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. 2025 Jan;14(1):13-22.
doi: 10.1007/s40123-024-01073-z. Epub 2024 Nov 30.

An Emerging Multi-mechanism and Multi-modal Approach in Interventional Glaucoma Therapy

J Morgan Micheletti  1 , Mitchell Shultz  2 , Inder Paul Singh  3 , Thomas W Samuelson  4
Affiliations

An Emerging Multi-mechanism and Multi-modal Approach in Interventional Glaucoma Therapy

J Morgan Micheletti et al. Ophthalmol Ther. 2025 Jan.

Abstract

The glaucoma treatment paradigm is in evolution. The topical medications-first approach is limited by significant barriers such as high rates of nonadherence and side effects including ocular surface disease. The era of interventional glaucoma has seen the development of selective laser trabeculoplasty (SLT), procedural pharmaceuticals, and minimally invasive glaucoma surgeries (MIGS). New and emerging data support the use of these interventional treatment modalities early in the course of glaucoma rather than reserving them for advanced or treatment-recalcitrant cases. The various treatments available represent multiple mechanisms (e.g., trabecular outflow, uveoscleral outflow, aqueous suppression) and modalities (medications, laser, incisional surgery) by which intraocular pressure (IOP) is reduced. Many patients require more than one treatment to achieve adequate IOP reduction and glaucoma control. Comprehensive IOP control-reduction of both mean IOP and IOP fluctuation-can best be achieved by targeting multiple mechanisms of IOP reduction and taking advantage of the attributes of multiple treatment modalities.

Keywords: Laser; MIGS; Mechanism; Medication; Modality; Procedure; Sustained release; Trabecular; Uveoscleral.

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Conflict of interest statement

Declarations. Conflict of Interest: J. Morgan Micheletti: Alcon (consultant, researcher, speaker); Allergan (AbbVie)(consultant, researcher); Avellino (consultant); Bausch & Lomb (consultant), BVI (consultant); Centricity Vision (consultant); Diamatrix (consultant, patent); Elios (consultant); Glaukos Corp. (consultant, speaker); Johnson and Johnson Vision (consultant, researcher); Lenstec (consultant, researcher, speaker); New World Medical (consultant, speaker); RxSight (consultant); Samsara (consultant); STAAR (consultant, researcher, speaker); Tarsus (consultant); Visus Therapeutics (consultant); Zeiss (consultant, speaker). Mitchell Shultz: Alchemy Vision (Co-Founder, Investor, Speaker); Allergan/AbbVie (Consultant, Speaker); Aerie/Alcon Pharmaceuticals (Consultant, Researcher); Bausch + Lomb (Consultant, Researcher, Speaker); BVI (Consultant, Researcher); Cloudbreak (Consultant, Researcher, Speaker); Glaukos (Consultant, Researcher, Speaker); Glint Pharma (Consultant, Medical Advisory Board); Harrow (Consultant, Speaker); HDMD (Consultant); Johnson & Johnson (Consultant, Researcher); LENSAR (Consultant); New World Medical (Consultant, Researcher); Ocuphire (Consultant, Researcher); RegenTree (Consultant, Researcher); RxSight (Consultant, Researcher, Speaker); Sanoculis (Consultant, Researcher, Speaker); Scope Pharm (Consultant); Sight Science (Consultant, Speaker); SUN Pharm (Consultant, Speaker); Tarsus (Consultant, Researcher, Speaker); Tracey Technologies (Consultant, Speaker); Trukera (Consultant); Twenty Twenty (Consultant); Zeiss (Consultant, Researcher. Speaker). Inder Paul Singh: speaker and consultant for Glaukos, Allergan, New World Medical, Ivantis, Sight Sciences, Ocular Therapeutix, Sun Pharmaceuticals, Novartis, Bausch + Lomb, Kala Pharmaceuticals, and EyePoint Pharmaceuticals. Thomas W. Samuelson: consultant for Aerie Pharmaceuticals, Alcon Surgical, Allergan, Bausch & Lomb/Valeant, BELKIN Vision, ELT Sight, Equinox, Glaukos, Imprimis, Irisvision, Ivantis, Johnson & Johnson Vision, Ocuphire, MicroOptx, New World Medical, PolyActiva, Ripple Therapeutics, Santen, Sight Science, TearClear, Vialase, and Zeiss Meditec; and stock options from Belkin Vision, Equinox, Ivantis, Ocuphire, Sight Science, Tear Clear, and Vialase. Ethical Approval: This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.

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