Welcome to our annual look at the Glaucoma Pipeline—A View Into Ongoing Innovation. Now in its 4^th year, the glaucoma pipeline poster provides an overview of the expansive array of currently available pharmaceutical and surgical treatment options, as well as a preview of modalities that may soon come to our clinics.

Innovation has, quite literally, reshaped how glaucoma is managed. With the gift of hindsight, we can see that the introduction of MIGS over a decade ago sparked a true paradigm shift in treatment—a fundamental change in the approach to managing glaucoma, one that has since replaced the old way of thinking with a new and different perspective. For evidence of this, we need only look to the expanding embrace of interventional glaucoma, or the mindset of proactive management that suggests clinicians should prioritize the use of devices, surgeries, and lasers for early intervention, with the goal of lowering IOP, slowing irreversible loss of vision, and reducing the need to rely on patients’ compliance with topical therapy. It’s an idea that stands in contrast to the traditional reliance on medication and the “watch-and-wait” approach. Such a development in strategy would be impossible without the continual evolution in procedural management.

Although much of the focus in this new era is on procedural management, we should not lose sight of important developments in the medical management of glaucoma. Although it is no longer the mainstay of early glaucoma management, topical therapy still has an important role to play. In fact, the pharmaceutical landscape is expanding, with new classes of topical medications and sustained-release drug delivery systems designed to improve both efficacy and adherence. These approaches are especially important given that non-compliance with daily drops remains a significant barrier to successful long-term IOP management. As these new drugs— which feature novel mechanisms and target different parts of the aqueous pathway—move toward the clinic, they will invariably spark debate about their best use in the individualized care of patients with ocular hypertension or glaucoma.

If there is one limitation to the expanding array of treatment options, it is the question of how to stay abreast of new developments. This is where we hope that our glaucoma poster can play a role. Those familiar with previous iterations of the poster will notice some similarities and some subtle changes to the format and layout. As in years past, the listings are organized according to the anatomical site at which their mechanism of action has an effect. However, we have made the decision to reorganize things on the surgical side: There are now fewer categories, and they have been renamed to reflect current thinking in how interventions are targeted.

All the typical caveats about pipeline candidates apply to the products listed in our poster. Namely, there is no guarantee that investigational devices, surgeries, lasers, and drugs will successfully navigate the rigors of clinical development and regulatory approval. Nevertheless, the sheer number of listings on the poster demonstrate industry’s continued interest in improving the care of glaucoma patients.

Indeed, we are at a remarkable moment in history where we can help patients achieve better outcomes more effectively than at any other point of managing this insidious disease, and yet we can also be cautiously optimistic that even better treatment options are just around the corner.