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Micro Incisional Glaucoma Surgery (MIGS)

If you have been diagnosed with glaucoma, you may have heard of micro incisional glaucoma surgery, also known as MIGS, one of the latest treatments for glaucoma. Although there is currently no cure for glaucoma, it is extremely important to treat and control the disease in order to prevent vision loss. Sierra Nevada Eye Center remains committed to providing the latest cutting-edge technology to our patients. Dr. Wolff was the first surgeon in northern Nevada to implant the iStent, iStent Inject, and Hydrus microstent.

What Is Micro Incisional Glaucoma Surgery?

MIGS is a group of surgeries that are designed to lower eye pressure for individuals who have glaucoma, all with fewer possible complications. Traditional glaucoma surgeries, such as a trabeculectomy or external tube shunts, can lead to complications such as discomfort, abnormally low eye pressure, and eye infections. MIGS procedures use devices that are microscopically sized to work in tandem with tiny incisions, resulting in higher safety and fewer complications than typically experienced with traditional invasive glaucoma procedures. These can be performed at the same time as cataract surgery in most cases. Common MIGS procedures include the iStent shunt, Hydrus microstent, ABiC (ab internocanaloplasty), GATT (gonioscopy-assisted transluminal trabeculotomy), and Kahook Dual-Blade. Both Dr. Wolff and Dr. Westafer are experienced in nearly all of the various MIGS procedures.

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Common MIGS procedures include the iStent shunt, Hydrus microstent, ABiC (ab interno canaloplasty), GATT (gonioscopy-assisted transluminal trabeculotomy), and Kahook Dual-Blade. Dr. Wolff is the first surgeon to perform the iStent procedure in northern Nevada, and both Dr. Wolff and Dr. Westafer are experienced in nearly all of the various MIGS procedures. If you have glaucoma, consult our surgeons to see if there is a MIGS procedure appropriate for you.

iStent® Trabecular Micro-Bypass


Technology has always played an important role in eye care and the treatment of eye diseases. For those ready to undergo cataract surgery advanced technology is now available that can also help manage mild-to-moderate open-angle glaucoma. Advancements in technology allow your surgeon to add another step to your cataract surgery that will allow you to treat your open-angle glaucoma in a completely new way. This is important because once glaucoma diagnosed, most patients spend the rest of their lives putting one, two or even three different kinds of drops in every day. Unfortunately, all of these drops are not only inconvenient, but can also be very expensive. The iStent Trabecular Micro-Bypass Stent is designed to reduce your eye pressure and you can have it done at the same time you have cataract surgery.

One small implant can deliver big results in mild-to-moderate open-angle glaucoma
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While mild-to-moderate open-angle glaucoma is very common, many people are unaware of their condition, especially in the early stages, when their vision may be unaffected. In many people, open-angle glaucoma is characterized by an increase in the intraocular pressure (IOP) of your eye. This pressure is caused by the buildup of fluid within the eye. In most cases, glaucoma progresses slowly, but its damage is irreparable.

The world’s tiniest medical device—iStent—is 20,000 times smaller than the intraocular lenses (IOL) used in your cataract surgery. But the size of iStent is only part of its story. By increasing the eye’s ability to drain fluid, this technology is designed to reduce the pressure in your eye.

In a U.S. clinical study, 68% of glaucoma patients who received iStent remained medication free at 12 months while sustaining a target IOP of ≤ 21 mm Hg vs. only 50% of patients who underwent cataract surgery alone.

iStent works like the stents used to prevent heart attacks and strokes. When blood vessels get clogged, a stent creates access to the vessel flow. While a highly innovative technology, how iStent works is very similar:

  • If you have glaucoma, over time the eye’s natural drainage system becomes clogged
  • iStent creates a permanent opening through the blockage to improve the eye’s natural outflow
  • Restoring this mechanism lowers and controls pressure within the eye.

iStent is implanted during your cataract surgery procedure. Once implanted, iStent will begin working to safely and effectively manage pressure. What’s more, patients who receive iStent may experience a reduction in glaucoma medications; but this will be at the discretion of your surgeon.