Four articles. Four minutes. | Issue #5
Surgery: MIGS shows similar 2-year success rates to filtering surgery in young adults with secondary glaucoma
Medication: Personalized glaucoma coaching improved drop adherence versus written education
Epidemiology: 15-year OAG incidence rose with age, pseudoexfoliation, myopia, and IOP
Diagnostics: Delayed follow-up was not linked to VF progression, but advanced glaucoma eyes showed risk with >60-day mean delays
Outcomes of minimally invasive glaucoma surgery, trabeculectomy, and tube shunt surgery in secondary glaucoma: IRIS Registry analysis.
Methods
This IRIS Registry cohort included 2,483 eyes from patients aged 18 to 40 years with secondary glaucoma who underwent MIGS, trabeculectomy, or tube shunt surgery from 2013 to 2024. Investigators assessed 2-year failure by procedure type and secondary glaucoma subtype, with failure defined by insufficient IOP reduction, hypotony, additional glaucoma surgery, or development of no light perception.
Results
Tube shunts were the most common procedure (68.1%), followed by MIGS (18.3%) and trabeculectomy (13.6%). Overall 2-year failure rates were high and similar across trabeculectomy (50.6%), tube shunt surgery (52.1%), goniotomy (53.3%), and canaloplasty (49.0%). Outcomes significantly varied by subtype: traumatic glaucoma had higher failure after MIGS than trabeculectomy or tubes, glaucoma due to other eye disorders had the highest failure after trabeculectomy and tubes, and trabeculectomy had its lowest failure in steroid-induced glaucoma (37.6%) but more hypotony (10.0%).
Conclusion
Among young patients with secondary glaucoma, surgical failure was common across MIGS, trabeculectomy, and tube shunt surgery, with meaningful variation by glaucoma subtype. These findings suggest that secondary glaucoma should not be treated as a single surgical category, although procedure comparisons are limited by differences in baseline disease severity.
Our Angle
This study reinforces that secondary glaucoma is not a single disease entity, and surgical outcomes vary considerably by underlying etiology. One notable finding was that MIGS achieved approximately 50% two-year success rates despite being used in young patients with elevated preoperative IOP, supporting its role as a conjunctiva-sparing option in carefully selected cases. The results also highlight the challenges of uveitic glaucoma, and the relatively favorable outcomes seen in steroid-induced glaucoma. However, because this was a retrospective registry study with substantial selection bias and limited clinical detail, the findings should be viewed as real-world observational data rather than definitive comparisons between surgical procedures.
Medication
Effect of the Support, Educate, Empower Personalized Glaucoma Coaching Program on Medication Adherence: The SEE Program Randomized Clinical Trial.
Design: Randomized clinical trial
Journal: JAMA Ophthalmology, April 2026
Authors: Newman-Casey et al.
In this randomized clinical trial of 235 glaucoma patients with poor baseline medication adherence, a personalized coaching program combining motivational interviewing, tailored glaucoma education, adherence feedback, and medication reminders improved electronically monitored medication adherence by nearly 20% compared with standard written education alone (77.6% vs 58.0%) and significantly reduced glaucoma-related distress. The findings suggest that individualized behavioral interventions can meaningfully improve adherence beyond traditional patient education, although the study was limited by a relatively short 6-month follow-up, higher dropout rates in the intervention arm, inclusion of predominantly insured patients, and lack of demonstrated improvement in IOP or other long-term clinical outcomes.
Epidemiology
Fifteen-Year Incidence of Open-Angle Glaucoma: The Blue Mountains Eye Study.
Design: Population-based prospective cohort study
Journal: Ophthalmology, May 2026
Authors: Kha et al.
In the Blue Mountains Eye Study, 140 of 2,432 participants without baseline glaucoma developed definite or probable open-angle glaucoma (OAG) over 15 years, corresponding to an age-standardized incidence of 5.67% (4.72% for definite OAG). Increasing age, pseudoexfoliation, myopia, and higher baseline IOP were the strongest risk factors, with each 1 mmHg increase in IOP associated with a 24% increase in risk and baseline ocular hypertension conferring a fourfold greater risk. However, more than half of incident cases occurred in eyes with baseline IOP below 18 mmHg, underscoring the multifactorial nature of glaucoma. Generalizability is limited by the predominantly older Australian cohort and declining follow-up over time.
Diagnostics
Visual Field Progression in Glaucoma Patients with Delayed Follow-Up.
Design: Retrospective cohort and matched case-control study
Journal: American Journal of Ophthalmology, May 2026
Authors: Kolli et al.
In this retrospective cohort of 1,121 eyes of 600 glaucoma patients and suspects followed for a mean of 7.3 years at a tertiary center, 53.4% of visits occurred after the recommended interval, yet delayed follow-up was generally not associated with faster visual field progression. However, among patients with moderate to severe glaucoma, prolonged delays exceeding 60 days were associated with a higher risk of progression. Interpretation is limited by the single-center retrospective design, reliance on VF mean deviation as the sole progression metric, and the inability to account fully for care received outside the health system or the reasons for delayed follow-up.
ViaLase’s femtosecond laser trabeculotomy enters commercial use in Europe for open-angle glaucoma but remains investigational in the United States.
Contaminated trypan blue was linked to six postoperative Sarocladium kiliense endophthalmitis cases after cataract surgery in Japan.
Nature Microbiology reports covert mortality nodavirus (CMNV), an aquatic animal virus, is associated with persistent ocular hypertensive anterior uveitis in 70 patients.
CMS finalizes No Surprises Act changes that lower the federal fee for resolving out-of-network payment disputes to $15 and revise batching, payer registration, and portal workflows.
Which ophthalmic implant was inspired by the observation that polymethyl methacrylate (PMMA), sold as Perspex, could remain quiet inside the eye?
A. Acrylic keratoprosthesis
B. Synthetic scleral buckle
C. Intraocular lens
D. Canalicular stent
See answer at bottom of newsletter
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The Open Angle is a weekly glaucoma research digest for busy eye care professionals.
Four papers worth knowing, in under four minutes.
Edited by Jella An, MD, MBA and Jason Dossantos, MD.
The Open Angle is an educational editorial product. It is not medical advice. Readers should review original sources before changing practice.
Trivia Answer: C