Interventional glaucoma: Redefining control and elevating patient outcomes

At Envision Summit 2026 in Puerto Rico, Inder Paul Singh, MD, discussed office-based surgery and the evolving concept of interventional glaucoma in a CE Spotlight Symposium with Mary Qiu, MD, and Danica J. Marrelli, OD, FAAO, AAODip. He outlined interventional glaucoma as a proactive, patient-centered approach that emphasizes earlier intraocular pressure (IOP) reduction, reduced medication burden, and improved adherence to prevent disease progression while preserving quality of life. Singh sat down with the Eye Care Network to further discuss his contributions to the session.

Can you please introduce yourself and share what you presented on at Envision Summit?

Inder Paul Singh, MD: My name is Paul Singh, MD. I’m president of The Eye Centers of Racine & Kenosha in southeastern Wisconsin, and I’m a glaucoma and anterior segment surgeon. At the Envision Summit 2026 in Puerto Rico, I had the opportunity to speak on two topics. The first was office-based surgery, clarifying what’s truly happening in that space and addressing some common misconceptions. The second focused on interventional glaucoma, particularly the patient journey and how we frame discussions around the many treatment options now available.

How do you define interventional glaucoma, and how does it differ from traditional glaucoma management strategies?

Singh: Interventional glaucoma isn’t about rushing to surgery or favoring one specific procedure. It’s about recognizing that compliance is a real issue and that earlier, meaningful IOP reduction can prevent progression while maintaining quality of life. For me, interventional glaucoma starts with the mindset that glaucoma management is a journey. It often begins with primary SLT, which is a physiologic way to address the trabecular meshwork, which is the source of resistance for many patients. SLT sets the tone for discussing procedures early in the disease process.

From there, the journey may include repeat SLT, drug delivery systems, cataract surgery combined with MIGS, or other procedural options, whether targeting the conventional outflow pathway, the suprachoroidal space, or the subconjunctival space. No single intervention is expected to last forever. The key is expectation building. I tell patients, “My job is to prevent vision loss while preserving your quality of life.” That may require multiple procedures over time. When patients understand this framework, it reduces anxiety—both for them and for us as providers.

Can you elaborate on what you mean by “controlled glaucoma?”

Singh: Absolutely. Historically, if a patient’s pressure looked “fine” on two or three medications, we considered them controlled. But how do we know they’re truly controlled throughout the day? Are they fluctuating? Are they progressing despite acceptable pressures? Tools like home tonometry or diurnal measurements can reveal more. If a patient is progressing on OCT or visual fields, or experiencing cost barriers, side effects, or forgetfulness, that’s not true control, even if the pressure appears acceptable in clinic. We now have data showing that patients who achieve the same IOP reduction without medications tend to do better over time. They experience less progression, less visual field loss, and fewer secondary surgeries. So I think we need to redefine success. It’s not just pressure reduction. It is also drop burden reduction, improved adherence, and addressing barriers to compliance. Even patients who aren’t “complaining” may warrant intervention if their long-term risk profile suggests they would benefit.

Is there anything else you’d like to add about these topics?

Singh: I would emphasize that both office-based surgery and interventional glaucoma reflect the same underlying philosophy: proactive, patient-centered care. Whether it’s improving the surgical experience or intervening earlier in glaucoma, our goal is to maintain vision and quality of life over the long term.