Investigating the Journey of Minimally Invasive Glaucoma Surgery (MIGS) Adoption Among Glaucoma Specialists in India

Abstract

Purpose: To examine the adoption of Minimally Invasive Glaucoma Surgery (MIGS) among glaucoma specialists in India and identify barriers to its integration into clinical practice.

Methods : This anonymous online survey was conducted among glaucoma specialists in India using a validated questionnaire, following CHERRIES guidelines. The questionnaire was distributed via email and WhatsApp between 16th and 29th February 2024. Participants included those with at least two years of surgical glaucoma fellowship or ten years of glaucoma surgery experience. The questionnaire addressed four themes: MIGS knowledge, attitudes towards adoption, barriers to adoption, and strategies to improve uptake. The primary outcome was barriers to MIGS adoption.

Results : The survey, sent to 405 glaucoma specialists, received 102 responses (25%), with 61 meeting inclusion criteria. Respondents had a mean age of 43.7 ± 8.2 years; 64% were women, 84% practiced in urban areas and 52% were in purely private practice. Half reported having moderate MIGS knowledge, 60% believed it reduced IOP with cataract surgery, and two-thirds lacked confidence in intraoperative gonioscopy. In ideal clinical scenarios, 54% would opt for MIGS, though those in rural settings were 75% less likely to do so (p=0.04). Cost (84%), efficacy concerns (79%), and surgical confidence (62%) were significant barriers, though 85% viewed MIGS as safer. Hands-on workshops (77%) and insurance coverage significantly improved adoption likelihood (p=0.07).

Conclusion : MIGS adoption among Indian glaucoma specialists remains modest, with about 50% opting for it in the best-case scenario. Cost, limited knowledge, and surgical confidence were key barriers.