Eyeworld

90 | EYEWORLD | SPRING 2026 G UCOMA by Manjool Shah, MD Glaucoma Editor A s we turn our sights toward Washington, D.C., for the 2026 ASCRS Annual Meeting, this quar- ter's Glaucoma section high- lights a significant maturing of the "interventional" philosophy that has come to define our subspecialty. We are no longer simply managing a chronic disease through a ladder of escalating drops; we are orchestrating a complex, proactive surgical jour- ney where refractive excellence and long-term pressure stability are no longer at odds. This evolution is particularly evident in how we've begun to embrace the Light Adjustable Lens (LAL, RxSight) in our glaucoma population. Historically, we might have been hesitant to of- fer premium, adjustable optics to patients with compromised nerves, fearing the unpredictabili- ty of the postop course. However, we are finding that the ability to fine-tune refractive outcomes after the eye has settled offers a level of pre- cision that these patients arguably need more than anyone. The challenge, of course, lies in navigating the "lock-in" period and ensuring our glaucoma monitoring—particularly during those crucial early weeks—doesn't interfere with the UV-light treatments required for the lens. This pursuit of elite vision is necessarily underpinned by a renewed focus on the "safety" side of the surgical equation: the management of postop IOP spikes. Even the most flawlessly executed cataract or refractive procedure can be undermined by a transient pressure elevation that a healthy eye might tolerate, but a glauco- matous eye cannot. In this issue, we take a crit- ical look at the predictive factors and prophy- lactic protocols that allow us to guard the optic nerve during that vulnerable postop window. It is a reminder that in the interventional era, our responsibility doesn't end when the speculum is removed; it extends through the entire physio- logical stabilization of the eye. We also explore the expanding options within the suprachoroidal and supraciliary space. By utilizing this "third space" for uveo- scleral outflow, we are moving toward a more tailored, physiology-based surgical algorithm that moves beyond the trabecular meshwork alone. These advancements in MIGS reflect the collaborative and open culture that makes ASCRS such a unique "home base" for innova- tion in our specialty. It is a space where the tra- ditional silos between comprehensive cataract surgery and specialized glaucoma care continue to dissolve, fueled by our shared goal of better patient outcomes. Whether we are discussing the finer points of a supraciliary stent or the nuances of LAL adjustments, I look forward to seeing many of you at the ASCRS Annual Meet- ing and especially at Glaucoma Day to share our successes and challenges in person. The interventional philosophy in glaucoma María José Cosentino, MD, EyeWorld Refractive Editorial Board member, shared what she is looking forward to at the 2026 ASCRS Annual Meeting: "The ASCRS Annual Meeting is much more than a conference for me. It's a place where I learn, feel inspired, and reconnect with colleagues and friends who share the same passion for our specialty. Every year I leave with new ideas, meaningful discussions, and renewed energy to keep growing professionally, which is why I always look forward to coming back." These advancements in MIGS reflect the collaborative and open culture that makes ASCRS such a unique 'home base' for innovation in our specialty.

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