Eyeworld

68 | EYEWORLD | SUMMER 2026 G UCOMA tracking and patient observation. Whether stem- ming from blunt trauma like hyphema, chemical injuries, or open globe damage, traumatic glau- coma often presents as a late-onset disease that can arise decades after the initial event. Patients are often forgetful of the inciting trauma, but careful and detailed examination and diagnos- tics can shed light on such difficult cases. A critical clinical clue is angle recession, visible on gonioscopy, which demands that a pa- tient be evaluated annually for the rest of their lives—especially since even the healthy, unin- volved eye inexplicably carries a 50% chance of developing glaucoma. When medical manage- ment is insufficient and surgical intervention becomes necessary, traumatized, inflamed, or scarred eyes are at a high risk for traditional filtration surgery failure. Newer surgical tech- nologies or glaucoma drainage implants may be preferred over traditional bleb-forming surger- ies. Careful consideration of preexisting ocular comorbidities is essential in these complex eyes; fortunately, these comorbidities offer a skilled surgeon the opportunity to tackle multiple prob- lems for the patient at once. Whether we are leveraging AI to synthe- size thousands of multicenter patient outcomes or carefully monitoring a single patient for decades following a childhood eye injury, our core mission remains the same: providing precise, patient-oriented care. The integration of cutting-edge digital diagnostics with our foundational clinical principles ensures that our glaucoma toolkit will continue to broaden and deepen. I hope this issue inspires you to look closely at both the data on your screens and the history of the patients in your chairs as we con- tinue to define the future of glaucoma care. by Manjool Shah, MD Glaucoma Editor A s we find ourselves navigating an era increasingly defined by big data, arti- ficial intelligence, and new digital tools, we are watching our subspecialty transform from a reactive disci- pline to a highly proactive one. In this issue, we dive into the overarching theme of expanding digital technologies, while also continuing our exploration of nuanced clinical challenges that require our steadfast, long-term vigilance. First, we explore the incredible momen- tum digital tools are bringing to personalized medicine. Sophia Y. Wang, MD, and Barbara Wirostko, MD, FARVO, share their insights on how immense, newly available datasets—in- corporating IOP, visual fields, and multimodal imaging like OCT—are being leveraged to train sophisticated AI models. These models have the potential to accurately predict patient outcomes following procedures like trabeculectomies, tube shunts, and MIGS. Furthermore, home monitoring technolo- gies are revolutionizing our understanding of IOP fluctuations, revealing crucial early-morn- ing pressure spikes that routinely go undetected in standard clinic visits. Dr. Wirostko shares a fascinating case where intensive home tonome- try data eventually led to a sleep apnea diagno- sis; treating the sleep apnea with a CPAP ma- chine flattened the patient's early morning IOP spikes and completely bypassed the need for an impending tube shunt. While we embrace this brave new world of polygenic risk scores and virtual reality visual fields, Dr. Wang rightly re- minds us of the work ahead: We must overcome integration hurdles across different electronic health record systems and rigorously ensure our algorithms do not inadvertently amplify existing health disparities. Yet alongside these futuristic leaps, we must remain rooted in the meticulous clinical evaluations required for complex, individual cases. Won Kim, MD, and Maria Charria, MD, offer an essential review of traumatic glaucoma, a disease in which detailed and individualized examination and nuance is king. This condi- tion highlights the necessity for lifelong data Navigating a new era The integration of cutting- edge digital diagnostics with our foundational clinical principles ensures that our glaucoma toolkit will continue to broaden and deepen.

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