Recommendations on the optimal use of minimally invasive glaucoma surgery

Friday March 8, 2019

These recommendations were developed by the Health Technology Expert Review Panel (HTERP) based on evidence reviewed in a CADTH Health Technology Assessment (HTA) report. The HTA included a review of the clinical effectiveness and safety, costeffectiveness, patients’ and caregivers’ perspectives and experiences, ethical issues, and implementation issues regarding minimally invasive glaucoma surgery (MIGS) for the treatment of adults with glaucoma.

The information retrieved and the HTERP deliberations aimed to address the policy questions: What is the optimal use, including appropriate patient selection, of MIGS devices and procedures for adults with glaucoma? Should MIGS devices and procedures be funded by the public health care system?

The target population for these recommendations is patients with glaucoma who are deemed eligible for MIGS by their care provider. The target users of these recommendations are Canadian health care decision-makers, those in provincial and territorial ministries of health, and glaucoma researchers.

  1. HTERP considered that there is insufficient evidence at present to make recommendations specific to the optimal use and funding of MIGS.
  2. HTERP suggests that there is a potential role for MIGS devices and procedures in the treatment of adult patients with glaucoma, if the choice of MIGS is presented to patients with full consideration and disclosure of relevant factors, including:
    • the diversity of MIGS options, and uncertainties and unknowns associated with their benefits and risks
    • individual patient factors bearing on the choice of treatment (e.g., vulnerabilities, geographical location, and financial considerations)
    • the surgeon’s experience performing MIGS and potential conflicts of interest
    • alternative forms of treatment.
  3. HTERP suggests that provinces and territories establish harmonized procedure codes for MIGS (to enable surveillance of access and treatment patterns) and document actual costs associated with MIGS and alternative treatments.
  4. HTERP suggests that the optimal use, including funding, of individual MIGS be reassessed if further research is conducted that includes: detailed reporting of results stratified by patient characteristics; valid and reliable measures of direct, patient-important outcomes; and long-term evaluation of clinical effectiveness, adverse events, harms, and cost-effectiveness.