Interventional Glaucoma and Minimally Invasive Bleb Surgery
In Redwood City and the Bay Area
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Treating glaucoma earlier with safe, proven procedures, not just more eye drops, to protect your sight and simplify daily life.
What is interventional glaucoma?
For many years, glaucoma was treated by adding one eye drop after another, and surgery was saved for when drops were no longer enough. Interventional glaucoma is a newer approach. It uses safe, effective procedures earlier in the course of the disease to lower eye pressure more reliably, reduce the burden of daily drops and lower the long term risk of vision loss.
Drops work well when they are used every day, but many people find that hard. Missed doses, side effects and cost can all leave pressure higher than it should be. Dr. Philip Ngai is a fellowship trained glaucoma specialist who uses a wide range of in office lasers, medicine implants and surgical procedures, so treatment can be matched to your eyes and your life. Learn more on our glaucoma care page.
Options in an interventional approach
Your plan depends on your type and stage of glaucoma, your target eye pressure and your other eye conditions. Options include:
- Laser trabeculoplasty, a quick in office laser that can be used as a first treatment instead of drops
- Medicine implants such as iDose TR and Durysta, which release glaucoma medicine inside the eye for months
- MIGS, tiny stents and canal procedures that improve the eye’s natural drainage, often during cataract surgery. See MIGS.
- Bio-interventional surgery such as AlloFlo, which uses natural donor tissue to support the eye’s second drainage pathway. See bio-interventional glaucoma surgery.
- Minimally invasive bleb surgery when pressure needs to come down further
What is minimally invasive bleb surgery?
Minimally invasive bleb surgery, often called MIBS, creates a new path for fluid to leave the eye. The fluid collects under the clear outer layer of the eye in a small, low pocket called a bleb, which sits under the upper eyelid where it is usually not visible. Because it bypasses the eye’s natural drain, bleb surgery can lower pressure more than most MIGS procedures, while using smaller incisions and a gentler technique than a traditional trabeculectomy.
The XEN Gel Stent is one MIBS option. It is a soft, flexible tube about the length of an eyelash that is placed through a tiny incision. Dr. Ngai also performs traditional trabeculectomy and tube shunt surgery, such as the Ahmed and Baerveldt implants, when they are the better choice.
- Glaucoma that is not controlled with drops, laser or MIGS
- Moderate to advanced glaucoma that needs a lower target pressure
- Glaucoma that is getting worse despite treatment
- Patients who may be able to avoid or delay a traditional trabeculectomy or tube shunt
Our surgical armamentarium in the fight against glaucoma
Dr. Ngai uses a wide range of the newest implants, devices and lasers, and often combines techniques based on the unique needs of each patient, so your plan fits your eyes and your stage of glaucoma.
Microstents
Tiny stents placed in the eye’s natural drain, usually during cataract surgery.
Hydrus Microstent
A tiny scaffold placed in the drainage canal, usually with cataract surgery.
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iStent Inject W Microstent
Two of the smallest implants in medicine, placed to improve natural drainage during cataract surgery.
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iStent Infinite
Three tiny stents that improve drainage, and can be done without cataract surgery.
Learn moreOpening the natural drain
Procedures that open, clear or treat the eye’s own drainage canal through a tiny incision.
OMNI Surgical System
Opens and treats the eye’s natural drainage canal in one procedure, often with cataract surgery.
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VIA360 Surgical System
Dilates and treats the eye’s natural drainage canal through a tiny incision.
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MANI Trabeculotomy
A precise micro instrument used to open the drainage tissue from inside the eye.
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New drainage pathways
Options that create a new path for fluid to leave the eye, including minimally invasive bleb surgery, for glaucoma that needs more pressure lowering.
XEN Gel Stent
A tiny gel stent that creates a new drainage path for fluid to lower eye pressure.
Learn more
Iantrek AlloFlo
A bio-interventional approach that reinforces a new outflow pathway inside the eye.
Learn more
Medicine implants and laser
Treatments that can lower pressure and may reduce your need for daily drops.
Durysta Intracameral Implant
A tiny dissolvable implant that releases glaucoma medicine inside the eye, which can reduce daily drops.
Learn more
iDose TR Implant
A tiny titanium implant that releases glaucoma medicine continuously for months.
Learn more
Micropulse Cyclophotocoagulation
A gentle laser that reduces fluid production to lower eye pressure.
Learn more
Selective Laser Trabeculoplasty (SLT)
A quick in office laser that helps the eye’s natural drain work better. It can be a first treatment instead of drops.
Learn moreWhat to expect
Bleb surgery is an outpatient procedure at a nearby surgery center, usually with light sedation and numbing. A medicine is often used during surgery to help the new drainage path stay open. You will use drops for several weeks and see us more often in the first month or two, because the bleb sometimes needs a small adjustment in the office as it heals. Most patients return to light daily activities within a few days.
Insurance coverage
Interventional glaucoma procedures are medical treatments for glaucoma. Medicare and most insurance plans cover them when they are medically necessary, subject to your deductible and copay. See surgery costs and insurance for more.
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Related care to consider
Interventional glaucoma FAQs
Is interventional glaucoma a single procedure?
No. It is an approach to care. It means considering lasers, medicine implants and surgery earlier, instead of only adding more eye drops over time.
What is the difference between MIGS and bleb surgery?
Most MIGS procedures improve the eye’s own drainage system and are often done with cataract surgery. Bleb surgery creates a new drainage path and can lower pressure further, so it is usually used when pressure needs to be lower than MIGS can reach.
Will I still need eye drops?
Many patients use fewer drops after treatment, and some stop completely. It depends on how much your pressure drops and what your target pressure is.
Can glaucoma be cured?
Not yet. Treatment lowers eye pressure to protect the optic nerve and slow or stop further damage. Regular glaucoma checkups are still needed.
Let’s take care of your eyes
Call, text or request an appointment online. We verify your insurance before your visit.
162 Clinton Street, Redwood City, CA 94062 · Monday to Friday, 8am to 5pm