Glaucoma is a leading cause of irreversible vision loss worldwide, affecting millions around the globe [1]. Despite major advances in glaucoma treatment, complications of surgery and long-term disease management remain challenging due to poor adherence to topical medications, fluctuating intraocular pressure (IOP) and complications of surgery [2].
Emerging technologies are now attempting to address these limitations through sustained drug delivery systems, minimally invasive laser procedures and remote monitoring devices. Together, these innovations may reshape how glaucoma is detected, monitored and treated over the coming decade.
Sustained release glaucoma delivery systems
Poor adherence is a major challenge with current glaucoma therapies, with up to 80% of patients failing to adhere to prescribed regimens. The main barriers identified are lack of social support, forgetfulness and inconvenient regimens, especially with multiple drops. Sustained drug delivery systems aim to address these barriers, offering improvements in drug delivery and glaucoma management [2]. Although intracameral implants are the latest generation of sustained drug delivery, earlier delivery systems demonstrated both the promise and the challenge of sustained glaucoma therapy. For instance, pilocarpine Ocusert inserts were introduced in 1975. These devices were worn in the upper or lower conjunctival fornix and provided sustained drug delivery for up to seven days. Despite reducing the dosing burden, Ocusert was later withdrawn due to many side-effects including dislodgement, foreign body perception, burning sensation, conjunctival hyperemia and high cost.
Similarly, topical bimatoprost ocular inserts showed encouraging results in lowering IOP, however, they failed to demonstrate non-inferiority to topical timolol. Additionally, they were also associated with side-effects including device dislodgment and patient discomfort [3]. Newer devices appear to overcome these limitations. The two latest US food and drug administration (FDA)-approved sustained-release drug implants for open-angle glaucoma or ocular hypertension are Durysta (bimatoprost intracameral implant) and iDose TR (travoprost intracameral implant).
Durysta
Durysta is a small biodegradable implant (Durysta; Allergan, an AbbVie company, North Chicago, IL, USA) containing 10mcg of bimatoprost that is gradually released in a non-pulsatile manner over three months into the anterior chamber [4].
Two identical, randomised, double-masked, multinational phase III trials (ARTEMIS 1 and ARTEMIS 2) were conducted to evaluate the safety and efficacy of the bimatoprost implant. These trials included 594 and 528 patients respectively with primary outcome being the change in IOP from baseline at weeks two, six and 12 alongside safety profile of bimatoprost implant. The inclusion criteria included a baseline IOP of 22–32mmHg following washout, gonioscopically open inferior angles and a diagnosis of ocular hypertension or open-angle glaucoma. The bimatoprost implant was positioned inferiorly in the anterior chamber. The baseline IOP for all participants was 24.5mmHg. At 12 weeks, both dosing regimens of the bimatoprost implant (10ug and 15ug) were found to be non-inferior to topical timolol with 6–7mmHg reduction in IOP from baseline. In both trials, the Durysta implant lowered eye pressure by about 30% (5–8mmHg) over 12 weeks. The IOP reduction was found to be statistically non-inferior to the IOP reduction seen with twice-daily eye drops [5,6].
However, due to variability in implant biodegradation between individuals, the optimal timing for a second bimatoprost administration remains uncertain. Moreover, limited diversity in the patient pool in both age and ethnicity, alongside the exclusion of the glaucoma subtypes such as pseudoexfoliation glaucoma, may restrict the generalisability of these findings [5,6]. Although real-world studies have helped bridge this gap by including patients with severe primary open-angle glaucoma, chronic angle-closure glaucoma, previous glaucoma surgery and more diverse populations, they were limited by small sample sizes (46–197 eyes) and relatively short follow-up periods of approximately one year [4].
Moreover, Durysta is currently approved for a single administration per eye because repeated implantation in the Phase 3 ARTEMIS studies was associated with corneal endothelial cell loss and other commonly reported adverse events in the clinical trials such as conjunctival hyperaemia, occurring in approximately 27% of patients [4–6]. Thus, highlighting the need for larger cohorts with long-term follow-up data to further evaluate the safety and efficacy of the bimatoprost implant, particularly in advanced glaucoma and other under representative patient populations.
iDose TR (travoprost intracameral implant)
Similarly, iDose TR (Glaukos Corporation) is a small implantable titanium device that steadily releases prostaglandin analog to lower IOP by increasing uveoscleral outflow for up to three years [7].
Two identical phase III clinical trials compared a single dose of iDose TR implant with twice daily timolol eye drops. iDose TR lowered eye pressure by 6.6 to 8.5mmHg over 12 weeks compared to baseline. At 12 months after single administration, 81% of patients receiving iDose TR were completely free from topical IOP-lowering medications. Additionally, several patients maintained a medication-free status and follow-up data showed that about 70% kept their eye pressure well-controlled on the same or fewer medications after three years. The most common ocular adverse reactions reported in 2–6% of patients were increased IOP, iritis, dry eye, visual field defects, eye pain and reduced visual acuity [8].
Direct selective laser trabeculoplasty (DSLT)
Another emerging intervention for glaucoma management is DSLT. Direct selective laser trabeculoplasty is a newer, non-contact laser treatment that uses automated image guided technology to deliver laser pulses to eye drainage tissue, the trabecular meshwork. Since it is an automated procedure and does not require the operator’s experience, it can be administered by a broader range of eyecare professionals than conventional SLT [9].
It works by delivering 120 laser pulses directly through the limbus to the trabecular meshwork to improve aqueous outflow and reduce IOP. Preliminary studies conducted with earlier versions of the DSLT device suggested similar effectiveness to conventional SLT. Notably, the advantages of DSLT include the possibility of treating narrow iridocorneal angles that are difficult to visualise and treating patients with unfavourable anatomical characteristics or those who are not compliant with having a gonioscopy lens applied to their eyes during conventional SLT. Additionally, the absence of contact between the lens and cornea reduces the risk of corneal complications [10].
In October 2025, the GLAUrious study group published the first randomised control trial (RCT) evaluating the efficacy of DSLT against conventional SLT. The study included 192 participants randomised to DSLT (n=99) or SLT (n=93). Although statistical noninferiority achieved compared with conventional SLT at six-month primary endpoint, DSLT was well tolerated and provided effective reduction in IOP with positive results sustained up to 12 months. Moreover, the safety profile was similar in both groups and ocular adverse effects were generally mild and resolved without intervention [11].
Remote IOP monitoring
Traditional single-measurement methods such as clinic-based Goldmann applanation tonometry (GAT), fail to provide a comprehensive picture of diurnal and nocturnal IOP fluctuations. Remote monitoring has the potential to transform glaucoma care by helping identify diurnal and nocturnal IOP fluctuations, detect treatment failure earlier and support more personalised management [12].
Currently, the iCare Home2 (iCare Finland Oy) is the most widely used device for home IOP monitoring. Using a handheld rebound tonometer, the device automatically takes six readings while eliminating the highest and lowest values. The device is linked to the patient’s smartphone, allowing IOP readings to be uploaded and shared remotely with clinicians [12].
Another key emerging device is the miLens device. This wearable device is a soft contact lens consisting of a network of microfluidic channels embedded in a silicone hydrogel material. The miLens contains no electronic components, so it can be worn and handled in a variety of conditions. The lens relies on the passive displacement of volumes within the microfluidic channels to detect changes in IOP directly. Elevated IOP causes a change in the radial curvature of the eye: Each 1mmHg change in IOP causes a 4µm alteration in the radius of curvature. This change is translated into the movement of fluids across the microchambers, which can be read directly by a high-resolution camera or a slit lamp. The integrated hardware and software features of the miLens system have the potential to make continuous IOP monitoring accessible to patients in even the most remote locations [13].
An early feasibility study evaluated the safety and efficacy of the miLens device in 25 healthy participants and found that the device was well tolerated, with no major adverse effects reported. Importantly, the device achieved 78% agreement with GAT and rebound tonometry. However, larger studies are needed to establish its safety, efficacy and role in glaucoma management [14].
Another emerging technology is the EYEMATE implantable telemetric IOP sensor. Unlike handheld or contact lens-based devices, these sensors are surgically implanted within the eye and allow continuous IOP measurements that can be obtained wirelessly using an external handheld reader [15]. Early clinical studies have demonstrated encouraging results in terms of long-term safety, tolerability and functionality in almost 25,000 IOP measurements taken during the ARDOS-01 study. However, a major limitation of EYEMATE-IO device is that implantation is typically performed during cataract surgery as it is inserted into the ciliary sulcus, restricting its use to patients requiring cataract surgery. Newer models such as the EYEMATE-SC seem to address these limitations as they are implanted in the suprachoroidal space, allowing use in younger patients and those without an indication for cataract surgery. However, larger and more heterogenous studies are needed to confirm the safety and efficacy of these devices [15].
Deployable microstent (Oxford)
Over the last decade, minimally invasive glaucoma surgery (MIGS) has emerged as a safer alternative to traditional surgeries, aiming to reduce IOP using medicated eye drops, laser therapy or surgical interventions. However, current surgical implants for glaucoma have shown limited long-term effectiveness due to issues like fibrosis and the eventual loss of bleb function even with the use of anti-fibrotic medications alongside susceptibility to breakage and migration over time [16].
To address these limitations, Oxford researchers have developed a deployable microstent. At 200µm, the microstent features a unique structural shape that allows it to be delivered minimally invasively via a needle and subsequently expanded within the suprachoroidal space. Once expanded, the microstent spans the entire suprachoroidal space. This design incorporates structural elements to sustain conjunctival-episcleral separation without relying on anti-fibrotic treatment. Moreover, it is specifically optimised to form posterior, consistently elevated bleb while preventing migration, improving durability and ensuring long-term efficacy [16].
In preclinical studies, the deployable microstent (Oxford, 2025) has demonstrated sustained IOP reduction. Moreover, compared with the XEN Gel Stent, it demonstrated superior sustained IOP reduction over six weeks. However, the evidence is limited to preclinical animal studies and human clinical trials are needed to evaluate the safety and efficacy [17].
Conclusion
From sustained drug delivery systems to remote IOP monitoring, emerging innovations are reshaping glaucoma management by improving treatment adherence, allowing monitoring beyond the clinic and reducing the disease burden. As these technologies continue to evolve, they have the potential to improve long-term visual outcomes, personalise glaucoma care and increase access to effective treatment worldwide.
References
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Declaration of competing interests: None declared.
