INTERVENTIONAL GLAUCOMA (IG) PUBLICATIONS

Explore the latest insights from the paradigm shift in glaucoma management and discover emerging evidence supporting interventional approaches over traditional drop-based treatments.

These publications evaluate the benefits of moving toward earlier, procedure-based interventions in glaucoma care and provide commentary from experts on adopting the IG mindset.

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Title Author(s) Study Details Distinguishing Feature Key Insights
Interventional glaucoma consensus treatment protocol1

Christine M. Funke

Consensus-based review

Summary of 10 glaucoma specialists’ expert opinions on the optimal stepwise interventional glaucoma treatment protocol

Interventional glaucoma treatment recommendations:

  • Ocular hypertension: Procedural pharmaceuticals or lasers first, MIGS second, medications as a bridging therapy

  • Mild glaucoma: Procedural pharmaceuticals or lasers first. Tissue-sparing MIGS followed by non-tissue–sparing MIGS and medications are secondary

  • Moderate glaucoma: Target 12 mmHg to 15 mmHg of IOP reduction, intervene early with MIGS, and use filtering surgery as a last resort

  • Severe glaucoma: Immediate procedural intervention for rapid IOP reduction with simultaneous procedural pharmaceuticals and MIGS before incisional surgery. Deprioritize SLT for faster IOP control and use filtering surgery for uncontrolled cases

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Alternatives to topical glaucoma medication for glaucoma management2

Sahar Bedrood

Perspective

Real-world data from multiple studies discussing the evolution of glaucoma treatments
Interventional alternatives outperform drops:

  • Sustained-release drug delivery implants eliminate the need for daily drops, reducing adherence issues and ocular surface side effects

  • iDose® TR (travoprost intracameral implant) maintained IOP control with fewer medications at 3 years

  • MIGS improves patient quality of life by reducing medication burden and is a financially viable option compared with long-term medication use

Topical medications show serious limitations:

  • Poor adherence: 30% to 80% of patients struggle with consistent use

  • Side effects: including ocular surface disease in 30% to 70% of patients

  • Inconsistent IOP control: leading to disease progression

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Early diagnostics and interventional glaucoma3

Ticiana De Francesco

Review article

Summary of the evolution of glaucoma diagnostics, interventions, and technology

Continuous, technology-driven monitoring could enhance early detection, prevent vision loss, and reduce costs of interventional treatment approaches for glaucoma.

Targeted screening for high-risk populations may further improve outcomes.

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Interventional glaucoma and the patient perspective4

Mark Gallardo

Perspective

Expert opinion emphasizing the benefits of shifting to an interventional approach in glaucoma care

Interventional treatment approaches improve the patient experience:

  • Consistent, long-term IOP control with reduced ocular surface disease

  • Reduced long-term health costs

  • Practical for those struggling with self-administering drops

  • Reduced anxiety, restored sense of control, and improved quality of life

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Long-term chronic drop therapy vs intracameral procedural pharmaceuticals for glaucoma: What does the evidence support?5

Shivani Kamat

10 years Comparative review

Evaluates long-term glaucoma treatment strategies from multiple studies
iDose® TR Travoprost Intracameral Implant (36-Month Phase 3 Trial):

  • IOP Reduction: 6.6 mmHg to 8.4 mmHg from mean baseline IOP of 24 mmHg

  • Medication Reduction: 81% of patients were medication free at 12 months

Durysta® Bimatoprost Implant (24-Month Phase I/II Trial):

  • Mean IOP Reduction: 5 mmHg to 8 mmHg

  • Medication Reduction: 40% of eyes were medication free at 12 months

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Interventional glaucoma: Improving the patient-provider educational exchange6

L Jay Katz

Perspective

Expert opinion focusing on patient education and HCP engagement in glaucoma management

Interventions such as motivational interviewing, workshops, and AI tools can help educate patients about glaucoma, leading to better understanding about the disease, improved screening and diagnosis, and greater adherence to treatments.

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Standalone interventional glaucoma: Evolution from the combination-cataract paradigm7

J Morgan Micheletti

Review/update

Discusses the role of MIGS, laser procedures, and procedural pharmaceuticals in standalone treatment for glaucoma

MIGS devices rose to account for 43.7% of glaucoma surgeries in the United States in 2017, reflecting the trend for treating earlier to provide greater IOP reduction and medication stability.

Less invasive glaucoma solutions have become more available, making earlier standalone intervention a reality.

Areas in the United States with higher adoption of MIGS have lower rates of trabeculectomy.

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An emerging multi-mechanism and multi-modal approach in interventional glaucoma therapy8

J Morgan Micheletti

Commentary/review

Advocates for early combination therapy to provide better long-term IOP control

Targeting multiple pathways provides comprehensive IOP reduction, for example:

  • MIGS or selective laser trabeculoplasty can enhance aqueous outflow at multiple points

  • Trabecular micro-bypass with sustained-release pharmaceuticals reduce medication burden while stabilizing IOP

  • Canaloplasty with trabeculotomy: improves drainage by addressing both trabecular and post-trabecular resistance

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Challenging the “topical medications-first” approach to glaucoma: A treatment paradigm in evolution9

Nathan M Radcliffe

Commentary/review

Critiques the long-standing approach of starting glaucoma treatment with eye drops and delaying procedures until later disease stages
Interventional approaches provide superior outcomes:

  • Sustained-release drug delivery implants potentially provide stable, 24-hour IOP control

  • Less-invasive interventions with topical medications equip patients and doctors with treatment plans that span all disease severities and individual needs

Topical medications have consequences and diminishing returns:

  • Loss of effectiveness at night, causing IOP spikes that lead to progression

  • Adding a 3rd or 4th medication only provides a 10% to 15% additional IOP reduction

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Adopting interventional glaucoma via sustained-release therapies: The wide-ranging impact of procedural pharmaceuticals in ophthalmology10

Arkadiy Yadgarov

Commentary/review

Emphasizes how sustained-release therapies could significantly reduce the burden of daily medication adherence
iDose® TR (travoprost intracameral implant):

  • Non-biodegradable implant anchored in the trabecular meshwork

  • 36-month trials show sustained IOP reduction without significant ECL

Durysta® bimatoprost implant:

  • Biodegradable, providing IOP control for 3 to 4 months

  • FDA approved for one-time admission due to endothelial cell loss (ECL) with repeat dosing

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The emergence of breakthrough procedural pharmaceutical therapies11

Mark Gallardo

Commentary/review

Describes procedural pharmaceuticals and how they remove the burden of self-administration from patients; highlights lessons from other ophthalmic subspecialties

Procedural pharmaceuticals across subspecialties:

  • Glaucoma: Sustained-release drug delivery implants like iDose® TR and Durysta® deliver consistent therapeutic levels, eliminating peaks and troughs in IOP

  • Retinal disease: Anti-VEGF injections transformed the management of neovascular AMD, diabetic retinopathy, and macular edema, while emerging sustained-release options allow for 6-month dosing intervals

  • Uveitis: Long-acting corticosteroid implants provide continuous microdosing over months to years

  • Genetic ophthalmic diseases: The first FDA-approved gene therapy for inherited retinal disease, administered via subretinal injection

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References

1. Funke A, Ristvedt D, Yadgarov A, Micheletti JM. Interventional glaucoma consensus treatment protocol. Ophthalmol Ther. 2025;13(2):1-15 2. Bedrood S, Berdahl J, Sheybani A, Singh IP. Alternatives to topical medications for glaucoma management. Clin Ophthalmol. 2023;17:3899-3913. 3. DeFrancesco A, Radcliffe NM, Myers JS, et al. Early diagnostics and interventional glaucoma. Ophthalmol Ther. 2024;13(1):1-12. 4. Gallardo MJ, Smith O, Trubnik V, Reiss G. Interventional glaucoma and the patient perspective. Expert Rev Ophthalmol. 2024. 5. Kamat S, Radcliffe NM, Shah M, et al. Long-term chronic drop therapy vs intracameral procedural pharmaceuticals for glaucoma: What does the evidence support? J Clin Exp Ophthalmol. 2024;15:988. 6. Katz LJ, Berdahl JP, Myers JS, et al. Interventional glaucoma: Improving the patient-provider educational exchange. Ophthalmol Ther. 2024. 7. Micheletti JM, Brink M, Brubaker JW, Ristvedt D, Sarkisian SR. Standalone interventional glaucoma: An evolution from the combination-cataract paradigm. J Cataract Refract Surg. 2024. 8. Micheletti JM, Radcliffe NM, Myers JS, et al. An emerging multi-mechanism and multi-modal approach in interventional glaucoma therapy. Ophthalmol Ther. 2025. 9. Radcliffe NM, Shah M, Samuelson TW. Challenging the “topical medications-first” approach to glaucoma: A treatment paradigm in evolution. Ophthalmol Ther. 2023;12(6):2823-2839. 10. Yadgarov A, Provencher L, Shafer B, Funke C. Adopting interventional glaucoma via sustained-release therapies: The wide-ranging impact of procedural pharmaceuticals in ophthalmology. Ophthalmol Ther 2024;13:2825-2838. 11. Gallardo MJ, Bovee C, Teymoorian S. The emergence of breakthrough procedural pharmaceutical therapies. Cataract Refract Surg Today. 2024. Sponsored by Glaukos Corporation.



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©2025 Glaukos Corporation. All rights reserved. iDose® TR is a registered trademark of Glaukos Corporation. Durysta® is a registered trademark of Allergan, an AbbVie company. PM-US-2623

iStent inject® W Important Safety Information

Indication for Use

The iStent inject® W Trabecular Micro-Bypass System Model G2-W is indicated for use in conjunction with cataract surgery for the reduction of intraocular pressure (IOP) in adult patients with mild to moderate primary open-angle glaucoma.

Contraindications

The iStent inject® W is contraindicated in eyes with angle-closure glaucoma, traumatic, malignant, uveitic, or neovascular glaucoma, discernible congenital anomalies of the anterior chamber (AC) angle, retrobulbar tumor, thyroid eye disease, or Sturge-Weber Syndrome or any other type of condition that may cause elevated episcleral venous pressure.

Warnings

Gonioscopy should be performed prior to surgery to exclude congenital anomalies of the angle, PAS, rubeosis, or conditions that would prohibit adequate visualization of the angle that could lead to improper placement of the stent and pose a hazard.

MRI Information

The iStent inject® W is MR-Conditional, i.e., the device is safe for use in a specified MR environment under specified conditions; please see Directions for Use (DFU) label for details.

Precautions

The surgeon should monitor the patient postoperatively for proper maintenance of IOP. The safety and effectiveness of the iStent inject® W have not been established as an alternative to the primary treatment of glaucoma with medications, in children, in eyes with significant prior trauma, abnormal anterior segment, chronic inflammation, prior glaucoma surgery (except SLT performed > 90 days preoperative), glaucoma associated with vascular disorders, pseudoexfoliative, pigmentary or other secondary open-angle glaucomas, pseudophakic eyes, phakic eyes without concomitant cataract surgery or with complicated cataract surgery, eyes with medicated IOP > 24 mmHg or unmedicated IOP < 21 mmHg or > 36 mmHg, or for implantation of more or less than two stents.

Adverse Events

Common postoperative adverse events reported in the iStent inject® randomized pivotal trial included stent obstruction (6.2%), intraocular inflammation (5.7% for iStent inject® vs. 4.2% for cataract surgery only), secondary surgical intervention (5.4% vs. 5.0%) and BCVA loss ≥ 2 lines ≥ 3 months (2.6% vs. 4.2%).

Caution

Federal law restricts this device to sale by, or on the order of, a physician. Please see DFU for a complete list of contraindications, warnings, precautions, and adverse events.

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