We can now minimize vision loss from glaucoma while maintaining patient comfort and well-being thanks to a growing list of options for interventional glaucoma management. Here, I discuss these options.

Genetic Testing

Glaucoma genetic testing offers a risk assessment for disease progression. As a result, if testing reveals the patient is likely to have aggressive glaucoma, we can take a more aggressive and watchful approach from the start by educating the patient and following up more frequently. Additionally, genetic testing allows for patient education on the importance of consistently adhering to follow-up appointments because it shows the risk of conversion from ocular hypertension to glaucoma. Seonix Bio offers genetic testing for glaucoma. 

Selective Laser Trabeculoplasty

The Laser in Glaucoma and Ocular Hypertension (LiGHT) Trial shows that first-line selective laser trabeculoplasty (SLT) provided long-term disease control in patients with open-angle glaucoma and ocular hypertension.¹ This, in turn, decreased the need for intraocular pressure (IOP)-lowering drops, incisional glaucoma, and cataract surgery.¹ Of note: scope-of-practice expansion laws in 14 states now enable optometrists to perform in-office laser procedures. The following companies offer US Food & Drug Administration (FDA)-approved SLT systems: Alcon, Lumenis, Lumibird Medical, Nidek, and Optimus.

Sustained-Release Devices and Procedural Pharmaceuticals

These devices release IOP-decreasing medication over specific durations of time. The following devices are FDA-approved: Durysta (bimatoprost intracameral implant 10 mcg; AbbVie) and iDose TR (travoprost intracameral implant 75 mcg; Glaukos). Durysta, utilizing a 25-gauge needle, is placed in the inferior angle of the eye and elutes medication for 4 to 6 months.² iDose TR is placed in the iridocorneal angle through a clear corneal incision, and releases medication for up to 3 years.³

Minimally Invasive Glaucoma Surgery

Minimally invasive glaucoma surgery (MIGS) procedures cause minimal disruption to the normal ocular anatomy, offer meaningful IOP reductions, and have a high safety profile, with rapid recovery.⁴ There are several approaches MIGS take in interrupting normal aqueous dynamics to lower IOP:⁴

1. Inserting a trabecular meshwork bypass stent or Schlemm’s canal microstent to enable aqueous to flow directly through the stent from the anterior chamber into Schlemm’s canal (an ab interno approach) sometimes at the time of cataract surgery and sometimes as a standalone procedure. Stents available for this approach include iStent Inject (Glaukos), iStent Infinite (Glaukos), and Hydrus Microstent (Alcon). Other treatments in the trabecular meshwork include goniotomies utilizing the Kahook Dual Blade (New World Medical), Sion (Sight Sciences), iAccess (Glaukos), or Trabectome to remove trabecular meshwork tissue.  Procedures that dilate and remove obstructions in Schlemm’s canal include devices like the Omni system (Sight Sciences) and gonioscopy-assisted transluminal trabeculotomy.
2. Inserting a microstent to access the suprachoroidal space to augment the uveoscleral outflow pathway. No such devices are currently FDA approved.
3. Shunting the aqueous into the subconjunctival space via a small incision via an ab interno or ab externo approach. Xen Gel Stent (AbbVie) is FDA approved for this.
4. Ablating the ciliary body by inserting an endoscopic laser probe through a clear corneal incision or via transscleral cyclophotocoagulation. Endoscopic laser probes FDA approved to ablate the ciliary body include the Leos Laser Endoscopy Ophthalmic System (BVI), the EndoOptiks E2 MicroProbe Laser & Endoscopy System, and the Iridex GProbe Illuminate.
5. The AlloFlo Uveo from Iantrek is a new supraciliary procedure that targets the uveoscleral pathway. It bypasses episcleral venous pressure, but it does carry risk of hypotony.⁵ 

We have an important role in identifying MIGS candidates, educating them on what they can expect before and after their procedure, postoperative care, and referring them for surgery at the right time in the disease process.

Ocular Nutritional Supplements

In addition to a diet that is high in nitrates, ocular nutritional supplements or nutraceuticals can be considered for patients who have glaucoma.⁶ The following are available in the United States: Botanic Choice Eye Pressure Complex, Dr. Whitaker Ocular Pressure & Retina Defense, Life Extension Eye Pressure Support, and OpticNerve Formula Softgels (ScienceBased Health).⁶

Conclusion

These options for interventional glaucoma management address our goals of maintaining a healthy optic nerve and hindering disease progression in our patients, while also preserving patients’ comfort and quality of life. I have no doubt that advances in these areas will continue. OM

References

1. Gazzard G, Konstantakopoulou E, Garway-Heath D, et al. Laser in Glaucoma and Ocular Hypertension (LiGHT) Trial: six-year results of primary selective laser trabeculoplasty versus eye drops for the treatment of glaucoma and ocular hypertension. Ophthalmology. 2023;130(2):139-151. doi:10.1016/j.ophtha.2022.09.009
2. Shen Y, Sun J, Sun X. Intraocular nano-microscale drug delivery systems for glaucoma treatment: design strategies and recent progress. J Nanobiotechnology. 2023;21(1):84. doi:10.1186/s12951-023-01838-x
3. Szekely G, Voskanyan LA, Stephens KG, et al. Aqueous humor concentrations of travoprost free acid and residual drug in explanted implants from patients administered a travoprost intracameral implant. Ophthalmol Ther. 2025;14(5):989-1003. doi:10.1007/s40123-025-01130-1
4. Microinvasive glaucoma surgery (MIGS). EyeWiki. Accessed January 2, 2026. https://eyewiki.org/Microinvasive_Glaucoma_Surgery_(MIGS)#:~:text=High%20safety%20profile:%20Compared%20to,and%20through%20the%20Schlemm%20canal 
5. Chaya CJ, Herndon LW, Lince J, et al. Surgical outcomes, ocular safety and tolerability of bio-interventional cyclodialysis with allograft scleral reinforcement: clinical experience of more than 240 cases. J Clin Med. 2024;13(16):4593. doi:10.3390/jcm13164593
6. Harris A, Gross J, Moore N, et al. The effects of antioxidants on ocular blood flow in patients with glaucoma. Acta Ophthalmol. 2018 Mar;96(2):e237-e241. doi:10.1111/aos.13530