2024 Glaucoma Pipeline

With the accelerating pace of innovation in glaucoma, physicians and patients are gaining access to an unprecedented number of treatment options. This expanding toolkit is bringing us closer to fulfilling our ultimate objective to provide care that addresses the individual patient, from both a disease-specific and a quality-of-life standpoint.

The growth of the glaucoma market, particularly on the surgical side, has also bred a change in real-world practice. Many ophthalmologists who manage the disease now subscribe to the idea of interventional glaucoma, embracing a mindset that promotes earlier surgical or laser-based intervention. Fundamentally, practicing interventional glaucoma means being more proactive in our approach while considering the longer-term outcomes of our interventions and the patient’s potential needs in the future.

Within this framework of earlier intervention with surgery and laser, we can begin to challenge some of the conventional thinking in our field, such as how we define maximum tolerated medical therapy. The historical thinking was that a four-drop regimen was the upper limit, after which an invasive surgical option was warranted. Now, with the evolution of MIGS and these procedures’ medication-reducing abilities, it is reasonable to ask a patient whether three drops, two drops, or even one drop is too many.

An outgrowth of the interventional mindset is the idea that glaucoma surgery is no longer the sole domain of fellowship-trained specialists. This is an important development, as wider adoption of MIGS by comprehensive ophthalmologists and anterior segment surgeons increases the likelihood that patients will receive treatment when their disease is milder. Waiting to intervene until late-stage disease increases the chances of treatment failure regardless of the modality of treatment. It has yet to be determined whether this approach will ultimately result in fewer patients with advanced disease on the precipice of irreversible vision loss. However, there is evidence (LIGHT¹ and HORIZON² studies) that early treatment may delay vision loss and more invasive surgical interventions such as trabeculectomy.

If there is remotely a downside to such progress, it is the need to stay on top of all the growth and development in the glaucoma pipeline. We hope that this is where the accompanying poster will play a role. In putting this together, we made every attempt to be as comprehensive as possible to show not only the array of options already available for use but also all the exciting research with potential to shape the future. We invite readers to use this poster as a starting point to learn more about the individual drugs, devices, surgeries, and lasers listed.

As providers and patients know well, for a long time, the treatment options available for glaucoma were limited. We celebrate both the recent and upcoming growth as well as the opportunity to intervene at a time and in a way that is best for each patient we treat.