ASCRS 2026: Glaucoma shifts from intervention to optimisation

ASCRS 2026 highlighted a clear shift in glaucoma management, with a move beyond proving efficacy toward refining outcomes, durability and real-world application.

Across surgical and medical approaches, the focus is increasingly on sustained intraocular pressure (IOP) control, reduced treatment burden and integration into earlier stages of care.

Durability and optimisation in MIGS

Longer-term and real-world datasets reinforced the role of MIGS as a reliable strategy for sustained IOP control, with increasing emphasis on procedure selection and patient stratification to maximise outcomes.

Abstract highlight: Ab-interno canaloplasty shows durable IOP control at scale
This large retrospective study (>500 eyes) demonstrated that ab-interno canaloplasty using the iTrack microcatheter significantly reduced IOP and medication burden at a mean follow-up of ~20 months, whether performed standalone or combined with cataract surgery (p<0.001). Greater absolute IOP reduction was observed in standalone cases (−4.5 mmHg vs −3.3 mmHg; p=0.025), with the strongest outcomes seen in patients with higher baseline IOP. Surgical success reached 75% in eyes with uncontrolled disease, and complication rates were low (1.6%), supporting its safety and scalability across disease severities. See the full abstract here.

Abstract highlight: Three-year data support durable IOP reduction with supraciliary MINIject
Three-year follow-up from the STAR-GLOBAL study showed that standalone MINIject implantation achieved sustained IOP reduction (−36.2%, from 23.9 to 15.1 mmHg) alongside a meaningful decrease in medication burden (2.5 to 1.3). Over 90% of patients achieved ≥20% IOP reduction and more than one-third were medication-free at three years. Adverse events were limited, with isolated cases of endothelial cell loss and cataract progression, supporting the device as a durable, bleb-free option for long-term management. See the full abstract here.

How might this impact clinical practice?

These data reinforce MIGS as a durable treatment strategy, with growing evidence supporting both canal-based and supraciliary approaches. Patient selection remains critical, particularly baseline IOP, but the consistency of outcomes supports broader use of tissue-sparing procedures earlier in the treatment pathway.

Expanding standalone procedural options

Beyond combined cataract procedures, ASCRS 2026 highlighted growing confidence in standalone interventions for patients with more advanced or refractory disease.

Abstract highlight: Sustained 12-month outcomes with third-generation micro-bypass stents
In this retrospective analysis, standalone implantation of the iStent infinite in refractory open-angle glaucoma resulted in a significant 20.4% reduction in IOP at 12 months (19.3 to 15.4 mmHg; P<0.001), with medication burden remaining stable. Importantly, 81% of eyes maintained or reduced medication use, and no adverse events were reported. However, a subset of patients required additional procedures within the first year, highlighting the need for careful patient selection in more advanced disease. See the full abstract here.

How might this impact clinical practice?

Standalone MIGS is emerging as a viable option beyond mild-to-moderate disease, but expectations should be balanced. While effective and safe, some patients may still require adjunctive interventions, reinforcing the importance of tailoring procedural choice to disease severity and progression risk.

Reducing treatment burden: drug delivery and adherence

A strong theme across ASCRS 2026 was reducing reliance on topical therapy through sustained delivery and improving real-world adherence where drops remain necessary.

Abstract highlight: Sustained 12-month IOP control with intracameral travoprost
Real-world data from 55 eyes showed that the intracameral travoprost implant (iDose TR) achieved a 31.5% reduction in IOP at 12 months (19.9 to 13.6 mmHg; p<0.001), with 89% of patients remaining drop-free. Efficacy was consistent across disease severities and independent of prior SLT, with minimal safety concerns reported. These findings highlight the potential for sustained drug delivery to meaningfully reduce treatment burden. See the full abstract here.

Abstract highlight: Latanoprostene bunod shows stable adherence in patients with and without dry eye
This large Medicare claims analysis (n=912) demonstrated stable real-world adherence to latanoprostene bunod, with a mean proportion of days covered of 0.73 and no significant difference between patients with or without dry eye disease. While discontinuation occurred in ~45% of patients, over 60% restarted therapy, suggesting acceptable tolerability and persistence in routine practice. See the full abstract here.

How might this impact clinical practice?

Both sustained drug delivery and well-tolerated topical therapies play an important role in reducing treatment burden. Long-acting implants may significantly improve adherence and outcomes, while real-world data suggest that certain topical agents remain viable even in patients with comorbid ocular surface disease.