option with you so that your decision is fully informed.
Schedule Your Consultation at Rhode Island Eye Institute
If you have been diagnosed with both cataracts and glaucoma, our team of specialists is here to help you understand every option available to you. Rhode Island Eye Institute brings together fellowship-trained surgeons, advanced diagnostic technology, and a patient-centered approach to give you the comprehensive, personalized care you deserve. We would be glad to review your eye health, discuss your goals, and help you take the next step toward protecting your vision.