By Dr. Da-Wen Lu, Director of Ophthalmology, Tri-Service General Hospital & Chairman, Taiwan Glaucoma Care Association
On August 27, 2025, Tri-Service General Hospital held a press conference titled “Dual Drainage Approach—A New Option for Glaucoma Surgery”, where Dr. Lu, Director of General Ophthalmology, presented recent clinical achievements and treatment innovations. He explained that approximately 1.75% of Taiwan’s population suffers from glaucoma, with incidence rates increasing significantly with age.
Often referred to as the "silent thief of sight," glaucoma results from inadequate drainage of aqueous humor within the eye, leading to increased intraocular pressure (IOP) that damages the optic nerve. This damage causes a gradual narrowing of the visual field and, if left untreated, can lead to irreversible blindness.
The Challenge of Medication Adherence
Controlling intraocular pressure is the cornerstone of glaucoma treatment. However, statistics reveal that nearly half of Taiwanese glaucoma patients discontinue medication on their own, with 80% citing side effects as the primary reason—most stopping within the first year of treatment. This poses a major challenge in glaucoma care: how to improve patient awareness and promote consistent treatment, especially during the early stage when intervention can preserve more vision.
Surgical Options: From Traditional to Minimally Invasive
When medications or laser therapies fail—or when side effects are intolerable—surgery is considered. The traditional trabeculectomy remains the gold standard for significantly lowering IOP, but it involves a relatively large incision, longer recovery time, and higher postoperative risks, which can reduce patient acceptance.
In contrast, Minimally Invasive Glaucoma Surgery (MIGS) involves implanting tiny drainage devices into the eye to enhance aqueous outflow. These procedures have smaller incisions, fewer complications, and faster recovery. However, MIGS typically achieves lower IOP reduction (20–30%), which may not be sufficient for patients with more advanced disease.
A New Surgical Innovation: Combining Strengths
To address these limitations, the ophthalmology team at Tri-Service General Hospital spent the past three years developing a new hybrid procedure that combines the efficacy of trabeculectomy with the safety and recovery advantages of MIGS. Dr. Lu introduced this innovation as the “Micro-Trabeculectomy with Drainage Stent”—a novel surgical approach that integrates both methods.
Data from the hospital over the past three years showed:
IOP reduction of 35–45% (higher than MIGS’ typical 20–30%)
Complication rate below 5%
Patient satisfaction rate of over 90%
Because the procedure utilizes both internal (MIGS) and external (trabeculectomy-like) drainage mechanisms, it’s been dubbed a “dual drainage approach.” Clinical outcomes indicate not only significant IOP reduction and higher surgical success rates but also a shorter recovery period for patients.
Real-Life Success Story
One notable case involved a 68-year-old female patient referred from a private clinic due to poorly controlled IOP. She underwent this new combined procedure on April 9, 2025. Before surgery, her IOP exceeded 20 mmHg; postoperatively, it stabilized at 7–8 mmHg. She is now recovering well and is highly satisfied with her vision stability and surgical results.
Long-term follow-up over the past three years confirms that the procedure provides sustained pressure control and faster patient recovery, making it an increasingly common treatment option.
A Call for Early Detection
Dr. Lu emphasized that visual field loss progresses like a snowball—slow at first, then rapidly worsening as the disease advances. Once lost, vision cannot be restored. Early intervention makes a significant difference: those treated early retain much more vision than those who delay care.
He strongly urges individuals aged 18 and above with a family history of glaucoma, as well as the general public aged 35 and older, to undergo regular glaucoma screenings. Early detection is the key to protecting sight.