New Treatments for Glaucoma

Why New Treatments for Glaucoma Are Urgently Needed

Glaucoma is often called the silent thief of sight because optic nerve damage progresses slowly and without pain, frequently going undetected for years. A Swedish population study within the long-running H70 project examined 560 adults aged 70 and found that nearly 5% had glaucoma, with roughly half of those individuals never previously diagnosed. 1 Globally, the disease is estimated to affect up to 80 million people, and Black individuals face a risk approximately five times higher than the general population, with a risk of blindness from the disease up to 15 times greater, a disparity linked in part to recently identified genetic variants including those in the ARHGEF12 pathway. 2 Approximately 40% of glaucoma patients do not reach their target intraocular pressure (IOP) on existing monotherapies, creating persistent demand for therapeutics with stronger or complementary mechanisms of action. 3

Current standard pathways begin with topical eye drops, advance to laser treatment, and ultimately progress to surgery when pressure control is insufficient. Each step carries its own adherence challenges, side-effect burden, and procedural risks. Long-term use of preserved eye drop formulations is associated with ocular surface disease, a complication that can itself compromise treatment adherence. Research published in 2026 demonstrated that aloe vera gel combined with 0.3% hyaluronate eye drops significantly improved tear break-up time, reduced corneal fluorescein staining, and lowered both SANDE and OSDI dry-eye symptom scores compared with hyaluronate alone in patients suffering from glaucoma therapy-related ocular surface disease. 4

Novel Pharmacological Agents Reaching Regulatory Milestones

NCX 470, a novel nitric oxide-donating bimatoprost developed by Nicox, demonstrated best-in-class IOP-lowering efficacy of up to 10 mmHg from baseline in phase 3 studies presented at the 2026 American Glaucoma Society Annual Meeting, meeting the efficacy requirements for a New Drug Application in both the United States and China. 3 Partner company Kowa formally submitted that New Drug Application in the United States in July 2026, triggering a milestone payment of 3 million euros to Nicox. 5 NCX 470 works through dual trabecular meshwork and uveoscleral pathways, a mechanistic advantage over single-pathway agents. Sepetaprost, a novel dual FP/EP3 receptor agonist, completed the phase 3 ANGEL-J1 study across 49 sites in Japan, enrolling 325 patients. At week 4, the drug reduced mean diurnal IOP by 5.77 mmHg, meeting the pre-specified non-inferiority margin of 1.5 mmHg versus latanoprost, with comparable reductions sustained over the full three-month observation period. 6

Netarsudil mesylate (Rhopressa) received manufacturing and marketing approval in Japan from Santen Pharmaceutical in June 2026. 7 The Rho-kinase inhibitor lowers IOP through a dual mechanism: promoting aqueous humor outflow via the trabecular pathway and reducing aqueous production by inhibiting the norepinephrine transporter, with additional ROCK inhibitory activity from its active metabolite AR-13503. The phase 3 J-ROCKET-2 trial conducted in Japan enrolled 246 participants with primary open-angle glaucoma or ocular hypertension inadequately controlled on latanoprost monotherapy. Adding netarsudil to latanoprost produced a mean diurnal IOP of 15.29 mmHg versus 17.65 mmHg for placebo plus latanoprost at week 4, a statistically significant difference of 2.36 mmHg (p less than 0.0001). 8 Clinicians should note that conjunctival histopathological changes have been reported with netarsudil 0.02%, underscoring the importance of monitoring ocular surface health during long-term use.

Laser-Based Innovations: Incision-Free and Excimer Approaches

Bausch + Lomb announced positive 24-month results from a pivotal U.S. multicenter trial of the ELIOS System in March 2026. The study enrolled 318 patients across 20 U.S. sites, all with mild to moderate primary open-angle glaucoma and concurrent cataracts. Both co-primary effectiveness endpoints were met, demonstrating statistically significant and clinically meaningful IOP reduction. ELIOS is an implant-free procedure employing next-generation excimer laser technology, currently CE-marked in Europe and under FDA review in the United States. 9 Achieving freedom from glaucoma medication for a majority of patients was reported among the key clinical signals from the data.

A separate laser innovation, the FLIGHT procedure, uses the ViaLuxe laser system developed by ViaLase, which employs image-guided femtosecond laser technology combined with OCT imaging to create microscopic channels in the eye's drainage tissue without any incision. Centre for Sight in London performed the first UK FLIGHT procedure in 2026, treating a 25-year-old patient in approximately five minutes in an outpatient setting. 10 Traditional surgical approaches to create equivalent drainage channels require entry into the eye and are performed in an operating theatre, making FLIGHT's outpatient profile a meaningful procedural distinction. Micropulse transscleral cyclophotocoagulation (MP TSCPC), which delivers 810 nm diode laser energy in short pulsed cycles targeting ciliary body melanin, has also emerged as a significant innovation by broadening cyclodestructive procedures beyond last-resort scenarios, with the longer off-phase allowing tissue cooling that histological analysis confirms minimizes collateral thermal damage. 11

Next-Generation Surgical Devices and Drainage Implants

Avisi Technologies' VisiPlate aqueous shunt is constructed from a novel metamaterial thinner than a human hair and incorporates multiple redundant microchannels designed to reduce the blockage risk that affects older drainage devices. In the VITA pilot trial presented at the 2025 American Academy of Ophthalmology meeting, 15 patients with open-angle glaucoma and no prior filtration surgery began with a mean diurnal IOP of 24.1 mmHg while using an average of 2.0 glaucoma medications; twelve-month follow-up showed a dramatic reduction in mean diurnal IOP. 12 The company subsequently initiated the SAPPHIRE trial (NCT07220876), a multicenter, open-label study evaluating VisiPlate safety and effectiveness, with the first patient implanted at Sacramento Eye Consultants in California. 13

The Implante Plano Miranda (IPM), a novel flat glaucoma drainage device, was evaluated in a prospective phase II trial including 24 eyes with uncontrolled primary open-angle glaucoma despite maximal tolerated medical therapy, with results published in Clinical Ophthalmology in April 2026. 14 These devices represent a broader expansion of minimally invasive glaucoma surgery (MIGS), which also includes trabecular micro-bypass implants such as iStent and the Hydrus microstent targeting the Schlemm's canal drainage pathway. Each device category carries distinct eligibility criteria, typically requiring specific glaucoma severity grades and, in some cases, concurrent cataract surgery, and all carry risks of hypotony, device migration, or insufficient IOP reduction that patients should understand before proceeding.

Disease-Modifying and Neuroprotective Research

PER-001, a first-in-class small-molecule endothelin receptor antagonist developed by Perfuse Therapeutics, targets endothelin, the most potent vasoconstrictor in the body, to improve retinal blood flow and prevent retinal cell apoptosis. Phase 2a randomized controlled trials demonstrated reversal of progressive vision loss in glaucoma patients, with improvements in optic nerve blood flow and structure, alongside a favorable safety and tolerability profile. 15 Bayer announced its full acquisition of Perfuse Therapeutics in May 2026, citing glaucoma's high unmet medical need affecting up to 80 million people worldwide and the potential for PER-001 to become one of the first disease-modifying treatments for the condition. 16

Separately, Tavo Biotherapeutics raised $17 million in Series A financing in 2026, led by Pureos Bioventures with participation from Polaris Partners and Tau Capital, to advance lead candidates TAV-001 and TAV-002 through clinical development for glaucoma and retinal disease. 17 Gene therapy research, including neuroprotective agents designed to address underlying optic nerve neurodegeneration rather than solely reducing IOP, remains in active clinical investigation per ongoing registrations at ClinicalTrials.gov. 18 Genetic research has further identified three variants in individuals of African ancestry, including ARHGEF12 variants that regulate the RhoA/ROCK pathway and appear to influence response to Rho-kinase inhibitors like netarsudil, opening pathways toward precision-medicine prescribing. 2

Smart Technology and Precision Monitoring

A battery-free, all-polymer microfluidic smart contact lens described in Science Translational Medicine demonstrated the ability to monitor IOP continuously and release glaucoma drugs timolol and brimonidine at preset pressure thresholds in preclinical animal studies. 19 The device combines optical transparency, biocompatibility, and a theranostic design that integrates diagnostics and therapy without requiring electronics or external power. Current clinical gold-standard IOP measurement occurs only every six to twelve months in an office setting; a lens capable of real-time home monitoring and responsive drug release would represent a fundamental shift in disease management, though the technology remains in preclinical stages and regulatory pathways for such combined devices are complex. Artificial intelligence paired with optical coherence tomography imaging is simultaneously improving early glaucoma detection and enabling individualized progression modeling, helping clinicians personalize treatment selection before irreversible vision loss occurs. 20

Despite this technological momentum, important cautions apply across the treatment landscape. Many of the interventions described are still in active trials or under regulatory review and are not yet universally available. Eligibility criteria vary significantly by disease stage, surgical history, and comorbidities. Patients should receive individualized assessments from qualified ophthalmologists, and long-term post-procedural monitoring remains essential regardless of the modality chosen, as no current treatment restores vision already lost to optic nerve damage.

Sources

1. Knowridge Science Report – The Hidden Eye Disease Many Older Adults Don't Know They Have (knowridge.com, 2026)
2. BlackDoctor Pro – Black People Far More Likely to Get Glaucoma, This Study Can Explain Why (blackdoctor.pro, 2026)
3. GlobeNewswire – Nicox Highlights Positive NCX 470 Phase 3 Data at the 2026 American Glaucoma Society Annual Meeting (globenewswire.com, February 2026)
4. Exa.ai / Biomedicines – Clinical Benefits of Aloe vera Gel in 0.3% Hyaluronate Eyedrops in Glaucoma Therapy-Related Ocular Surface Disease (doi.org/10.3390/biomedicines14010186, 2026)
5. The Pilot News / GlobeNewswire – Nicox's NCX 470 New Drug Application Submitted in the United States by Kowa (business.thepilotnews.com, July 2026)
6. Springer Nature / Japanese Journal of Ophthalmology – Efficacy and safety of sepetaprost in ANGEL-J1 study (link.springer.com, June 2026)
7. Santen Pharmaceutical – Rhopressa Ophthalmic Solution 0.02% Manufacturing and Marketing Approval in Japan (santen.com, June 2026)
8. Springer Nature / Advances in Therapy – Phase III J-ROCKET-2 Study of Netarsudil and Latanoprost in Japan (link.springer.com, March 2026)
9. BioSpace – Bausch + Lomb Announces Positive 24-Month U.S. Data on the ELIOS System for Treatment of Glaucoma (biospace.com, March 2026)
10. LaingBuisson News – Centre for Sight Performs First UK Incision-Free Laser Glaucoma Procedure (laingbuissonnews.com, 2026)
11. Exa.ai / Indian Journal of Ophthalmology – Commentary on Micropulse Transscleral Cyclophotocoagulation (doi.org/10.4103/ijo.ijo_3301_25, 2026)
12. Third News – Avisi Technologies Reveals Promising Twelve-Month Results for VisiPlate at AAO 2025 (third-news.com, 2025)
13. Third News – Innovative VisiPlate Glaucoma Device Successfully Implanted in First Patient During SAPPHIRE Trial (third-news.com, 2026)
14. Dove Medical Press / Clinical Ophthalmology – Intermediate Outcomes of a Novel Flat Glaucoma Drainage Device (dovepress.com, April 2026)
15. Ophthalmology Times – PER-001 Shows Vision Restoration in Glaucoma and DR in Phase 2a Trials (ophthalmologytimes.com, July 2025)
16. StreetInsider / Business Wire – Bayer to Acquire Perfuse Therapeutics to Complement Ophthalmology Pipeline (markets.financialcontent.com, May 2026)
17. CityBiz – Tavo Biotherapeutics Raises $17M Series A to Advance Glaucoma and Retinal Disease Pipeline (citybiz.co, 2026)
18. National Institutes of Health – National Eye Institute, Glaucoma Research Areas (nei.nih.gov)
19. Inside Precision Medicine – Smart Contact Lens Offers Glaucoma Treatment Potential (insideprecisionmedicine.com, 2026)
20. Ophthalmology Times – Advances in Glaucoma Diagnosis and Treatment via AI and OCT Imaging (ophthalmologytimes.com)