There has to be a better way: evolution of internal filtration glaucoma surgeries

Accelerating progress in biomedical engineering1 and the ability to live image and understand delicate outflow structures2 have produced an abundance of new surgical options in the last few years for an ancient disease that stubbornly defies the best hands and minds. Glaucoma, first described by Hippocrates 400 BC as vision loss in the elderly that is different from cataract,3 is now a leading cause of irreversible blindness with increasing prevalence in an aging population.4 Despite the many new arrivals, the concepts behind recent names like Trabectome,5 iStent,6 Hydrus,7 Xen,8 Solx,9 Cypass,10 Canaloplasty,11 ECP12 are not entirely new: open angle glaucoma has been surgically treated for 150–100 years by either increasing external filtration,13 internal filtration (angle surg…