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The COMPARE randomized trial directly compared two trabecular MIGS approaches—Hydrus and two iStent Trabecular Micro-Bypass devices—as standalone procedures in open-angle glaucoma. At 12 months, the Hydrus group had a higher proportion of eyes meeting the study's complete surgical-success definition and used fewer glaucoma medications. Secondary glaucoma surgery occurred in some iStent-treated eyes and none of the Hydrus eyes, while safety profiles were broadly similar. The study is useful because it compares devices rather than simply comparing MIGS with no surgery. For HCPs, the message is that MIGS devices are not interchangeable. Their mechanism, implant geometry, target anatomy and expected pressure-lowering range differ, and evidence for one platform should not automatically be extrapolated to another. The trial also studied a selected population with open angles and relatively good baseline vision, so the results should not be extended to advanced glaucoma requiring very low target pressures. For AIOC's MIGS theme, the paper provides a practical framework for discussing device selection and realistic expectations.
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The COMPARE randomized trial directly compared two trabecular MIGS approaches—Hydrus and two iStent Trabecular Micro-Bypass devices—as standalone procedures in open-angle glaucoma. At 12 months, the Hydrus group had a higher proportion of eyes meeting the study's complete surgical-success definition and used fewer glaucoma medications. Secondary glaucoma surgery occurred in some iStent-treated eyes and none of the Hydrus eyes, while safety profiles were broadly similar. The study is useful because it compares devices rather than simply comparing MIGS with no surgery. For HCPs, the message is that MIGS devices are not interchangeable. Their mechanism, implant geometry, target anatomy and expected pressure-lowering range differ, and evidence for one platform should not automatically be extrapolated to another. The trial also studied a selected population with open angles and relatively good baseline vision, so the results should not be extended to advanced glaucoma requiring very low target pressures. For AIOC's MIGS theme, the paper provides a practical framework for discussing device selection and realistic expectations.
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