Eyeworld

70 | EYEWORLD | FALL 2026 G UCOMA by Manjool Shah, MD Glaucoma Editor L ooking through old photos from residency and fellowship, wheth- er it's the boxy clinic scrubs, the post-call ex- haustion, or the noticeable lack of gray hair (or in my case, the presence of hair), it is always humbling to see how much has changed. But while hairstyles and eyewear have undeniably evolved, nowhere is that shift more apparent than in how we practice glaucoma. Even if our training days are well past the 1990s, the lingering paradigms of that era cast a long shadow over ophthalmic education for decades. If we rewind to our earliest days at the slit lamp, glaucoma management still followed a rigid, largely reactive staircase: start a drop, add a second or third medication as pressure crept up, and treat incisional surgery as the high- stakes final frontier. The gulf between maximum medical therapy and the operating room was vast, often leaving both surgeon and patient in a holding pattern while the disease quietly marched on. Today, our specialty is undergoing a much needed and invigorating refresh. We have moved beyond passive disease management into an era of proactive, interventional glaucoma care. Innovations over the past decade haven't just added new tools to our surgical trays; they have fundamentally transformed our clinical philosophy. First-line laser trabeculoplasty, sustained-release drug delivery platforms, and the rapidly expanding spectrum of MIGS have successfully bridged what used to be an intimi- dating chasm. Yet having access to innovative technology is only the starting point. The real art lies in how we refine our approach with experience. In this issue, we tackle these themes with some unique articles. The 2026 ASCRS Annual Meet- ing featured several special programs, but a per- sonal favorite of mine was the "Glaucoma Survi- vor: Temporal Island" symposium. Our intrepid panelists, Charles Frank, MD, Ariana Levin, MD, James Murphy, MD, Lorraine Provencher, MD, Douglas Rhee, MD, and Brian Shafer, MD, provided high-impact pearls that covered a wide range of interventional glaucoma topics, from lasers to "blood and guts" glaucoma surgery, and we feature some of the highlights in this issue. As our knowledge continues to grow, it is no longer just about performing a standalone procedure or tacking on a single device during routine phacoemulsification. Today's surgical decision-making involves tailoring procedur- al combinations, whether pairing outflow enhancement with cyclophotocoagulation, sequencing sustained drug delivery with canal- based surgery, or staging interventions earlier in the disease course to protect the ocular surface and endothelial health. Our second article, featuring Christine Funke, MD, Samantha Goldburg, MD, and Michael Lin, MD, highlights the evolving role of combining interventional modalities to best serve our patients and deliver safe and highly effective care. As you flip through the glaucoma articles in this issue, you will see this innovation and refinement in action. The contributors high- light how long-standing techniques are being modernized with contemporary data and how emerging modalities are finding their precise place within a multimodal toolkit. Looking back reminds us how far our field has traveled; continuing to refine our craft is what ensures our patients have a clearer future. Enjoy this issue's throwback to foundational concepts and its look ahead to where modern care is heading next. Throwback to foundational concepts and a look ahead to where modern care is heading Dr. Shah (left) with co-fellow Xavier Campos-Möller, MD, in 2015 Source: Manjool Shah, MD REFRESH. REFINE. REWIND.

• Cover