iStent^® and iStent inject^® trabecular bypass for micro-invasive glaucoma surgery (MIGS)

Notice Santécom: 126453

Glaucoma is described as an evolving chronic optic neuropathy that leads to irreversible visual field loss and, in certain cases, to blindness.

The current treatment strategy aims at reducing intraocular pressure (IOP) caused by aqueous humor formation in the eye and its elimination. Implantable devices have been designed to improve physiological aqueous humor flow and reduce the pressure. The iStent^® and iStent inject^® trabecular bypasses are currently offered to patients with open angle glaucoma, but access to such devices remains limited.

INESSS assessed the pertinence of increasing access to these devices and concluded that, despite the therapeutic value of iStent^® and iStent inject^®, the cost/benefit ratio is considered to be too high and uncertain such that public coverage would not be a fair allocation of the Québec health system’s resources.

However, a decision in favour of public coverage of iStent^® and iStent inject^® trabecular bypasses could be fair and reasonable if significant measures to reduce the cost were implemented and their use governed by the following criteria:

• patients who do not respond to at least two hypotonic drugs or with a documented medical condition that prevents optimal administration of eye drops;
• poor candidates for filtration surgery.