What's in a Name?

Glaucoma terminology has always intrigued me. Some surgical terms are more confusing than illuminating. For example, trabeculectomy suggests removal of the trabecular meshwork, whereas ophthalmologists are actually performing a keratectomy and iridectomy during most filtering procedures. Taken literally, nonpenetrating surgery would not incise the eye, but the glaucoma community uses this term to indicate that the anterior chamber is not entered. Limbus-based conjunctival incisions are actually performed in the fornices, and fornix-based surgery is carried out at the corneal limbus. Go figure!

Recently, Ike Ahmed, MD, has sought to clarify the definition of MIGS, an acronym he coined. Initially, he used it when discussing the new microstent technologies, but the acronym is now often used as almost an all-encompassing term for any glaucoma surgery that does not create a bleb. Companies may label a technology or procedure MIGS in an effort to gain marketing advantages and expand its use. That certainly was not Dr. Ahmed's intention, and in response, he has redefined MIGS as microinvasive rather than minimally invasive glaucoma surgery and has specified the sort of technologies and procedures that fit the description.¹ The table illustrates my current thinking about glaucoma surgery as a stimulus for further discussion.

As more new technologies join the growing number of available glaucoma surgical options and physicians' understanding of glaucoma treatment evolves, terminology will change to reflect the alterations. My hope is that glaucomatologists will help inform these discussions to better educate ophthalmologists entering the glaucoma surgical space. More important, I feel it is vital that physicians provide patients with accurate information that allows them to make educated decisions about their surgical care. In addition, surgeons must continue to underpromise and overdeliver on results. Anything less could be deleterious, not only for patients, but ultimately for the profession.

1. Saheb H, Ahmed II. Micro-invasive glaucoma surgery: current perspectives and future directions. Curr Opin Ophthalmol. 2012;23(2):96-104.