Glaucoma, the leading cause of irreversible blindness globally, is often called the “silent thief of sight.” Despite its complex pathophysiology, lowering intraocular pressure (IOP) remains the mainstay of glaucoma treatment. Topical therapies, such as miotics, beta-adrenergic receptor antagonists, carbonic anhydrase inhibitors, alpha-2 adrenergic receptor agonists, and FP-prostaglandin receptor agonists, were historically the first line of treatment for glaucoma. A rho kinase inhibitor was FDA-approved in 2017, almost 20 years after the advent of prostaglandin analogs.

However, barriers to topical therapy use, including high nonadherence due to side effects, difficulties with administration, and forgetfulness, have driven the treatment algorithm to a more interventional approach. New medical, surgical, and laser options offer patients a greater variety of treatment options, often with better outcomes that traditional management.

Sustained-Release Intraocular Implants: Reducing the Need for Topical Treatments

Two prostaglandin-based intraocular implants were approved by the FDA in recent years: Durysta and iDose. Durysta is an intracamerally injected biodegradable polymer matrix containing sustained-release bimatoprost. The implant is injected into the anterior chamber, sinking down to the inferior angle.

Its approval represents the first sustained-release implant in the therapeutic landscape. Data from clinical trials and real-world studies show that the implant is noninferior to twice-daily timolol maleate and provides consistent IOP reduction comparable to topical prostaglandin analogs.

Additionally, it reduces the need for daily topical treatments, providing possible benefits for improvement in patient adherence and fewer side effects. A safety concern that emerged with repeated administrations was endothelial cell loss, and the implant is only approved for a single administration. The implants appear to last for 12-18 months, and a real-world retrospective study supported their safety at 1 year. iDose TR, a travoprost intraocular implant, was approved by the FDA in 2023 and became commercially available in 2024. This implant, which is made from medical-grade titanium, is injected through the trabecular meshwork and anchored to the scleral wall. It elutes travoprost via membrane-controlled diffusion. Clinical trials showed that the implant is noninferior to twice-daily timolol maleate for a period of up to 3 years post implantation. The concentration of eluted travoprost is maintained at nearly a constant state, minimizing IOP fluctuations that potentially predispose patients to progressive visual field damage. The implant is designed to function for 4 to 5 years. Possible side effects include iritis, decreased vision, conjunctival hyperemia, IOP spike, implant dislodgement, and endophthalmitis.

Laser Therapy for Glaucoma Offers Sustained Results

Beyond drug-eluting implants, another innovation in the field is an updated laser technology. The Voyager direct selective laser trabeculoplasty (DSLT) treatment was FDA-approved in 2023 and made available in the marketplace in February 2025.

Building on the well-established efficacy and safety of traditional selective laser trabeculoplasty (SLT), DSLT automatically detects the limbus and applies direct laser energy to the underlying trabecular meshwork without a gonioprism. It treats the entire 360 degrees of the angle in less than 3 seconds. The major benefits of DSLT compared to SLT are that gonioscopy skills are not needed, and the procedure takes less time. The GLAUrius trial showed that DSLT provides effective IOP control with a low risk of adverse events. Notably, in the trial, 62% of patients who received DSLT were free of medications at 12 months.

Ocular Pump: A Non-Pharmacologic and Non-Surgical Option Another recently approved novel therapeutic for treating IOP in glaucoma is the FSYX Ocular Pressure Adjusting Pump. Approved by the FDA in 2024, the pump is the first non-pharmacological and non-surgical means of lowering IOP in patients with glaucoma who have low or normal eye pressure.

The ocular pump produces a vacuum in each chamber of pressure-sensitive goggles that are worn during sleep, creating an atmosphere of negative pressure above each eye. The system can be easily titrated and personalized to a patient’s needs, or reversed by removing the goggles.

The device allows treatment of nocturnal IOP spikes in patients who have low or normal baseline daytime IOP, a condition that has been historically hard to treat. In the pivotal trial leading to the device’s approval, IOP-lowering data were consistent over 1 year of use, with 97% of patients achieving at least 20% IOP reduction while the device was worn.

AlloFlo: The Newest Glaucoma Treatment Device Another new product in the glaucoma therapeutic space is AlloFlo Uveo, a device that targets the uveoscleral pathway, rather than the trabecular pathway, during minimally invasive glaucoma surgery (MIGS). AlloFlo Uveo, made commercially available in late 2025, is a bio-tissue spacer made from donor scleral tissue.

It provides an alternative route for fluid drainage from the eye via ab-interno homologous structural reinforcement. The AlloSert Uveo is a delivery platform that creates controlled cyclodialysis and positions the AlloFlo Uveo spacers. AlloFlo Uveo was tested in the CREST clinical trials, and interim data from a 2-year follow-up study show that patients maintain greater than 30% IOP reduction, with no serious adverse events.

The Future of Glaucoma Care An implant attached to an intraocular lens that elutes bimatoprost and is combined with standard cataract surgery is in the late stages of development for glaucoma treatment. The device platform consists of a hydrophobic lens with two drug-eluting pads attached at the haptic-optic junction. Designed to provide continuous drug delivery over 3 years, the device performed well in a phase 1/2 study, with patients remaining off all topical therapies and a safety profile similar to standard cataract surgery. Another implant that targets vision loss associated with both glaucoma and diabetic retinopathy is under investigation as the first disease-modifying treatment for these diseases. Unique in that it does not affect IOP, the intravitreal implant releases a small-molecule endothelin receptor antagonist, designed to improve retinal blood flow and prevent apoptosis of retinal cells. In a phase 2 trial, visual field performance, ocular blood flow, and optic nerve structure improved in the treatment group. Other modes of treatment that are generating some excitement in the field include gene therapy and stem-cell therapy. Gene therapy using viral vectors and siRNA can potentially change the outflow and reduce the production of aqueous humor, thereby reducing IOP. Animal studies have also shown that it can improve retinal ganglion cell survival. Replacing or stimulating the growth of the trabecular meshwork may be achievable by stem cells, restoring outflow potential. Treatments providing neuroprotection, which is associated with enhancing cell survival and resistance to optic nerve damage, are also being studied to a significant extent. Studies with nicotinamide, ciliary neurotrophic factor, and Fas-L inhibition are ongoing in this area.

Glaucoma Treatment: Advances to Improve Patient Outcomes

The therapeutic landscape for glaucoma treatment is expanding rapidly, with many modalities under investigation. Some of the latest approved therapeutics include prostaglandin-based implants, direct selective laser trabeculoplasty, a negative-pressure pump device, and a bio-

tissue spacer for uveoscleral drainage. Emerging therapies include new drug-eluting implants, gene and stem-cell therapies, and various neuroprotective treatments.