Eyeworld

HIGHLIGHTS FROM THE 2026 ASCRS CLINICAL SURVEY Glaucoma I was taught early in my ophthalmology residency that glaucoma is a disease of change. The optic nerve, visu- al field, and intraocular pressure all change over time. Our procedural options and our utilization of new technologies change, too. The ASCRS Clinical Survey is a great way for us to take an annual snapshot of the glaucoma treatment preferences and practices of the ASCRS membership. In the 2026 survey, we see a few notable trends. To begin with, laser trabeculoplasty is evolving. The proportion of respondents who indicated using SLT as first-line therapy grew from 29% in 2025 to 35% in 2026. That is a fairly substantial change over just 1 year. Generally speaking, utilization as an adjunct or second-line therapy remained fairly similar, but we also chipped away at the number of ophthal- mologists who do not perform laser trabeculoplasty at all. That number fell from 37% in 2025 to 29% in 2026. We also saw 20% of respondents indicate that they perform direct SLT. This is the first year direct SLT was specifically included in this question, so we cannot make a direct year-over-year comparison. Neverthe- less, 20% is notable for a relatively new technology, and we will certainly want to follow this trend and compare the utilization of direct SLT with traditional SLT in the years to come. On the incisional and interventional glaucoma side, we see some movement as well. Fewer surgeons are avoiding incisional glaucoma surgery altogether, with that proportion dropping from 34% in 2025 to 26% in 2026. Again, because these are different annual survey cohorts, we should be cautious about interpreting this as a change in the behavior of individual surgeons. But an eight percentage point year-over-year shift is meaningful. Among MIGS procedures, utilization is fairly evenly split between goniotomy, reported by 31% of respon- dents, and trabecular bypass stents, reported by 30%. We are also beginning to see newer technologies rep- resented in the survey. For the first year, we included cyclodialysis cleft creation with scleral allograft, which was reported by only 3% of respondents, but this is still a relatively new procedure. We are also now tracking sustained drug delivery. Bimatoprost sustained delivery implants were reported by 12% of respondents, while 7% reported using the travoprost sustained delivery implant. This is another important expansion of the interventional glaucoma toolbox and another trend worth following over time. To me, the results of the ASCRS Clinical Survey indicate that ASCRS members are continuing to learn, evolve, and adopt new technologies to better care for our patients with glaucoma. Perhaps the larger message is that interventional glaucoma is not simply adding new procedures to our toolbox. Treatment appears to be moving earlier, while the proportion of ophthalmologists who do not intervene at all is getting smaller. That is a great thing, and it also challenges ophthalmic educators to stay current and continue teaching these new and evolving techniques. —Nathan Radcliffe, MD ASCRS Glaucoma Clinical Committee Chair n=817 Which answer best describes when you most commonly perform laser trabeculoplasty? (Select one) 35% First line 15% After first-line medication After two medications 10% When medications are not tolerated 11% I do not perform laser interventions 29% n=817 Which glaucoma procedures do you perform? (Select all that apply) 20% Direct SLT 6% Endoscopic cyclophotocoagulation 15% Tube shunt 3% Cyclodialysis cleft creation with scleral allograft 12% Bimatoprost sustained delivery implant 9% Other 12% Transscleral cyclophotocoagulation 26% I do not perform incisional glaucoma surgical procedures Goniotomy 31% 30% Trabecular bypass stents 22% Trabeculectomy 7% Travoprost sustained delivery implant 23% Canaloplasty 11% Transscleral gel stent

• Cover