The unmet needs of glaucoma care with Dr Ben Casella

Glaucoma care continues to evolve rapidly, driven by parallel advances in technology, therapeutics, and our understanding of disease biology. While lowering IOP remains the cornerstone of management, the past year has underscored a broader shift in how clinicians think about diagnosing, treating, and even personalizing glaucoma care. From refinements in laser-based therapies to emerging interventional approaches and the growing influence of artificial intelligence, the field is moving beyond a one-size-fits-all model toward more efficient, patient-centered, and data-driven strategies.

At the same time, long-standing unmet needs remain. Despite meaningful progress in slowing disease progression, true neurorestorative treatments—those that can improve vision already lost to glaucomatous damage—continue to elude us. This tension between innovation and limitation defines the current moment in glaucoma: exciting tools are entering clinical practice, yet fundamental questions about disease modification and visual recovery persist.

In this Q&A, Ben Casella, OD, FAAO, shares perspectives on the most impactful glaucoma developments over the past year, the future role of interventional and personalized care, key gaps in current management paradigms, and emerging areas of clinical research that eye care providers should watch closely in the year ahead.

What was the most exciting development in glaucoma (ie, tech, clinical trials, treatment options) in the past year?

I must say that direct selective laser trabeculoplasty (DSLT) really got my attention when it was approved in 2025. The Voyager system from Alcon has the [potential] to really streamline SLT, making it less invasive and simpler for patients and clinicians. I would look for this technology to have staying power.

What role will interventional glaucoma take in the coming years?

I believe the approach to treatment of glaucoma will become much more tailored to the individual patient and less cookie cutter over the next several years. To date, over 120 gene loci associated with glaucoma have been identified, and advances in genetic therapies over the next several years will lead to more personalized treatment.

What is missing in how glaucoma is treated and managed?

What is still by and large missing is the holy grail of actually making vision better with respect to glaucomatous damage. Recent years have brought about intriguing concepts, such as oral supplementation with vitamin B3 possibly enhancing vision, but we still have no treatment to date [that] has proved that it should come before lowering IOP. We are still in the keep-it-from-getting-worse paradigm of glaucoma treatment.

What clinical trials should ODs keep their eyes on in the coming year?

I really don't have one in particular, but I would encourage the reader to search [for] glaucoma with respect to artificial intelligence and glaucoma with respect to novel drug-delivery systems in the world's peer-reviewed literature. Artificial intelligence–focused diagnostic studies and sustained delivery systems are at the top of glaucoma trials this year.