What will be the nature of glaucoma surgery in 20 years?
As a glaucoma specialist, I envy the continual advances in cataract and retinal surgery. During the past 35 years, progress in our field has consisted of releasable and “laserable” sutures, antifibrotic regimens, and minor technical refinements. The aqueous shunts we use now are only slightly more effective than the single-plate implant (Molteno Ophthalmic Limited, Dunedin, New Zealand) introduced in 1973. This glacial progress is about to change. Because the majority of resistance to aqueous outflow from the eye resides at the level of the juxtacanalicular apparatus, multiple investigators are attempting to overcome this obstacle. Devices to shunt aqueous from the anterior chamber into Schlemm’s canal have been developed for both the transanterior-chamber and the ab externo approaches. Additionally, researchers are successfully using the excimer laser to open passages into Schlemm’s canal. Admonitions from Peng Khaw, PhD, FRCS, FRCOphth, of London that filtering surgery should be perf
