“Glaucoma is a chronic disease, with two different ways to be treated – either eye drops or laser,” Mahmoud Rabie, clinical director for ophthalmology and consultant ophthalmologist at CHEC, told OT.
Another option has also traditionally existed, in invasive surgery – something that Rabie describes as only being available for advanced glaucoma patients and being akin to “changing the whole plumbing.”
Now, a pioneering and less invasive solution has also been developed by CHEC, the ophthalmology and gastroenterology hospital group that has 20 locations within community settings across England.
OT visited CHEC Watford, one of the locations where the surgery is being carried out, to find out more.
What is minimally invasive glaucoma surgery?
Minimally invasive glaucoma surgery (MIGS) involves small incisions, minimal tissue disruption, and faster recovery than that that has traditionally been available, Rabie explained to OT.
The MIGS option means less reliance on eye drops and better control over intraocular pressure, the latter of which “is the main factor that leads to the progression of glaucoma,” Rabie said.
He explained that MIGS is suitable for mild to moderate glaucoma patients who are undergoing cataract surgery.
These patients “should be offered the option of having minimally invasive glaucoma surgery, simply because, if the patient is going for surgery anyway, it is appropriate to address both conditions together,” Rabie said.
Cataract surgery might control the intraocular pressure to a certain extent, but MIGS will help to control further glaucoma progression, he added.
Rabie noted that, when performed either directly before or after cataract surgery, MIGS is a procedure that is likely to take less than five minutes.
“It is an extra step during cataract surgery,” Rabie said, adding that feedback that CHEC was received from patients so far has been positive.
Before surgery, patients are often under the impression that they will have to administer eye drops for the rest of their lives, Rabie explained – something that, with the expansion of MIGS, will no longer be true.
Expansion in the community
A small-scale trial was conducted at various CHEC locations to assess the clinical effectiveness of the service ahead of the larger roll-out that is now taking place, Rabie explained.
The roll-out will see MIGS being undertaken at more CHEC hospitals, across more geographic locations, and with more patients.
“It means more glaucoma patients will benefit from this kind of treatment,” Rabie said.
He told OT that patients who took part in the initial trial appreciated that they were able to receive treatment in a community setting, rather than being placed on the NHS hospital waiting list.
Rabie acknowledged that the independent sector must align with the NHS when planning treatment for patients.
“It is time, now, to work collaboratively with the NHS, to see what they are struggling with, so then we can elevate what we can do in the community,” Rabie said.
“If you look at the ophthalmology world, the clinical world, there is a lot more that can be done in the community.”
There is no material difference for patients whether they are being treated in a hospital or within the community, Rabie believes.
“Whether it is in glaucoma or in other specialties in ophthalmology, there is still more that can be done in the community,” he said.
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