Glaucoma is the second leading cause of blindness worldwide, and it rarely announces itself: most patients notice nothing until meaningful functional loss has already occurred.1 As of 2020, the disease affected about 76 million people globally, a number projected to reach 111 million by 2040, including 4.2 million adults in the US, a figure the aging population will only push higher.1,2
Elevated intraocular pressure (IOP) is the primary modifiable risk factor, but glaucoma itself is a chronic, progressive optic neuropathy defined by retinal ganglion cell loss, retinal nerve fiber layer thinning, optic disc cupping, and corresponding visual field defects.3 Management is shifting to match that understanding. Interventional glaucoma moves minimally invasive procedures ahead of topical medications as first-line IOP control, with the goal of preserving vision and quality of life.3,4
EyesUp: Glaucoma Edition, filmed at the 2026 Women in Ophthalmology Summer Symposium in Monterey, pairs fun, fast-paced gameplay with the clinical substance. Teams of two paired up, with one taking the role of host and the other as contestant, to test their knowledge. With only three clues and 30 seconds, see how they met the challenge.
Small incision, big shift
For years, glaucoma care had a gap. Drops and laser trabeculoplasty handled early disease, while trabeculectomy and tube shunts, which were effective but invasive and slow to recover from, were reserved for advanced cases.5 Microinvasive glaucoma surgery (MIGS) fills that gap with fewer severe complications and faster recovery, and it is often performed alongside cataract surgery.5,6
It is best suited to mild to moderate open-angle glaucoma, including patients who are controlled on paper but struggle with drop side effects or adherence.5 MIGS procedures target trabecular, suprachoroidal, or subconjunctival outflow, and they are not designed to replace traditional surgery, which remains the standard for advanced disease.5,6
Going with the flow
Named for German anatomist Friedrich Schlemm, who described it in 1830, Schlemm's canal is the main drain of the conventional outflow pathway.7 The trabecular meshwork and the canal's inner wall account for an estimated 50% to 75% of outflow resistance, which makes this the logical place to intervene.5
Several MIGS approaches work at this site, including trabecular bypass stents, goniotomy, trabeculotomy, and canaloplasty. Most of them aim to restore flow through the eye's existing drainage system rather than create a new one, with one key exception.5,6,8
OMNI combines two of these approaches without an implant. A microcatheter viscodilates the canal and collector channels, then unroofs the trabecular meshwork.9 In the GEMINI study, which paired OMNI with cataract surgery, unmedicated IOP dropped from 23.8 to 15.6 mmHg at 12 months. Results held through 36 months, with 74% of patients medication-free.9,10
That’s a stretch
Canaloplasty restores outflow by stretching tissue rather than cutting it. A microcatheter is threaded through Schlemm's canal and withdrawn while it injects viscoelastic, which dilates the canal and its collector channels.
This allows one procedure to address resistance at the trabecular meshwork, the canal, and the distal outflow system.11 The original technique was performed ab externo with a tensioning suture. Ab interno approaches now reach the canal through a clear corneal incision without opening the conjunctiva.11
In OMNI, canaloplasty is the first step of a two-part procedure, performed through the same incision before the trabeculotomy.9 Viscodilation alone also lowers pressure. In 206 eyes treated with OMNI canaloplasty only, the IOP and medication reductions seen at 12 months held with little change through 36 months.12
A cut above the rest
Trabeculotomy is the incisional half of OMNI's dual mechanism. After canaloplasty, the microcatheter is advanced through the canal a second time and withdrawn to unroof the trabecular meshwork, 180° in the GEMINI study.10 Removing the tissue that carries most outflow resistance gives aqueous a direct path into Schlemm's canal and the collector channels beyond it.5,10
That pairing is the rationale for OMNI: trabeculotomy clears the proximal resistance at the meshwork, while canaloplasty addresses the distal resistance in the canal and collector channels.9 In GEMINI, adverse events were mild and transient, and the most common was layered hyphema, in 6% of eyes.10
In closing
MIGS, Schlemm's canal, canaloplasty, and trabeculotomy each cover a different stop along the same outflow pathway. Knowing where resistance builds, and which procedure addresses it, is what lets clinicians intervene earlier and with more precision. EyesUp: Glaucoma Edition keeps that clinical foundation sharp, one round at a time.
