Minimally Invasive Glaucoma Surgeries, Health Economics, and the Moral Imperative of Equity in Glaucoma Care

different from that in India, where the WTP threshold is roughly `150,000 (approximately $1,800).14,15 This framing matters because cost-effectiveness is not an abstract academic exercise.It determines whether interventions can realistically be scaled, included in national health schemes, or reach the patients who need them most. MiniMally invasive GlaucoMa surGeries: ProMise a n d realityMinimally invasive glaucoma surgeries emerged as a transformative category of procedures: safer than trabeculectomy, less invasive than drainage implants, and more acceptable than lifelong eye drops.4,5,16 For patients, the appeal is clear-shorter hospital stays, minimal postoperative visits, and lower complication risks.For surgeons, MIGS represents innovation, skill advancement, rapid turnover surgeries, and alignment with the global shift toward minimally invasive therapeutics.However, when subjected to economic scrutiny in LMICs, MIGS falters.A back-of-the-envelope calculation for India shows that the ICUR for the iStent is approximately `400,000 per QALY over both 5-and 10-year horizons.Against a WTP threshold of `150,000, the procedure is not cost-effective.For comparison, generic medical management costs around `6,000 annually, with similar QALY gains of approximately 0.3.The annual per capita health spend in India Glaucoma is one of the most important and paradoxical global health challenges of our time.We know how to prevent the blindness it causes; we have diagnostic tools, effective medications, and surgical options.Yet the disease remains the leading cause of irreversible blindness worldwide, with its heaviest toll borne by low-and middle-income countries (LMICs).In these settings, fewer than 5% of patients receive timely intervention, and those who do often face catastrophic out-of-pocket expenditures.[1][2][3] At the same time, the field of glaucoma has never been more exciting from a technological standpoint.Minimally invasive glaucoma surgeries (MIGS) have transformed the surgical landscape, offering shorter recovery, improved safety, and better long-term adherence than conventional therapy.[4][5][6][7] But the promise of MIGS collides with the stark realities of health economics and disparities in access.As a community of glaucoma specialists, we must ask: Are we widening the gap between the possible and the accessible?[8][9][10] This editorial reflects on these tensions-drawing from health economic principles, real-world data, and ethical considerationsand argues that equity must be the defining principle of innovation in glaucoma care.