As the ophthalmology community observes Glaucoma Awareness Month this January, glaucoma specialists point to incremental integration of technologies that support earlier intervention, individualized care, and long-term disease management within existing clinical workflows.

This article draws from recent interviews conducted by the Eye Care Network with Joel Schuman, MD, of Wills Eye Hospital in Philadelphia, Pennsylvania, and Oluwatosin U. Smith, MD, of Glaucoma Associates of Texas, in Dallas, who discussed emerging technologies, evolving treatment strategies, and practical considerations shaping glaucoma care.^1-3 From these conversations, 8 key themes emerge, highlighting the trends and innovations shaping the future of glaucoma care.

1. AI for imaging, detection, and risk prediction

Innovation in glaucoma care may be driven less by a single breakthrough and more by the combination of multiple tools, including artificial intelligence (AI). Schuman pointed to AI’s expanding role in glaucoma diagnostics, particularly for imaging-based assessment.

“The use of AI for imaging and also for risk prediction, I think, is probably the closest [to]—and in some ways—already transforming practice,” Schuman said.

He noted near-term applications include automated detection of glaucoma progression using optical coherence tomography (OCT), fundus photography, visual fields, and multimodal data.

“That would include all of the things I just mentioned, as well as the electronic health record. It's close, because we've already seen the adoption of AI for imaging in retinal disease, specifically in diabetic retinopathy. This was the first technology that was approved for use with AI by the FDA, and that technology is out there commercially, and it's being used heavily,” he said. “I think that this has proven both the efficacy and safety of this sort of approach and the performance really rivals expert readers and the regulatory pathways are clear. Barriers in that area include the generalizability of the AI results, integration of the data into workflows, who bears the liability, and reimbursement.”

Smith emphasized that AI’s clinical impact will depend on data quality and thoughtful implementation.

“Is it perfect? Is it ready for clinical practice just yet? Not yet,” Smith said. “But there are many ways that AI will help the way we care for patients. We’re hoping things like early detection and screening would be ways that we would see some kind of improvement as technology improves.”

2. Remote and home-based monitoring technologies

Remote monitoring tools continue to evolve, driven in part by post-pandemic shifts in care delivery. Schuman highlighted home tonometry, virtual reality–based visual field testing, and early handheld or kiosk OCT systems as nearing broader use.

“In the post-COVID era, we have more comfort with remote care, and the technology is maturing,” Schuman said.

Smith noted that while adoption remains limited, awareness has increased.

“The era of COVID exposed us to the need for that,” Smith said, referring to remote monitoring. “I hope we’re not going to get into another pandemic before we realize the need to be actively engaged in developing those things so I wouldn't say there has been a big change in remote monitoring but I would say the awareness that the pandemic created. I'm sure that as glaucoma specialists, we all understand that [the] quarterly visit that we have is not enough for us to be able to tell. Four times a year is not enough for us to tell the complete disease state of somebody who has a chronic disease, but there hopefully will be other things that will be markers that will help to guide us.”

3. Sustained-release and controlled drug delivery

Sustained-release and controlled drug delivery approaches continue to expand the range of options available for glaucoma management, particularly for intraocular pressure (IOP) lowering. Schuman highlighted intracameral implants that have already received FDA approval, including the bimatoprost intracameral implant 10 mcg (Durysta; AbbVie) and the travoprost intracameral implant 75 mcg (iDose TR; Glaukos).

“The FDA has already approved [these implants], and I think that we’re going to see more devices like that,” Schuman said.

He noted that the pipeline for these therapies is continuing to mature, with additional devices under development, while also acknowledging that adoption will be influenced by factors such as cost, safety signals, patient acceptance, and workflow considerations.

Smith also referenced the growing availability of sustained-release options and the practical challenges of incorporating them into routine care.

“There’s stuff now on the market, and we now have a lot of tools,” Smith said. “Being able to engage with these tools in the right way, I would say is one of the things that we have learned well this [past] year.”

4. Laser-based therapies and evolving SLT approaches

Selective laser trabeculoplasty (SLT) continues to play a central role in interventional glaucoma management, with both refinements to existing techniques and longer-term outcome data influencing clinical decision-making. Schuman discussed newer direct SLT technology designed to simplify the procedure by reducing technical demands. “It decreases the level of expertise that’s necessary in order to perform the procedure,” Schuman said.

He explained that the direct SLT approach removes the need for a contact lens and delivers treatment translimbally but noted limitations. “It doesn’t work quite as well as standard SLT,” Schuman said, noting that the device did not meet noninferiority in clinical studies and results in approximately 2 millimeters less efficacy compared with conventional SLT.

Schuman also noted that adoption may be affected by professional debate around who should perform the procedure. “The barrier there is the ‘controversial’ aspect of it in terms of who should be doing the procedure,” he said.

Smith pointed to the impact of long-term clinical trial data in shaping how SLT is used in practice.

“The use of SLT is becoming something that more and more people are aware of and we're encouraging people to do in light of the LiGHT trial [NCT03395535],” she noted.

“The LiGHT trial had the 6-year results come out in the past 18 months, and now focusing on that and realizing that early intervention with laser trabeculoplasty is a change in the way we practice, it's earlier intervention with an interventive tool, not just topical medicine,” Smith said. “That is a classic example of where the focus is.”

5. Minimally invasive glaucoma surgery and earlier intervention

Minimally invasive glaucoma surgery (MIGS) continues to reshape treatment strategies. Smith noted increasing comfort among surgeons with selecting and mastering specific approaches.

“People are now getting more comfortable with picking something in each category and sort of mastering that,” she said.

“We’ve taken all of the tools that we’ve acquired and [are] now [able] to start to do either clinical trials to be more pointed in using the new things that we have and trying to find ways to find what’s best for who—telling our colleagues [that] we can’t be the surgeons who will be playing catch-up with patient care, but who will be more proactive with care that interventional glaucoma encourages us to do,” Smith said.

6. Neuroprotection and metabolic therapies

Research into neuroprotection and metabolic support remains an area of clinical interest, although approaches in this category are investigational. Schuman pointed to studies evaluating nicotinamide, also known as vitamin B3, alone or in combination with pyruvate, as a potential neuroprotective or neuro-enhancing therapy.

“It’s been shown now in a few studies that it may have a neuro-protective or neuro-enhancing effect,” Schuman said.

He noted that although nicotinamide is widely available and does not require a prescription, it is not without risk. “You can have some serious side effects, deleterious side effects from it, specifically liver inflammation related to the supplement,” he said.

Schuman stressed the importance of clinician involvement and patient education when discussing these therapies. “That’s where the clinician needs to educate the patient about both the risks and benefits,” he said, adding that “this is one you can’t just kind of throw into the mix.

“You need to really discuss it with your patient,” Schuman said. “It is not something that, for instance, the American Academy of Ophthalmology and the American Glaucoma Society are recommending that we prescribe or recommend to our patients, and certainly not without educating them about what the risks are.”

7. Regenerative medicine, gene therapy, and stem cell research

Early-stage research into regenerative strategies remains an area of active investigation, with several approaches still largely experimental.

“People are working very hard on optic nerve regeneration,” Schuman said. “We’re very much not there yet, but it is an area of intense scientific interest and of clinical importance.”

He noted that stem cell–based approaches are being explored both for optic nerve support and for restoring pressure regulation. “Stem cell approaches for optic nerve regeneration and support are also in studies,” Schuman said.

“One area that consortium and I are working on [is] stem cell therapy for trabecular meshwork regeneration in order to restore normal pressure control in people with glaucoma by introducing stem cells to the trabecular meshwork and outflow system,” Schuman noted.

“The early clinical signals there would reshape the long-term expectations,” he said.

8. Integration, workflow, and practice readiness

Both physicians noted that successful adoption of innovation depends on more than technology.

“The winners don’t have to be the flashiest tools in 2026,” Schuman said. “They’ll be the ones that make a busy clinic run better.”

Smith echoed the importance of mindset and ongoing education.

“It’s exciting to be a glaucoma specialist,” Smith noted, largely because today’s clinicians have more options to help patients than ever. She added that these options are not limited to subspecialists. For non-glaucoma ophthalmologists, there are “lots of great options out there” that may be helpful in changing their mindset for how they approach treatment.

Smith noted that “learning beyond fellowship or even residency is good.” She encouraged clinicians to stay engaged by reviewing literature, connecting with representatives, and learning from colleagues to identify “that new thing that you can add to your armamentarium.” Smith added that glaucoma management is a shared effort, since “the majority of that care happens outside of our offices as glaucoma specialists.”

Note: The thoughts and opinions expressed are those of Schuman and Smith and do not necessarily represent the opinions of this publication.

References

1. Schuman JS. Stevenson S. Glaucoma 2026: Which emerging technologies will change practice? Ophthalmology Times. December 26, 2025. Accessed January 7, 2026. https://www.ophthalmologytimes.com/view/glaucoma-2026-which-emerging-technologies-will-change-practice-

2. Smith OU, Stevenson S. What changed in glaucoma care in 2025: Surgeon perspective. Ophthalmology Times. December 30, 2025. Accessed January 7, 2026. https://www.ophthalmologytimes.com/view/what-changed-in-glaucoma-care-in-2025-surgeon-perspective

3. Schuman JS. Stevenson S. Innovations in glaucoma poised for breakthrough in 2026 (and what might hold them back). Ophthalmology Times. January 2, 2026. Accessed January 7, 2026. https://www.ophthalmologytimes.com/view/innovations-in-glaucoma-poised-for-breakthrough-in-2026-and-what-might-hold-the-back-