Glaucoma & MIGS
Protect your vision with fellowship-trained glaucoma specialist Medi Eslani, MD, FAAO, from SLT laser and sustained-release implants to the latest minimally invasive surgery and vision-saving advanced glaucoma surgeries.
Understanding Glaucoma
Glaucoma usually develops without symptoms. With early detection and steady, modern management, most patients keep their vision for life.
Glaucoma damages the optic nerve, frequently due to elevated pressure inside the eye. As a fellowship-trained glaucoma specialist, Dr. Eslani tailors a plan to your eyes, escalating only as much as needed to keep your pressure controlled.
A quick, comfortable in-office laser that helps the eye drain better, often reducing or delaying the need for drops.
Daily drops that lower eye pressure, used alone or alongside other treatments.
Implants such as Durysta and iDose TR release medication inside the eye for months.
Minimally invasive surgery that lowers pressure through tiny incisions.
Trabeculectomy or tube-shunt surgery for powerful, lasting pressure control when needed.
Risk Factors
Glaucoma is not one disease but a group of conditions that damage the optic nerve, the cable carrying sight from your eye to your brain. Raised pressure inside the eye is the main treatable cause, but it is not the whole story: some people sustain damage at pressures considered normal, while others tolerate higher pressures for years. What matters is whether your particular optic nerve is being harmed.
Age over 60, and earlier for some groups
A parent or sibling with glaucoma
African, Caribbean, or Hispanic ancestry, with earlier onset and faster progression
A raised eye pressure reading on a previous exam
High myopia, meaning strong nearsightedness
Thin corneas
Long-term steroid use in any form, including inhalers and drops
Diabetes, previous eye injury, or prior eye surgery
Damage begins in the peripheral vision, not the centre
The stronger eye quietly compensates for the weaker one
The brain fills in missing areas, so you do not perceive gaps
The common form causes no pain, redness, or blurring
Central reading vision is usually the last thing to be affected
This is why glaucoma is called the silent thief of sight. By the time most people notice a change, meaningful nerve tissue has already been lost, and that loss cannot be reversed. Detection through a dilated exam and imaging, before any symptom appears, is what preserves vision.
Types
The type you have determines the treatment, and the types are managed very differently. Establishing exactly which form you are dealing with, by examining the drainage angle directly, is a core part of a specialist evaluation.
Most common
The drainage angle looks open, but fluid leaves too slowly through the microscopic drainage tissue. Pressure rises gradually and painlessly over years. This is the form most patients have, and the one most MIGS procedures are designed to treat.
Can be an emergency
The drainage angle is narrow or blocked by the iris. It can develop slowly, or strike suddenly with severe eye pain, headache, nausea, blurred vision and halos, which needs immediate care. A preventive laser opening in the iris usually protects eyes found to be at risk.
Normal pressure
Optic nerve damage occurs even though eye pressure measures within the normal range, which is thought to involve blood flow to the nerve or a nerve unusually sensitive to pressure. Treatment still centres on lowering pressure further than 'normal'.
Driven by another cause
Pressure rises because of something else: pseudoexfoliation, pigment dispersion, inflammation inside the eye, advanced diabetic disease, steroid use, or previous injury or surgery. Treating the underlying cause is part of the plan.
Diagnosis
No single test diagnoses glaucoma. The diagnosis comes from putting several measurements together and, just as importantly, from watching them over time. These are the tests you can expect.
Eye pressure
Measures the pressure inside your eye. A single reading is only a snapshot: pressure fluctuates through the day, so it is interpreted alongside your corneal thickness and repeated across visits.
Nerve imaging
Optical coherence tomography images the optic nerve and measures the nerve fibre layer in microns. It can detect thinning years before you would notice any change in your vision, and it is the most sensitive way to track progression.
Function
Maps your peripheral vision to reveal blind spots you cannot perceive on your own. Repeated over time, it shows whether the disease is holding steady or advancing.
Anatomy
Gonioscopy uses a mirrored lens to inspect the drainage angle directly, separating open-angle from angle-closure disease. Pachymetry measures corneal thickness, which both corrects your pressure reading and is a risk factor in its own right.
Because glaucoma is diagnosed by change over time, consistency matters more than any one appointment. Dr. Eslani reviews your imaging and visual fields personally against your previous studies rather than reading a single visit in isolation.
MIGS Procedures
MIGS lowers eye pressure through tiny incisions with a faster recovery than traditional surgery. Dr. Eslani offers the full modern range. Here's how each works.
Your eye constantly makes a clear fluid called aqueous humor. When it can't drain quickly enough (usually at the eye's natural drainage angle), pressure builds and can damage the optic nerve. MIGS procedures gently reopen, bypass, or supplement that drainage pathway, letting fluid leave the eye and lowering pressure with minimal disruption and a faster recovery.
Aqueous fluid (gold) drains at the eye's natural angle (circled), the target for most MIGS procedures.
iStent infinite · Hydrus
Among the smallest devices in medicine, these tiny implants are placed in your eye's natural drain to improve fluid outflow.
OMNI · iTrack Advance · GATT · VIA360
A micro-catheter gently opens and reinforces the eye's natural drainage canal (Schlemm's canal) to restore outflow, effective without leaving a permanent implant.
Kahook Dual Blade · Sion
Gently removes the clogged drainage tissue (trabecular meshwork) so fluid leaves the eye more freely. This approach is bleb-free and often paired with cataract surgery.
Xen Gel Stent
A soft, flexible gelatin tube creates a new drainage pathway for moderate-to-advanced glaucoma, with a relatively quick recovery.
iDose TR · Durysta
Tiny implants placed inside the eye that release pressure-lowering medication for months to years, reducing or replacing daily drops.
Trabeculectomy · Tube shunts
When more pressure control is needed, time-tested procedures deliver powerful, lasting results, backed by fellowship training in complex glaucoma surgery.
AlloFlo
Directs fluid into the suprachoroidal space (a separate, natural outflow pathway between the choroid and sclera) to lower eye pressure through a tiny, minimally invasive approach.
Fellowship-trained under one of the field's leaders, Dr. Eslani offers the complete range of modern glaucoma care: SLT, sustained-release implants, every major MIGS platform, and advanced surgery. You get the right procedure for your eyes, not a one-size-fits-all plan.
Years of daily drops can leave the ocular surface inflamed, red, and sore. Dr. Eslani treats both conditions together, lowering your drop burden with MIGS while restoring comfort through advanced dry eye therapy, including LipiFlow, IPL, and serum tears.
What to Expect
Glaucoma treatment is a ladder, not a single decision. The aim is to reach a pressure your optic nerve tolerates using the least intervention that achieves it, then to escalate only when the evidence says you need to.
In-office laser
Selective laser trabeculoplasty takes a few minutes in the office with numbing drops. There is no incision and no real recovery period, and most people return to normal activity the same day. The effect builds over several weeks, typically lasts a few years, and can usually be repeated.
Sustained release
A tiny implant releases pressure-lowering medication continuously for months to years. For many patients it removes the daily drop routine altogether, and with it the surface irritation that long-term drops cause.
Often with cataract surgery
Most MIGS procedures add only a few minutes to cataract surgery and work through the same tiny incision. Recovery follows the cataract recovery rather than extending it, and many patients leave on fewer drops than they arrived on.
Advanced disease
Trabeculectomy and tube shunts deliver the largest and most durable pressure reduction when pressure has to come down substantially. Recovery is longer, with more frequent visits through the first months while the new drainage is fine-tuned.
Whichever step you are on, the goal is the same: protect the vision you still have. Damage already done cannot be undone, which is why steady, unglamorous pressure control over decades matters far more than any single procedure.
Why Dr. Eslani
Many ophthalmologists manage straightforward glaucoma capably. A fellowship-trained specialist spends an additional year of training devoted entirely to the disease, its surgery, and the harder judgment of when to act and when to wait.
Training
Glaucoma fellowship at UC San Diego under Dr. Robert N. Weinreb, one of the world's foremost authorities on glaucoma, following ophthalmology residency at the same institution.
Full range
From SLT and sustained-release implants through stents, canal-based procedures, goniotomy, and subconjunctival and suprachoroidal approaches, up to trabeculectomy and tube shunts. The recommendation follows your disease, not the one device a practice happens to stock.
The surface too
Years of pressure-lowering drops, particularly preserved ones, leave many patients red, burning, and uncomfortable. With a research background in cornea and ocular surface disease, Dr. Eslani treats both problems together instead of trading one for the other.
Recognition
Board-certified ophthalmologist and Fellow of the American Academy of Ophthalmology, Heed Fellow, and author of more than 70 peer-reviewed publications and textbook chapters.
FAQ
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Dr. Eslani provides the full range of surgical and medical eye care across San Diego County and the Imperial Valley.
Restore clear, vibrant vision with advanced technology lenses.
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Laser vision correction tailored to your cornea and lifestyle.
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Lasting freedom from reading glasses, with no cataract later.
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Treat the root cause of dry eye, not just the symptoms.
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