Should Surgeons Target Both Outflow Pathways?

Nathan M. Radcliffe, MD, editor of Glaucoma Physician, and Sean Ianchulev, MD, MPH, New York Eye and Ear of Mount Sinai, discuss whether addressing both trabecular and uveoscleral pathways could improve outcomes in moderate to advanced disease.

Ophthalmology Management April 14, 2026 Vol 30, Issue ASCRS 2026

Clinical Report: Should Surgeons Target Both Outflow Pathways?

Overview

This discussion explores the potential benefits of targeting both trabecular and uveoscleral outflow pathways in glaucoma surgery. The introduction of new technologies like AlloFlo and AlloSpan may enhance surgical outcomes for patients with moderate to advanced glaucoma.

Background

The management of glaucoma has evolved significantly, particularly with the advent of minimally invasive glaucoma surgery (MIGS). Understanding the dual-outflow pathways is crucial for optimizing intraocular pressure (IOP) reduction and preserving vision. As surgical techniques advance, there is a growing interest in comprehensive approaches that address both outflow pathways.

Data Highlights

No numerical data was provided in the source material.

Key Findings

Current surgical practices predominantly target trabecular outflow, with limited exploration of uveoscleral pathways.
New technologies like AlloFlo and AlloSpan aim to enhance both outflow pathways in glaucoma surgery.
There is a paradigm shift towards considering total outflow interventions for moderate to advanced glaucoma patients.
Evidence for combined trabecular and uveoscleral procedures remains limited, particularly in the U.S.
Ongoing trials are investigating the efficacy of dual-pathway MIGS, with promising results from European studies.

Clinical Implications

Surgeons should consider the potential benefits of targeting both outflow pathways in patients with moderate to advanced glaucoma. The integration of new technologies may provide a more comprehensive treatment approach, potentially improving patient outcomes.

Conclusion

The discussion highlights the need for further investigation into dual-pathway interventions in glaucoma surgery. As technologies evolve, they may reshape the treatment landscape for glaucoma management.

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