A growing number of investigational devices for glaucoma are in development, reflecting sustained interest in minimally invasive approaches to lowering intraocular pressure (IOP). These technologies span several categories, including sustained-release drug delivery systems, laser-based procedures designed to enhance aqueous outflow, and new stents and shunts targeting drainage pathways. At the 2026 meeting of the American Glaucoma Society in Rancho Mirage, California, Rachel Simpson, MD, offered a focused overview of these approaches, emphasizing both their technical promise as well as the regulatory and practical hurdles such devices face.

Dr. Simpson, residency program director, vice chair of education, and assistant professor of ophthalmology at the John A. Moran Eye Center at the University of Utah in Salt Lake City, structured her remarks around devices that fit a traditional definition of minimally invasive glaucoma surgery (MIGS). “Because this was a short talk, I stuck to a more classic definition of MIGS to decide what to include,” she explained.

The MIGS Pipeline

An active area of development involves sustained-release (SR) drug delivery, an approach intended to reduce reliance on topical medications and improve adherence. Among surgical options, Dr. Simpson highlighted iDose TREX (Glaukos), an implant designed to deliver travoprost over a longer duration than earlier versions. The updated design increases reservoir capacity, allowing extended drug release without altering the underlying mechanism of action. Glaukos is also exploring concepts aimed at making SR platforms more compatible with office-based injection, Dr. Simpson noted.

Another SR strategy is the bimatoprost drug–intraocular lens (BIM-IOL) system (SpyGlass). The platform integrates an intraocular lens (IOL) with haptic reservoirs that release bimatoprost for approximately 3 years following cataract surgery. Dr. Simpson noted that developers are also working on a replacement strategy once the initial drug supply is depleted. “They’re developing a ring-shaped implant that can be injected into the eye to replace the bimatoprost reservoirs,” she said. This bimatoprost drug ring system (BIM-DRS) could serve as retreatment for patients who previously received the BIM-IOL system or as a standalone option for pseudophakic patients.

Several devices aim to improve conventional aqueous outflow. The eyeFlow microstent represents “a hybrid of sustained release and more traditional canal-stenting technology,” Dr. Simpson explained. “It’s a nitinol scaffolding stent that slides into the trabecular meshwork, and it’s designed to have a drug-eluting reservoir attached to it that can provide about 12 months of sustained-release medication, in addition to the scaffolding you’re getting in the canal.”

Laser-based MIGS platforms constitute another area of active investigation. Dr. Simpson reviewed 3 systems designed to create microchannels or pores in the trabecular meshwork, each using a different laser modality. These include the ELIOS excimer laser (Bausch + Lomb), the Flight femtosecond laser system (ViaLase), and picosecond laser platforms such as PicoLumen (EyeX Solutions). Although the technologies differ in wavelength, pulse duration, and delivery setting, their shared goal is to enhance physiologic outflow without leaving an implant behind. “They’re fundamentally doing the same thing,” Dr. Simpson said, “just executed differently.” The most meaningful distinctions, she added, relate to where the procedures are performed—operating room, procedure room, or clinic—and the size and number of channels created.

Dr. Simpson also addressed investigational devices targeting the supraciliary or uveoscleral outflow pathways. While some, such as MINIject (iSTAR Medical), have been used outside the United States for years, domestic progress toward US Food and Drug Administration (FDA) approval has been limited. She devoted more attention to the InterCil uveoscleral spacer (CiliaTech), which she described as occupying a middle ground between MIGS and traditional filtering surgery. Unlike angle-based procedures that augment native anatomy, the device creates an alternative outflow route through limited scleral incisions. “It’s more tissue manipulation than classic MIGS,” she said, “but the footprint is small enough that many surgeons may see it as an intermediate option between MIGS and traditional filtering or bleb-forming surgery.”

Regulatory and Reimbursement Barriers

In closing, Dr. Simpson cautioned that technical innovation alone will not ensure clinical adoption. She emphasized that persistent challenges in clinical trial design, regulatory expectations, and payer policy can delay or derail promising technologies. As one example, she cited the long and uneven path to adoption of the PreserFlo microshunt (Glaukos), which was widely anticipated years before reaching clinical practice in the United States. “We kept hearing, ‘Just wait until this comes out,’” she recalled, noting that prolonged development timelines often reflect misalignment between study design and regulatory benchmarks rather than lack of innovation.

Dr. Simpson also highlighted reimbursement as an equally significant barrier, even after devices or procedures reach the market. She cited a recent decision by an insurance provider to classify goniotomy and trabeculotomy as experimental for adult glaucoma, limiting coverage to pediatric cases. “If you can’t get something approved, you’re never going to use it,” she said. “And if you can’t get it covered, you’re never going to use it.”

For the current MIGS pipeline to translate into routine practice, she emphasized, glaucoma specialists will need to engage more actively with the FDA to define clinically meaningful endpoints, while also advocating for regulatory and reimbursement frameworks that allow new technologies to reach patients. GP