At the Alan S. Crandall Center for Glaucoma Innovation, Director Iqbal Ike K. Ahmed, MD, FRCSC, and Associate Director Ian F. Pitha, MD, PhD, evaluate and advance new approaches to glaucoma care alongside their day-to-day clinical practices at the John A. Moran Eye Center.
We asked Drs. Ahmed and Pitha to share their perspectives on modern glaucoma care, emerging technologies, and how clinical judgment, data, education, and real-world constraints influence which innovations ultimately make a difference for patients.
Q: What do you see as the central challenge in glaucoma care today?
Pitha: I think one of the biggest challenges is identifying which patients really need to be treated, how closely they need to be followed, and how aggressive that treatment should be. You can treat everyone as if they’re imminently going blind, and that leads to overtreatment. Or you can be less aggressive, and then you’re going to miss some people, and they’re going to lose vision.
When you’re sitting in front of a patient, the care is very individualized. Even though it’s one disease, the variability between patients is huge, and we still must do a better job of matching the right level of treatment to the right patient.
Ahmed: Although we’re very technology-heavy in terms of what we do in glaucoma, the reality is that you have to be able to get new technologies to patients. Reimbursement and coverage are shifting, and access can be challenging. Decisions are being made that aren’t always clearly understood.
I believe this just pushes us to do better with our data and to be more science-driven and patient-driven. I also think we need to do more when it comes to patient-reported outcomes, because at the end of the day, that’s what matters most to patients. And that’s also what I think payers and ultimately policymakers will be most driven by.
Q: Where do emerging technologies—particularly AI and new devices—actually help right now?
Ahmed: The biggest opportunity for AI in glaucoma is risk assessment to better understand who needs treatment when.
We’re incorporating more data points—such as home tonometry—and analyzing larger datasets; AI has the potential to help correct the imbalance between overtreatment and undertreatment.
Pitha: I think of AI as an enabling tool rather than a single solution. It is effective in the lab for image analysis and drug screening because it can spot patterns and process huge amounts of data much faster than we can. Ultimately, it still works best when paired with human judgment and experimental insight.
Clinically, AI’s value will depend on how well it organizes information and supports decision-making. More data by itself isn’t necessarily helpful unless it supports or influences our decisions with actionable insights that naturally fit how we think and work as clinicians and surgeons.
Q: How do you think about evaluating new glaucoma devices before they reach widespread use?
Pitha: A lot of my work focuses on understanding how new devices behave once they interact with tissue—and whether they do what we hope they’ll do in real-world use. That includes looking at materials, design, and how small changes in technique can affect outcomes. Fiona McDonnell, PhD, here at the Moran Eye Center, is allowing us to answer a lot of these key questions early using an iPerfusion 3 system, which measures ocular pressure and aqueous fluid outflow using donated human eyes. The iPerfusion allows us to evaluate micro-invasive glaucoma surgery (MIGS) devices and their performance very early in their development.
I’ve worked closely with Gore on devices aimed at advanced glaucoma, which is an area where we still need better options. That work is really about modifying traditional filtering approaches using new biomaterials to improve safety and durability in patients where the stakes are highest.
Being involved early lets us start asking really practical questions—how a device integrates with tissue, how surgeons are actually going to use it, and where real-world might diverge from the intended design once it reaches practice.
Ahmed: I think a common thread in our work over the last few years has been the well-known advantages of laser-based therapies in glaucoma. These approaches allow us to be much more precise, to deliver treatment in ways that are less intrusive for patients, and often safer. We’re using them now in ways that we never have, including femtosecond lasers, ultrashort-pulse lasers, different wavelengths, picosecond lasers, and excimer lasers. So, I’m really excited about that aspect as a whole.
The other areas also continue to grow, including working in the middle segment of the eye targeting the uveoscleral outflow pathway using implants and gels to augment a pathway of glaucoma that isn’t well-optimized.
And we're still working on subconjunctival procedures, which I'm very excited about for more advanced patients. In that space, we’re taking things to the next level where we're moving from passive drainage approaches to programmable adaptive and auto-regulating drainage devices.
Q: Looking back, what is one study—or area of research—you think your glaucoma colleagues should be paying attention to?
Ahmed: The five-year results of the HORIZON trial evaluating the Hydrus Microstent in combination with cataract surgery. What made that study important wasn’t just pressure-lowering endpoints, but the impact on visual field progression.
We showed about a 50% reduction in visual field progression over five years compared to cataract surgery alone. That’s an important endpoint, and it’s something we don’t often see demonstrated clearly in surgical glaucoma trials. It highlights how translational work can connect innovation to outcomes that actually matter to patients.
Pitha: Another area I think people should be paying attention to is the work Brian Stagg, MD, here at Moran is doing around clinical decision-making and informatics. A lot of us struggle with how to consistently apply guidelines and synthesize the amount of data we generate in glaucoma.
His work focuses on how clinicians interact with EMRs and how decision support and dashboards can surface the right information at the right time. It’s not a flashy device or procedure, but it has the potential to meaningfully change how we practice day to day.
Q: How should our educational programs adapt to a rapidly changing clinical landscape?
Ahmed: Education must evolve in parallel with innovation. The field is moving quickly, and the way clinicians learn and connect has changed.
This year, I’ll be launching what I view as the next step in education. It will be an online community called EyeComplex meant to function more like a social media platform, but in a very deliberate, evidence-based way—where people can interact, share cases, engage with high-quality content, and learn from each other rather than just passively consume information.
It’s going to be heavily media-driven, very interactive, and focused on real-world decision-making. At the same time, it will give us the ability to understand what people are engaging with so we can tailor education to what is relevant to their practice.
Pitha: Training and education also must keep pace with technology, data, and surgical advancements in the field. Fellows now need experience with both traditional surgery and newer, less invasive techniques.
Education has to emphasize judgment and thoughtful adoption, not just exposure to new tools.
About the Crandall Center
The Alan S. Crandall Center for Glaucoma Innovation at the John A. Moran Eye Center leverages unique resources and collaborations to conduct preclinical, clinical, and comparative research to develop better therapies and surgical devices, deepen the understanding of glaucoma, and expand access to care.