New MIGS Approach for Glaucoma Patients

Hot Topic

Novel Glaucoma Therapy Launches in the US

Iantrek has launched AlloFlo Uveo in the United States, a groundbreaking surgical treatment designed to enhance aqueous outflow through the uveoscleral pathway, offering a novel solution for glaucoma management. Unlike traditional MIGS devices, AlloFlo Uveo employs a biointerventional approach to maintain the patency of a surgically created cleft, ensuring sustained outflow and addressing the progressive vision loss associated with glaucoma. This device targets the uveoscleral pathway, an underused outflow route, providing a minimally invasive, reproducible option for surgeons. Adam Szaronos, Iantrek’s CEO, noted that approximately 2.5 million eyes in the United States have undergone MIGS procedures with diminishing efficacy, underscoring the need for a more sustainable option. The device’s early-release program exceeded expectations, demonstrating strong surgeon adoption and validating its role in meeting unmet needs in glaucoma care. More than 100 surgeons worldwide have performed thousands of AlloFlo procedures, with clinical outcomes supported by seven peer-reviewed publications.

My Two Cents

Our practice is highly active in the field of interventional glaucoma, and I genuinely believe this is the future of glaucoma care (more on that later). This new procedure is certainly something to keep an eye on, and I’ll be discussing it with our surgeons tomorrow. The promising data the company has provided, coupled with the fact that this new MIGS device targets the uveoscleral pathway as opposed to most other MIGS options, which target the conventional trabecular outflow route, immediately differentiates itself in the market! This dual-flow potential involving both the trabecular and uveoscleral pathways could be highly beneficial to our patients!

OUTSIDE THE LANE

Blood Test Can Rule Out Alzheimer Disease

Roche Diagnostics, in collaboration with Eli Lilly, has received FDA clearance for its Elecsys pTau181 blood test, the second blood-based biomarker test approved in 2025 for assessing Alzheimer disease in adults 55 years of age and older with cognitive decline. Designed for primary care settings, the test measures pTau181 protein levels in blood plasma, which are elevated in Alzheimer and other neurodegenerative diseases, to help rule out Alzheimer pathology with a 97.9% negative predictive value, as shown in a study of 312 participants. A negative result indicates a high likelihood of no Alzheimer-related pathology, while a positive result requires further confirmatory testing. Unlike the Lumipulse test (Fujirebio), which uses a pTau217 and beta-amyloid 1:42 ratio, Elecsys pTau181 focuses on a single biomarker, offering a complementary approach to enhance diagnostic accuracy when used with other assessments. Brad Moore, CEO of Roche Diagnostics North America, emphasized the test’s role in enabling earlier answers for patients. At the same time, Joanne Pike, DrPh, of the Alzheimer’s Association, noted its value in identifying non-Alzheimer causes of cognitive decline, facilitating appropriate referrals. Roche plans to integrate it into 4,500 clinical laboratory instruments nationwide.

However, Richard Isaacson, MD, a preventive neurologist, cautioned that a panel of tests is needed for accurate diagnosis and monitoring, as no single biomarker fully captures Alzheimer progression. While promising, the test’s sensitivity and false positive rates require further study to ensure reliable clinical application. This clearance marks a step toward accessible, scalable Alzheimer’s diagnostics, supporting earlier intervention in a field where blood-based testing is still evolving.

My Two Cents

This is important stuff to know! My ex-wife’s family is heavily affected by Alzheimer disease, and it’s a big discussion point. They constantly ask me if I’ve heard anything new in the diagnosis/treatment of Alzheimer, and this story obviously qualifies! If you know anyone who has been affected by Alzheimer disease, you’re aware of how debilitating and life-changing it can be for not only the patient, but also those closest to them.

CAN YOU RELATE

With the recent announcement of yet another MIGS procedure, the time is right for my annual discussion about MIGS procedures and interventional glaucoma treatments.

In our practice, we actively recommend interventional glaucoma treatments for our patients, many of whom have been on drops for years, and, in most cases, their eyes show the effects. Whether it’s dry eyes and corneal toxicity due to the preservatives or the numerous cosmetic factors such as skin discoloration, irritation, and periorbital fat atrophy, the side effects of long-term glaucoma drops are well known. Whether you live in a laser state or not, these are procedures that our patients need to be informed about. Our patients need to be educated on all the options. Interventional glaucoma treatments—such as selective laser trabeculoplasty and procedure-based options like the iDose (Glaukos), iStent Infinite (Glaukos), and Durysta (Abbvie)—are game-changers for the ocular health of our patients. We can stop the ocular surface-damaging drops while ensuring compliance. If you had glaucoma, what would you want for yourself or your family member? To me, that answer is straightforward: interventional glaucoma treatments. It should also be noted that the rest of the world has been ahead of us on this for years.

One last thing: Not only should we, as optometrists, be on the lookout for patients who could benefit from interventional glaucoma treatments, but we also need to be aware of the services and procedures surgeons perform on our cataract surgery patients. Did the surgeon perform a MIGS procedure? As a gentle reminder, many procedures can be performed alongside (and at the same time as) cataract surgery to help our glaucoma patients achieve even greater pressure-lowering effects post-surgery. Make sure your patients are getting the best care and the most up-to-date options available.

Remember, many of these MIGS procedures can only be done alongside cataract surgery, so if your patient misses that window, that particular option may be off the table forever! Make sure your patients are getting offered the best. It would be shocking if, in 5 years, MIGS and interventional glaucoma surgeries are not the standard of care across the eye care world.

QUOTE OF THE WEEK

“Innovation distinguishes between a leader and a follower.”

— Steve Jobs