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Protect your vision — with a gentler approach.

If eye drops and SLT laser haven’t been enough to control your eye pressure — or if the daily drop routine is affecting your quality of life — minimally invasive glaucoma surgery (MIGS) may be the next step.

Dr. Rebecca Dale performs MIGS procedures at an outpatient surgery center, both as a standalone procedure and combined with cataract surgery. These aren’t the traditional glaucoma surgeries of the past — they’re gentler, recover faster, and are designed to lower your pressure while simplifying your daily routine.

If you’re tired of the daily drop routine — the cost, the irritation, the redness — or if your drops simply aren’t keeping your pressure where it needs to be, MIGS may be the right next step.

Request a Consultation or call 425.831.2020
Active older man outdoors, living well with managed glaucoma

How MIGS Works

MIGS uses microscopic tools and tiny incisions to improve the way fluid drains from your eye, lowering the pressure that damages your optic nerve. Here’s what you should know:

  • Outpatient procedure — you go home the same day
  • Performed under mild sedation, similar to cataract surgery
  • Most procedures take 15–30 minutes
  • Recovery is typically days, not weeks
  • Goal: lower eye pressure and reduce (or eliminate) daily eye drops

Where MIGS fits in your treatment pathway

MIGS is typically the next step when eye drops and SLT laser treatment aren’t keeping your pressure at a safe level — or when the side effects or burden of daily drops are affecting your quality of life. It’s not usually the first treatment for glaucoma, but when earlier options aren’t enough, MIGS can make a meaningful difference.

Not sure where you are in that pathway? Our glaucoma page walks through how we diagnose and monitor glaucoma, and what the treatment steps look like.

Request a Consultation or call 425.831.2020

Why Reducing Drops Matters

If you’ve been using glaucoma drops for years, you may have come to accept the burning, redness, or irritation as just part of the deal. But those aren’t minor inconveniences — they’re real side effects, and they add up over time.

What drops can do to your eyes: Most glaucoma drops contain preservatives that, with long-term use, can damage the surface of your eye. Many patients on chronic drops develop dry eye disease — not from their glaucoma, but from the drops themselves. You may notice redness, a gritty feeling, skin darkening around your eyes, or eyelash changes. These effects tend to get worse the longer you’re on drops and the more medications you use.

What drops can do beyond your eyes: Some glaucoma medications — particularly beta-blocker drops — can affect the rest of your body too. Fatigue, low energy, changes in heart rate, breathing difficulties, and mood changes are all possible. Many patients don’t connect these symptoms to their eye drops, but the medication absorbs into your bloodstream through the tissue around your eyes.

The adherence reality: Even with the best intentions, sticking to a daily drop schedule is hard. Studies show that patients have their drops available only about two-thirds of the time — meaning for significant stretches, the pressure in your eye isn’t being controlled. Missed doses aren’t a character flaw; they’re a reality of life. But uncontrolled pressure means ongoing damage to your optic nerve.

Reducing your drop burden isn’t just about convenience — it’s about protecting your eye surface, reducing systemic side effects, and making sure your pressure is actually controlled consistently. That’s the real value of MIGS.

Woman reading comfortably with glasses, enjoying clear vision after glaucoma treatment

Your MIGS Options

Dr. Dale will recommend the right procedure — or combination — based on your type of glaucoma, your eye pressure history, what treatments you’ve already tried, and your anatomy. Here’s an overview of what we offer:

iStent (Microstent)

A tiny titanium stent — the smallest medical device ever approved by the FDA — placed inside your eye’s natural drainage channel. It creates a permanent bypass for fluid to flow more freely, lowering eye pressure. You won’t see or feel it once it’s placed.

The iStent can be implanted during cataract surgery, and the newer iStent infinite is FDA-approved as a standalone procedure — meaning it’s an option even if you’ve already had cataract surgery or don’t need it.

TrabEx (Goniotomy)

Using a specialized blade, Dr. Dale removes a small strip of the trabecular meshwork — the eye’s internal drainage tissue that often becomes clogged in glaucoma. This opens up the natural drainage pathway.

iTrack (Canaloplasty)

A microcatheter is threaded through your eye’s natural drainage canal (Schlemm’s canal) to open and flush it. Think of it like clearing a blocked pipe — the canal is dilated so fluid can drain more efficiently.

Can be performed alone or combined with goniotomy for a more comprehensive result.

Canaloplasty + Goniotomy (Combined)

For some patients, combining canaloplasty with goniotomy gives the best pressure reduction — opening the drainage canal and removing the clogged tissue in one procedure. Dr. Dale will discuss whether a combined approach makes sense for your situation.

iDose (Sustained-Release Implant)

A tiny implant placed inside the eye that continuously delivers glaucoma medication for up to three years — giving you the effectiveness of the medication without the irritation to your eye surface or the need to remember a daily routine. When it’s no longer effective, it can be replaced.

This is a good option for patients who have difficulty with drop schedules, experience side effects from drops, or want to simplify their daily routine.

Need cataract surgery too? If you have both glaucoma and cataracts, Dr. Dale can often perform MIGS at the same time as your cataract surgery — one trip to the surgery center, one recovery. Combining the procedures is often ideal because cataract surgery itself lowers eye pressure, and adding MIGS provides an additional benefit on top of that.

Every patient’s glaucoma is different. Dr. Dale will evaluate your eyes, review your treatment history, and recommend the approach that gives you the best chance of long-term pressure control — whether that’s a standalone procedure, a combined approach with cataract surgery, or a combination of MIGS techniques.

Is MIGS Right for You?

MIGS works best for patients with mild to moderate open-angle glaucoma — the most common type. It’s not for every patient or every stage of glaucoma, but for the right candidate, it can meaningfully lower eye pressure and simplify treatment.

You may be a good candidate for standalone MIGS if:

  • You’ve already had cataract surgery and need better glaucoma control
  • Your eye pressure isn’t well controlled by drops or SLT laser alone
  • You’re experiencing side effects from your glaucoma drops — redness, irritation, fatigue, dry eye, skin changes
  • You have difficulty keeping up with your drop schedule — missed doses mean uncontrolled pressure
  • You want to reduce the number of medications you use every day

You may be a good candidate for MIGS combined with cataract surgery if:

  • You have both glaucoma and cataracts that are affecting your vision
  • You’re already planning cataract surgery and want to address your glaucoma at the same time
  • You’d like to reduce your drop burden while also improving your vision — in one procedure

MIGS works best for mild to moderate open-angle glaucoma. It isn’t right for every patient or every stage of the disease — some patients need more aggressive treatment, and others may do fine with drops and monitoring. Dr. Dale will evaluate whether MIGS is appropriate based on your specific situation — your type of glaucoma, your pressure trends, your optic nerve health, and what you’ve already tried.

If you’re not sure where you stand, start with a glaucoma evaluation. Our team will assess your eyes and help you understand your options.

Request a Consultation or call 425.831.2020

Common Questions About MIGS

Maybe. Many patients reduce the number of drops they use, and some are able to stop drops entirely. But the honest answer is that the goal of MIGS is lower eye pressure and fewer medications — not necessarily zero drops. Dr. Dale will set realistic expectations based on your specific situation so you know what to expect going in.

Yes, absolutely. Standalone MIGS is specifically designed for patients who’ve already had cataract surgery (or who don’t need it). In fact, that’s the primary situation where standalone MIGS is performed. Your previous cataract surgery doesn’t limit your options.

MIGS procedures are gentler, have a faster recovery, and carry a lower risk profile than traditional glaucoma surgeries like trabeculectomy or tube shunts. Traditional surgery is typically reserved for advanced or aggressive glaucoma. MIGS is designed for mild-to-moderate glaucoma and works with your eye’s natural drainage system rather than creating an entirely new drainage pathway.

Most patients return to normal activities within a few days. Dr. Dale will give you specific activity restrictions based on your procedure — some procedures require avoiding heavy lifting for a period of time. The main rules: don’t rub your eye, follow your drop schedule, and come to your follow-up appointments.

They’re not “bad” — they work, and for many patients they’re the right treatment. But they’re not harmless either, especially over years of daily use. The preservatives in most glaucoma drops can damage your eye surface over time, causing or worsening dry eye. Some drops cause skin darkening around the eyes, eyelash changes, or chronic redness. And certain classes — beta-blockers in particular — can affect your energy, heart rate, breathing, and mood.

Many patients have been on drops so long they’ve stopped noticing the side effects, or they assume the burning and redness are just part of having glaucoma. They’re not — they’re often from the drops themselves. If that sounds familiar, it’s worth having the conversation about whether MIGS could reduce or replace your medications.

Yes, and it’s often the ideal scenario. Cataract surgery by itself lowers eye pressure somewhat, and adding MIGS provides an additional benefit on top of that — all in one trip to the surgery center, one recovery. For patients with both glaucoma and visually significant cataracts, a combined procedure can simplify your care and give you a meaningful step down in medications. Dr. Dale will recommend the best approach based on your eyes and your goals.

→ Learn more about cataract surgery

It varies by procedure. iStent and goniotomy effects are generally long-lasting. iTrack canaloplasty results can be durable as well. The iDose implant delivers medication for up to three years and can be replaced when needed.

Regardless of the procedure, our team monitors your glaucoma over time — eye pressure, optic nerve imaging, visual fields — the full picture. How that looks day-to-day depends on you. Some patients come to us specifically for Dr. Dale’s surgical expertise and continue seeing her regularly alongside one of our optometrists. Others have an established relationship with one of our ODs who manages their glaucoma and brings Dr. Dale in when surgery becomes the right next step. Either way, your care is coordinated across a team that knows your eyes, your history, and your goals — because glaucoma management is a long-term relationship, not a one-time fix.

Just let us know you’re interested — you can click the button below to request a consultation and Sabrina, our surgery coordinator, will be in touch. Or call any of our three locations directly. We’ll take it from there, including getting any records we need from your referring doctor. You don’t need to do anything special.

Your Glaucoma Surgeon

Dr. Rebecca Dale, MD — Glaucoma Surgeon

Dr. Rebecca Dale, MD

Ophthalmologist & Glaucoma Surgeon

Dr. Dale performs all MIGS procedures at Arbor Eyecare, including iStent, iStent infinite, TrabEx goniotomy, iTrack canaloplasty, and iDose. She’ll evaluate your options, recommend the right approach, and be with you through recovery.

Your Glaucoma Care Team

Our optometrists are comprehensive eye care providers who manage glaucoma, perform post-operative follow-up visits, and take care of everything else — glasses, contacts, dry eye, and more. Whether your ongoing glaucoma care is with Dr. Dale, one of our ODs, or a mix of both, our doctors work as a team.

Dr. Elizabeth Stern-Green

Dr. Stern-Green, OD

Optometrist

Comprehensive eye care & glaucoma management

 Dr. Jaime Wang

Dr. Wang, OD

Optometrist

Comprehensive eye care & glaucoma management

 Dr. Mallory Troyer

Dr. Troyer, OD

Optometrist

Comprehensive eye care & glaucoma management

 Dr. Aleksandra Stratton

Dr. Stratton, OD

Optometrist

Comprehensive eye care & glaucoma management

Request a Glaucoma Surgery Consultation

Fill out the form below and Sabrina, our surgery coordinator, will be in touch.

Thank you!

Sabrina, our surgery coordinator, will be in touch to answer your questions and schedule your consultation.

Prefer to call? Reach us at 425.831.2020

No referral needed. New patients always welcome.

Related: Understanding glaucoma • SLT laser treatment • Cataract surgery — if you need both • Comprehensive eye exam

Medically reviewed by Dr. Rebecca Dale, MD — April 1, 2026