More recently, the Health Canada and FDA has approved the use of the iStent, which is the smallest implantable device approved for use in the human body. It is a titanium device that is implanted from inside of the eye (an ab interno approach) into the trabecular meshwork in order to bypass it and improve outflow of eye fluid. iStents are typically implanted during the time of cataract surgery, and in some cases more than one iStent is implanted. Again, the benefit of iStent is its higher safety profile, but the downside is that it does not lower eye pressure to the same extent as trabeculectomy. As with other MIGS procedures, iStent typically lowers eye pressure to the mid-teens. At PVSC we use the iStent Inject, which is the second generation device shown below. It can be combined with Cataract surgery or can be done as a sole procedure.