Last year in glaucoma at EnVision Summit 2025

Discussions from the EnVision Summit 2025 highlighted several clinical and surgical challenges that are expected to shape conversations heading into the 2026 meeting, taking place from February 13-16 in Río Grande, Puerto Rico. Key themes included managing glaucoma in complex clinical scenarios, addressing surgical complications, and refining patient-specific treatment strategies as therapeutic options continue to expand. In preparation of the meeting, take a look at the highlights in glaucoma from last year.

To learn more about EnVision Summit and to register, visit the conference’s website.

Glaucoma with co-existing ocular comorbidities

Poonam Misra, an assistant professor at Manhattan Eye Ear and Throat Hospital, discussed the management of corneal transplantation in patients with glaucoma. She emphasized the importance of understanding the patient's pre-existing conditions, including angle anatomy and degree of glaucoma, to effectively manage increases in intraocular pressure after transplantation. Misra explained that different types of transplants can have varying responses in terms of intraocular pressure elevation, and monitoring pressure is crucial due to the challenges posed by corneal shape and thickness. Misra outlined the treatment approach, starting with SLT and medical therapy, followed by milder glaucoma surgeries like canaloplasty or goniotomy, depending on the optic nerve health. In severe cases, she noted that more aggressive interventions such as trabeculectomy or tube shunt surgery may be necessary, with tube shunt surgery often preferred to avoid the corneal graft.

Alcina Lidder, an assistant professor of ophthalmology at the Northwestern University Feinberg School of Medicine, then discussed the diagnostic dilemma of glaucoma in myopic eyes. She referenced a 100-year-old paper by Arnold Knapp, MD, which highlighted the difficulty in diagnosing glaucoma in myopic patients. Lidder emphasized that myopia, especially high axial length and high myopia, is a significant risk factor for glaucoma, and patients may be underdiagnosed despite having glaucomatous visual field changes.

Complications in glaucoma surgery

Last year’s EnVision Summit featured several presentations on the complications of glaucoma surgery. Tania Tai, the vice chair of clinical operations and director of the glaucoma clinic and wet lab at the New York Eye and Ear Infirmary of Mount Sinai, discussed the issue of tube occlusions, a rare but known complication of glaucoma drainage implant surgery.

Tai highlighted a case where the tube was occluded by vitreous, which she explained is best managed by performing a pars plana vitrectomy. She emphasized the importance of first removing the vitreous plug from the tube to ensure there is no residual occlusion before amputating the vitreous. Tai also mentioned other causes of tube occlusions that may not require surgical intervention.

Shivani Kamat, a glaucoma specialist at UT Southwestern in Dallas, presented on the topic of cyclodialysis clefts in the setting of minimally invasive glaucoma surgery (MIGS). Kamat noted that as MIGS procedures have become increasingly popular, these types of complications have become more common. She stressed the importance of knowing the ocular anatomy well when performing MIGS, recommending that surgeons practice goniotomy in the clinic and get comfortable with the setup and instrumentation before operating.

Lucy Shen, the director of the glaucoma fellowship at Mass Eye and Ear, discussed the surgical management of an overhanging bleb, a complication that can occur after trabeculectomy. Shen explained that the overhanging portion of the bleb that has invaded the cornea must be removed, and the bleb itself must be revised to redirect the flow of aqueous humor posteriorly. She emphasized the importance for glaucoma specialists to be familiar with both minimally invasive glaucoma procedures as well as traditional surgeries like trabeculectomy, as patients with complications from prior operations may still present for care.

Developments in glaucoma treatment and tailoring them to the patient

Rachel Simpson, MD, discussed how glaucoma treatment has expanded significantly over the past 10 to 15 years, particularly with the growth of minimally invasive glaucoma surgery (MIGS) and other procedures that broaden options between medications and traditional surgeries. She highlighted that the main challenge clinicians now face is determining which procedure is best suited for each individual patient.

Simpson explained that although treatment tools have advanced rapidly, diagnostic tools have not kept pace. She noted that clinicians currently lack practical technologies to scientifically guide treatment selection, such as reliable imaging of the outflow tract or accessible 24-hour intraocular pressure monitoring. Simpson emphasized that future progress in glaucoma care will depend on developing better diagnostic methods to match patients with the most appropriate treatments.

References

1. Misra P, Lidder A, Harp MD. EnVision Summit 2025: Glaucoma with co-existing ocular co-morbidities. Ophthalmology Times. March 4, 2025. Accessed February 4, 2026. https://www.ophthalmologytimes.com/view/envision-summit-2025-glaucoma-with-co-existing-ocular-co-morbidities

2. Tai T, Kamat S, Shen L, Harp MD, Joy J. EnVision Summit 2025: Complications in glaucoma surgery. Ophthalmology Times. March 3, 2025. Accessed February 4, 2026. https://www.ophthalmologytimes.com/view/envision-summit-2025-complications-in-glaucoma-surgery

3. Simpson R, Harp MD. Envision Summit 2025: New developments in glaucoma treatment and tailoring them to the patient. Ophthalmology Times. February 19, 2025. Accessed February 9, 2026. https://www.ophthalmologytimes.com/view/envision-summit-2025-new-developments-in-glaucoma-treatment-and-tailoring-them-to-the-patient