ADVANCING THE STANDARD OF GLAUCOMA CARE

Interventional Glaucoma

For decades, glaucoma management has been centered around two treatment approaches—topical medications and incisional surgery. Discover how interventional glaucoma is reshaping the treatment landscape for patients with this sight threatening disease.1

Re-examining The Conventional Glaucoma Patient Journey

Reactive glaucoma management follows a stepwise approach, escalating treatment only after disease progression.1,2

The current “medication-first and always” mindset is being challenged

Limitations of Glaucoma Drop Therapy

Patients treated with glaucoma drop therapy regimens can suffer significant disease progression2

Probability of Primary Open Angle Glaucoma-related Blindness by Visual Field or Visual Acuity

13.5% of patients progressed to blindness

13.5% of patients progressed to blindness

Data collected from 1981-2000

In a 20-year study sponsored by the NIH in Olmsted County, Minnesota2:

Despite being diagnosed and treated with glaucoma drop therapy, the probability of disease progression leading to blindness in at least one eye shown to be 13.5%, and 4.3% bilaterally

Average time to blindness in these patients was 5.8 years

Drops-first management has compounding limitations:

Self-Application of Topical Medication Leads to Adherence Challenges:

of glaucoma patients are non-compliant with glaucoma drop therapy3

of glaucoma patients purposely discontinue glaucoma drop therapy within 6 months

Stepwise Introduction of Additional Topical Therapy has Diminishing Return on IOP Reduction

Additional topical medications provide only 8-11% further reduction in intraocular pressure (IOP) following treatment with the first drop.4

Long-term Glaucoma Drop Therapy Leads to Ocular Side Effects

Blurred Vision
Periorbitopathy
Ocular Surface Disease

Advancements in Glaucoma Treatment

Advancements in therapeutic options have addressed the limitations of drop-based therapy by effectively lowering IOP without relying on patient self-application of topical pharmaceuticals.1*

Interventional Glaucoma: A Proactive Approach

Moving towards a new standard

Incorporating early procedural interventions can slow disease progression more effectively than topical glaucoma drop therapy7

  • Illustration of an eye treated with glaucoma drop therapy
  • Illustration of an eye with reduced glaucoma drop therapy

An Interventional Approach that is Advancing Patient Care

Personalize

Personalize glaucoma management by early predictive diagnostics and active monitoring.

Proactive

Proactively manage glaucoma rather than waiting for significant progression or patient non-compliance and adherence.

Effective, low-risk

Effective, low-risk early procedural interventions allows the HCP to re-gain control of glaucoma treatment.

Integrating Interventional Glaucoma Into Your Practice

A consensus protocol was developed by eleven leading ophthalmologists in the US. The Interventional Glaucoma working group reviewed individual treatment strategies and established a consensus-based framework tailored to each stage of disease progression8.

Disclaimer: procedural pharmaceuticals is not available in Australia and New Zealand.

  • Ocular Hypertension

    • Lasers
    • Procedural Pharmaceuticals
    • Tissue-sparing MIGS
    • MTMT

  • Mild Glaucoma

    • Lasers
    • Procedural Pharmaceuticals
    • Tissue-sparing MIGS
    • Non-tissue-sparing MIGS Procedures
    • MTMT

  • Moderate Glaucoma

    • Lasers
    • Procedural Pharmaceuticals
    • Tissue-sparing MIGS
    • Non-tissue-sparing MIGS Procedure
    • MTMT
    • Filtering Surgery

  • Severe Glaucoma:

    Favoring a more aggressive intervention, skipping laser to focus on a combined protocol of procedural pharmaceuticals and tissue-sparing MIGS followed by non-tissue-sparing MIGS if IOP is not controlled. Filtering surgery is still the last resort but may be considered when prompt and substantial reduction of IOP is imperative to prevent irreversible optic nerve damage.

    • Procedural Pharmaceuticals
    • Tissue-sparing MIGS
    • Non-tissue-sparing MIGS Procedures
    • MTMT and/or Lasers
    • Filtering Surgery

  • Bridge therapy: Drops used as a temporary treatment while patient awaits procedural intervention | Supplemental: Drops used in addition to a procedural intervention MTMT: Maximum tolerated medical rherapy | Tissue-sparing MIGS: Either trabecular bypass or canaloplasty

Discover the Future of Glaucoma Care

Watch how Glaukos is advancing patient outcomes and supporting practices on their interventional glaucoma journey.

Applying Interventional Glaucoma in Practice

As awareness of interventional glaucoma continues to grow, translating this understanding into clinical practice is essential to advancing patient care.
Clinicians should assess their current treatment protocols and consider where opportunities exist to integrate interventional options earlier in the care continuum.

Discover how Glaukos' products meet the needs of Interventional Glaucoma

iStent Infinite®Preserflo* Glaukos provided reimbursement for the Interventional Glaucoma Working Group’s time and travel expenses to allow them to participate in consensus-building discussions.

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References

  1. 1. Bedrood S et al. Clin Ophthalmol. 2023;17:3899-3913.
  2. 2. Malihi M et al. Ophthalmology. 2014;121(1):134-41.
  3. 3. Nordstrom BL et al. Am J Ophthalmol. 2005;140(4): 598-606.
  4. 4. Johnson T , Jampel HD. Am J Ophthalmol. 2020;216:110-20.
  5. 5. Kolko et al. Ocular Surface. 2023;29:456-68.
  6. 6. O’Hare et al. Clin Exp Ophthalmol. 2012;40(7):675-81.
  7. 7. Litcher PR et al. Ophthalmol. 2001;108(11):1943-53.
  8. 8. Funke C et al. Exp Rev Ophthamol. 2025; 20:79-87.

iStent infinite® Important Safety Information

Indication for Use

The iStent infinite Trabecular Micro-Bypass System Model iS3 is intended to reduce intraocular pressure in adult patients diagnosed with primary open-angle glaucoma (POAG) currently treated with ocular hypotensive medication. The device can be implanted with or without cataract surgery.

Contraindications

The iStent infinite System is contraindicated under the following circumstances or conditions: In eyes with primary angle closure glaucoma, or secondary angle-closure glaucoma, including neovascular glaucoma, because the device would not be expected to work in such situations; In patients with retrobulbar tumor, thyroid eye disease, 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 visualisation that could lead to improper placement of the stent and pose a hazard.

MRI Information

The iStent infinite 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. Three out of 61 participants (4.9%) in the pivotal clinical trial were phakic. Therefore, there is insufficient evidence to determine whether the clinical performance of the device may be different in those who are phakic versus in those who are pseudophakic.

Adverse Effects

The most common postoperative adverse events reported in the iStent infinite pivotal trial included IOP increase ≥ 10 mmHg vs. baseline IOP (8.2%), loss of BSCVA ≥ 2 lines (11.5%), ocular surface disease (11.5%), perioperative inflammation (6.6%) and visual field loss ≥ 2.5 dB (6.6%).

Caution

Please see DFU for a complete list of contraindications, warnings, precautions, and adverse events.

Preserflo Important Safety Information

Indication for Use

The MicroShunt is intended for reduction of intraocular pressure in eyes of patients with primary open angle glaucoma where IOP remains uncontrollable while on maximum tolerated medical therapy and/or where glaucoma progression warrants surgery.

Contraindications

The implantation of the MicroShunt is contraindicated under the following circumstances and conditions: ANGLE CLOSURE GLAUCOMA; PRESENCE OF CONJUNCTIVAL SCARRING, PREVIOUS INCISIONAL OPHTHALMIC SURGERY INVOLVING THE CONJUNCTIVA OR OTHER CONJUNCTIVAL PATHOLOGIES (E.G., THIN CONJUNCTIVA, PTERYGIUM) IN THE TARGET QUADRANT; ACTIVE IRIS NEOVASCULARIZATION; ACTIVE INFLAMMATION (E.G., BLEPHARITIS, CONJUNCTIVITIS, SCLERITIS, KERATITIS, UVEITIS); SECONDARY GLAUCOMA SUCH AS POSTTRAUMATIC, PSEUDOEXFOLIATION OR PIGMENTARY; VITREOUS IN THE ANTERIOR CHAMBER; PRESENCE OF AN ANTERIOR CHAMBER INTRAOCULAR LENS (ACIOL); INTRAOCULAR SILICONE OIL.

Warnings

Rx only: This device is restricted to sale by, or on the order of, a physician. For one-time use only. Do not reuse or re-sterilise. Reuse, or re-sterilisation may compromise the structural integrity of the device and/or lead to device failure which, in turn, may result in serious patient injury, illness, blindness or death. Reuse, or re-sterilisation may also create a risk of contamination of the device and/or cause patient infection or cross-infection, including, but not limited to, the transmission of infectious disease(s) from one patient to another. Contamination of the device may lead to injury, illness, blindness, or death of the patient. After use, dispose of product and packaging in accordance with hospital, administrative, and/or local government policy. Long term effects of Mitomycin C (MMC) with the use of this device have not been evaluated. Necessary precautions and interventions on the use of MMC are highly recommended. The patient’s IOP should be monitored postoperatively. If IOP is not adequately maintained after surgery, appropriate additional therapy to maintain IOP should be considered. The MicroShunt should not be subjected to direct contact with petrolatum-based (i.e., petroleum jelly) materials (e.g., ointments, dispersions, etc.). No cutting or modification of the MicroShunt is allowed.

Potential Complications / Adverse Effects

The complications during and after surgery may include: Glaucoma progression not controlled, increase in cup-to-disc ratio (C/D), anaesthesia related complications, difficulty in inserting the MicroShunt, failure to implant the device, device malfunction, device repositioning, extended surgical procedure, tube migration out of anterior chamber, flat anterior chamber, shallow anterior chamber, excessive bleeding in anterior chamber or incision site or eye, MicroShunt touches cornea or iris, intraocular pressure too high or low, strabismus, viscoelastic used in anterior chamber, choroidal effusion or hemorrhage, retinal complications (retinal detachment, proliferative retinopathy), hyphema, hypotony or hypotony maculopathy, phthisis bulbi, endophthalmitis, tube erosion through conjunctiva, tube obstruction partial or complete (block by iris or vitreous or fibrin or debris), uveitis, iritis, diplopia, aqueous misdirection, corneal complications (abrasion, edema, ulceration, infection, decompensation, bullous keratopathy, endothelial cell loss, Descemet striae, keratitis), partial or complete vision loss, blurry vision, bleb leak, blebitis, cystic bleb, bleb failure, pupillary block, ptosis, macular edema, prolonged inflammation, use of glaucoma medications, ocular pain, conjunctival complications (buttonhole, dehiscence, dissection, hemorrhage, hyperemia, scar, tear, ulcer), iris adhesions/synechiae, iris abrasion, cataract development or progression, posterior capsule opacity, explantation of the MicroShunt, encapsulation reaction, foreign body sensation, fibrin in anterior chamber, visual field damage, unplanned glaucoma-related surgical re-intervention, optic disc hemorrhage, globe perforation, headache, vitreous hemorrhage, wound leak, and suture related complications.


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