Glaucoma has stolen the sight of millions of Indians without warning. It operates silently — no pain, no dramatic sudden blurring — just a slow, relentless erosion of peripheral vision that, by the time most patients notice it, has already caused irreversible damage. In India alone, over 12 million people are estimated to have glaucoma, and the World Health Organisation projects that number to rise sharply as our population ages. The tragedy is not just the disease itself, but the enormous treatment gap: the majority of glaucoma patients in India remain either undiagnosed or undertreated. A surgical revolution, however, is changing that story — and at Baweja Multispeciality Hospital, Chandigarh, we are at the forefront of it.
Understanding Glaucoma: The Silent Thief of Sight
Glaucoma is not a single disease but a group of conditions characterised by progressive damage to the optic nerve — the cable that transmits visual information from the eye to the brain. In most cases, this damage is driven by elevated intraocular pressure (IOP), which occurs when the natural drainage system of the eye becomes obstructed or inefficient. Think of the eye as a sink with a running tap: aqueous humour (the clear fluid inside the eye) is continuously produced and continuously drained. When drainage slows or stops but production continues, pressure builds. That pressure, sustained over months and years, crushes the delicate nerve fibres of the optic nerve at the back of the eye.
The critical point every patient must understand is this: once optic nerve fibres are lost to glaucoma, they cannot regenerate. Vision lost to glaucoma is lost permanently. This is what separates glaucoma from most other eye conditions and makes early detection and aggressive management so vital. The good news is that if glaucoma is caught early and pressure is effectively controlled, the disease can be halted — and patients can retain functional vision for their entire lives.
In India, the burden is particularly heavy because glaucoma screening is not yet standard practice in most communities. Patients often present at hospitals only after they begin bumping into objects, missing steps, or experiencing significantly restricted visual fields — all signs of advanced disease. Regular eye check-ups, especially after the age of 40, remain the single most effective public health intervention for glaucoma.
The Problem with Traditional Glaucoma Treatment
For decades, the standard approach to glaucoma management involved a step-wise ladder: eye drops first, laser procedures second, and major surgery last. Each step has significant limitations that many patients and even some healthcare providers do not fully appreciate.
Eye drops — specifically prostaglandin analogues, beta-blockers, alpha agonists, and carbonic anhydrase inhibitors — remain the most common first-line treatment. They work by either reducing aqueous production or improving drainage. However, their effectiveness is entirely dependent on consistent daily use, often multiple times per day, for the rest of the patient's life. Studies consistently show that medication adherence in chronic conditions like glaucoma is poor: patients forget, travel, run out of drops, or experience side effects (redness, stinging, cataract acceleration, systemic effects on heart rate and blood pressure) that cause them to quietly stop using their drops. The result is fluctuating IOP control and, over time, continued optic nerve damage despite being "on treatment."
When drops fail, the traditional surgical option was trabeculectomy — a procedure that creates a new drainage pathway by surgically removing a portion of the trabecular meshwork and creating a bleb (a small fluid pocket under the conjunctiva). Trabeculectomy is effective, but it carries significant risks: bleb-related infections, hypotony (dangerously low IOP), scarring that can cause the operation to fail, prolonged recovery, and the need for careful, long-term follow-up. It is a major surgical undertaking, and many patients — particularly older adults with other health conditions — are rightly hesitant.
Enter MIGS: A New Surgical Paradigm
Minimally Invasive Glaucoma Surgery — universally abbreviated to MIGS — represents a fundamentally different surgical philosophy. Rather than creating entirely new drainage structures or sacrificing conjunctival tissue, MIGS procedures work with and enhance the eye's existing drainage anatomy through tiny incisions, advanced micro-instruments, and, in many cases, implantable devices no larger than a grain of rice.
The MIGS category encompasses several distinct surgical approaches, each targeting a different anatomical pathway:
- Trabecular MIGS: These procedures target the trabecular meshwork and Schlemm's canal — the primary drainage route of the eye. Techniques like gonioscopy-assisted transluminal trabeculotomy (GATT) and devices like the iStent inject work by either removing obstructive trabecular tissue or inserting microscopic stents that bypass blockages, dramatically improving outflow with minimal tissue disruption.
- Suprachoroidal MIGS: These procedures direct aqueous fluid through the suprachoroidal space — the potential space between the ciliary body and the sclera — providing an alternative drainage route when the conventional pathway is severely damaged.
- Subconjunctival MIGS: Devices like the XEN gel stent create a micro-bleb drainage pathway with far greater precision and far lower risk than traditional trabeculectomy, using a tiny gel tube implanted ab interno (from inside the eye) without the need for large conjunctival dissection.
What unites all MIGS procedures is their defining characteristics: incisions under 2mm, preservation of conjunctival tissue for future surgical options, rapid recovery, and a significantly lower risk profile compared to conventional filtration surgery.
The Key Benefits of MIGS: A Detailed Look
The advantages of MIGS over traditional approaches are not merely incremental — in many ways they represent a categorical improvement in the quality of surgical glaucoma care.
Micro-incision surgery (<2mm): The incisions used in MIGS are so small that they are typically self-sealing, requiring no sutures. This dramatically reduces surgical time, eliminates the risk of wound-related complications, and means there is almost no induction of astigmatism — a significant advantage for patients who also wear glasses or contact lenses.
Minimal recovery time: Unlike trabeculectomy, which requires weeks of careful follow-up to monitor bleb morphology and titrate IOP, most MIGS patients resume normal light activities within 24 hours and return to routine daily life within a few days. There is no large bleb to protect, no risk of sudden hypotony, and no complex post-operative drop regimen in most cases.
Combination with cataract surgery: This is perhaps the most clinically significant advantage in the Indian context. The vast majority of glaucoma patients in the age group most affected (over 55) also have visually significant cataracts. MIGS procedures can be performed concurrently with cataract surgery — phacoemulsification — through the same corneal incision, treating both conditions simultaneously without adding meaningful operative risk. This is a transformative option for patients who previously faced multiple separate surgeries.
Reduction in drop dependence: One of the most consistent findings in MIGS clinical research is a significant reduction in the number of eye drops patients need post-operatively. For patients struggling with adherence, side effects, or medication costs, this is life-changing. Multiple studies have demonstrated one to three fewer medications needed per day following MIGS, with IOP control equivalent to continued maximal medical therapy.
Preservation of future surgical options: Because MIGS does not disturb the conjunctiva (the membrane covering the white of the eye), it does not compromise the success of future trabeculectomy or tube shunt surgery if disease progresses. Patients retain a full surgical ladder of options — something that conventional glaucoma surgery, which consumes conjunctival tissue, does not always allow.
BAWEJA MULTISPECIALITY HOSPITAL
Don't Wait for Vision Loss — Get a Glaucoma Assessment
A comprehensive glaucoma check at BMH includes IOP measurement, optic nerve imaging (OCT), visual field testing and personalised treatment planning with Dr. Varun Baweja.
Who Is the Ideal MIGS Candidate?
MIGS is not appropriate for every glaucoma patient, and part of what makes our assessment process at BMH so important is determining the right procedure for each individual. The ideal MIGS candidate typically has mild to moderate open-angle glaucoma — the most common form — with IOP that is inadequately controlled on maximum tolerated medical therapy, or where medication adherence is problematic. Patients who are scheduled for cataract surgery and have concurrent glaucoma are excellent candidates for combined phaco-MIGS. Those with a strong desire to reduce their drop burden but not yet requiring the more aggressive pressure reduction achievable with trabeculectomy are similarly well-suited.
MIGS is generally less appropriate for very advanced glaucoma requiring extremely low target pressures (below 12 mmHg), for angle-closure glaucoma without prior laser treatment, or for eyes with severely damaged drainage anatomy. These patients may be better served by conventional filtration procedures, and our team will always recommend the most appropriate intervention based on the individual clinical picture rather than defaulting to any single technique.
MIGS at BMH Chandigarh: Dr. Varun Baweja's Approach
Dr. Varun Baweja completed his ophthalmology training in the United Kingdom within the NHS — one of the world's most rigorous and evidence-based medical systems. His exposure to advanced MIGS techniques in the UK, combined with training in high-volume surgical environments, equipped him with both the technical precision and the clinical judgment required for safe, effective minimally invasive glaucoma surgery. Since returning to Chandigarh, he has brought those standards directly to BMH — making advanced glaucoma care accessible to patients in the Tricity region without the need to travel to Delhi or Mumbai.
The pre-operative assessment protocol at BMH is comprehensive. Before any surgical recommendation is made, patients undergo a full glaucoma workup: Goldmann applanation tonometry for accurate IOP measurement, gonioscopy to directly visualise the drainage angle, optical coherence tomography (OCT) of the optic nerve and retinal nerve fibre layer for structural damage assessment, Humphrey visual field analysis to map functional loss, central corneal thickness measurement (which influences target IOP), and, where appropriate, corneal topography. This multi-modal assessment ensures that no surgery is ever offered without a complete understanding of the disease stage, anatomy, and the patient's overall ocular health.
What to Expect: The MIGS Journey at BMH
Before surgery: Once the decision for MIGS is made, patients receive a pre-operative briefing explaining every step of the procedure. Eye drops to prepare the eye are prescribed typically for a few days prior. Patients are advised to arrange transportation home and to have someone with them on the day. Anaesthetic and medical fitness are assessed if needed for older patients or those with systemic conditions.
Day of surgery: Most MIGS procedures at BMH are performed under local anaesthesia (topical eye drops and/or a small periocular injection) with the patient comfortable and awake. The procedure itself typically takes 15 to 30 minutes, depending on whether it is combined with cataract surgery. Patients rest briefly in recovery, are reviewed by Dr. Baweja before discharge, and go home the same day — there is no hospital admission required in the vast majority of cases.
Day 1 to Week 1: Some mild redness, grittiness, and light sensitivity are expected and normal. Prescribed post-operative drops (usually antibiotic and anti-inflammatory) are used regularly. Vision may be slightly blurred initially, especially if combined cataract surgery was performed, as the eye settles. Patients are reviewed at Day 1 and Day 7 for IOP check and wound inspection.
Month 1 and beyond: The majority of the healing process is complete within the first month. IOP targets are reviewed, and adjustments to the drop regimen are made based on post-operative pressure readings. Most patients experience a meaningful, sustained reduction in IOP and a reduction in the number of medications required. Long-term annual follow-up to monitor optic nerve status and visual fields remains essential — glaucoma management is a lifelong commitment, and surgery is a powerful tool within it, not a cure.
Realistic Outcomes and Expectations
Honesty is a cornerstone of care at BMH. MIGS offers excellent IOP reduction for appropriately selected patients, but it is important to set realistic expectations. Most trabecular MIGS procedures achieve an IOP reduction of 20 to 35 percent from baseline, which is meaningful and often sufficient to slow or halt optic nerve progression in mild-to-moderate disease. They are not designed to achieve the ultra-low pressures sometimes required in advanced disease, where trabeculectomy remains the gold standard. The vision that has already been lost to glaucoma will not return — but the vision that remains can be preserved. That is the goal, and with timely intervention and proper follow-up, it is an achievable one.
Frequently Asked Questions About MIGS
Is MIGS suitable for all types of glaucoma?
MIGS is most effective for primary open-angle glaucoma (POAG), the most common type. It can also be used in pigmentary glaucoma and pseudoexfoliative glaucoma. Angle-closure glaucoma typically requires a different first-line approach (laser iridotomy), though MIGS may have a role after the angle is opened. Advanced or refractory glaucoma may require conventional filtration surgery. Your assessment at BMH will determine the most appropriate approach for your specific diagnosis.
Will I be able to stop my eye drops after MIGS?
Many patients significantly reduce their drop burden after MIGS, and some may be able to come off all medications. However, this depends on your pre-operative IOP, your target pressure, and your individual surgical response. Some patients still require one drop post-operatively, which is a significant improvement from three or four. The goal of MIGS is not necessarily zero drops, but optimal IOP control with minimal medication burden and minimal surgical risk.
How long does the effect of MIGS last?
Long-term data from studies spanning five years or more show that many MIGS procedures maintain meaningful IOP reduction over extended periods. As with all glaucoma surgery, some patients may see a gradual return of IOP over years, at which point additional treatment — additional drops or further surgical intervention — may be required. Regular annual follow-up is essential to monitor long-term outcomes.
Is MIGS covered by insurance?
Coverage for MIGS varies by insurer and the specific procedure. Standard phacoemulsification combined with glaucoma procedures may be considered by some private policies. Our billing team at BMH will verify your specific coverage prior to surgery and provide a clear breakdown of any costs. We work with all major available insurers to ensure patients receive the maximum benefit.
The Most Important Thing You Can Do
The greatest enemy of good glaucoma outcomes is not the disease itself — it is delay. Glaucoma is diagnosable, manageable, and in most cases preventable from causing blindness when identified early. If you are over 40, have a family history of glaucoma, are highly myopic (short-sighted), have diabetes, or have not had a comprehensive eye examination in the past year, please book a glaucoma screening appointment. It takes less than an hour, it is painless, and it could be the most important hour you invest in your long-term vision.
At Baweja Multispeciality Hospital, Chandigarh, we offer comprehensive glaucoma assessments, advanced imaging, and the full range of MIGS procedures for eligible patients. Dr. Varun Baweja and his team are here to guide you through every step — from diagnosis to long-term care. Don't wait for symptoms. With glaucoma, by the time you notice something is wrong, significant damage may already have occurred. Act now, and protect the vision you have.