What changed in glaucoma care in 2025: Surgeon perspective

In a year-end conversation, Oluwatosin U. Smith, MD, of Glaucoma Associates of Texas, in Dallas, sat down with the Eye Care Network to reflect on how glaucoma care evolved as 2025 drew to a close. Framing the discussion as a moment to assess progress after a decade of rapid innovation and the disruptions of the COVID era, Smith focused on how the field has begun to consolidate its tools and refine clinical decision-making. She characterized the past year as one in which innovation has “somewhat slow[ed] down, and slow down is not really a bad thing,” allowing clinicians to better interpret and apply the expanding array of diagnostic and therapeutic options now available.

Interventional glaucoma and evolving treatment strategies

A central theme is the maturation of interventional glaucoma. According to Smith, 2025 marked a year in which clinicians more actively communicated an interventional mindset to colleagues, moving away from reactive care toward earlier, proactive intervention. With numerous diagnostic and therapeutic options now established, the focus has shifted to determining “what’s best for who” and ensuring that surgeons are not “playing catch up with patient care.”

Treatment strategies continue to evolve, particularly within minimally invasive glaucoma surgery (MIGS). Smith noted that surgeons are becoming more comfortable selecting and mastering specific tools within each MIGS category, supported by emerging clinical trial data that better delineate patient selection across disease stages. Selective laser trabeculoplasty (SLT) stands out as an example of this shift. The 6-year results of the LiGHT trial, released within the past 18 months, have reinforced earlier use of SLT as a first-line interventional approach rather than reliance solely on topical medications. As Smith explains, this represents “earlier intervention with an interventional tool, not just topical medicine.”

Beyond laser therapy, the expanding armamentarium includes angle-based surgery, minimally invasive bleb surgery such as Xen, and sustained-release medications like iDose. The challenge, she emphasizes, is no longer availability but appropriate engagement: “We now have a lot of tools, and being able to engage with these tools in the right way…is one of the things that we have learned well this year.”

Data, AI, and remote monitoring

Artificial intelligence (AI) is discussed with cautious optimism. Smith noted, “I think it will help our jobs.” Although not yet ready for routine clinical use, AI holds promise for early detection, screening, risk prediction, and long-term monitoring, particularly through large datasets such as the IRIS Registry. Improved data integration may reduce subjectivity and support more personalized care, provided “the right data” are entered into these systems.

Remote monitoring saw increased awareness rather than widespread adoption. The pandemic highlighted unmet needs, prompting interest in tools such as virtual reality visual field testing and home IOP monitoring. However, limitations in cost, technology, and validation mean that comprehensive remote monitoring remains aspirational. As Smith notes, quarterly visits are insufficient for chronic disease management, underscoring the need for future biomarkers analogous to A1C in diabetes.

Patient outcomes and mindset shifts

Regarding patient outcomes and adherence, Smith emphasizes that while outcomes themselves have not dramatically shifted, clinician mindset has. Acknowledging persistent nonadherence, she stresses that outcomes are ultimately shaped by how proactively clinicians address these challenges and intervene earlier using newer options. Evidence from trials such as LiGHT and HORIZON supports earlier intervention to reduce the need for more invasive surgery later.

Smith highlights the breadth of opportunity in glaucoma care today. “It’s exciting to be a glaucoma specialist,” she says, while also encouraging ophthalmologists to engage in continued learning, literature review, and collaboration. With most glaucoma care occurring outside specialist offices, integrating these tools across the broader ophthalmic community remains essential to improving long-term patient outcomes.