Minimally Invasive Glaucoma Surgery (MIGS) for individuals with glaucoma. A health technology assessment

Executive summary Background: Glaucoma is a substantial public health problem, with a large negative impact on quality of life and the utilization of health care resources. Glaucoma refers to a group of eye conditions with a characteristic pattern of progressive damage to the optic nerve. Raised intraocular pressure (IOP) is the best characterized risk-factor, but IOP can also be normal. Globally, glaucoma is considered the leading cause of irreversible vision loss and one of the leading causes of blindness overall. There are approximately 77,000 Norwegian individuals with a glaucoma diagnosis. The incidence is expected to increase because of demographic changes and because the disease can now be diagnosed at earlier stages than before. Minimally invasive glaucoma surgery (MIGS) represents a class of new surgical procedures and devices to address this issue. Experts suggest MIGS may result in shorter procedure and recovery times than traditional surgical procedures, and that MIGS make it possible to offer treatment at an earlier stage of glaucoma. The indications for each MIGS procedure depend on its mechanism of action and the individual patient’s target IOP and concomitant eye diseases. MIGS procedures and devices can be used alone or in conjunction with cataract surgery. The procedure is already offered in many public hospitals in Norway. Objective The objectives of this health technology assessment (HTA) were to: 1) supplement the evidence of (effectiveness and safety ) of MIGS in an HTA published by the Canadian Agency for Drugs and Technologies in Health (CADTH) in January, 2019, 2) conduct a health economic evaluation of MIGS from a Norwegian health care perspective, and 3) assess organizational and ethical aspects of MIGS in a Norwegian setting. Method: Clinical effectiveness and safety We have summarized CADTH’s HTA evidence of effectiveness and safety, and adapted CADTH’s methods in the conduct of our supplementary review of more recent studies. CADTH carried out systematic literature searches in August and November 2017, while our updated searches were carried out in August 2019 and November 2020. Searches were run in electronic medical databases, such as MEDLINE, EMBASE, CINAHL and Cochrane Central Register of Controlled Trials, using peer-reviewed search strategies. Two reviewers independently selected studies meeting our inclusion criteria. Likewise, 8 Executive summary two reviewers independently judged the included studies’ risk of bias. On