From ASCRS 2026: iDose TR & Interventional Glaucoma (IG) (Part 2) – Featuring Glaukos

In Part 2 of our ASCRS 2026 coverage, we dive into iDose TR and the evolution of interventional glaucoma. Joined by Tom Powell and Cynthia Pointer from Glaukos, we explore what these innovations mean in practice, how they’re changing treatment approaches, and what providers should be paying attention to moving forward.

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Transcript

Hi everyone, welcome back to Ophthalmology Reimbursed. I'm Rebecca Greenlaw. Hi, it's Mary Pat Johnson. 

We're here live at ASCRS 2026, excited to be in Washington, D.C., and we are very excited to be joined by Glaukos today. We have with us Cynthia Pointer and Tom Powell. Welcome.

Thank you. Good morning, we're very happy to be here. So guys, we've been hearing the phrase interventional glaucoma more and more these days.

For our listeners, how would you define that concept? And how is it changing the way ophthalmologists think about treating glaucoma? Yes, so I'd be happy to answer that one. And that's a definition that's been evolving over the last 10 or 12 years since it was first introduced. And I think we finally landed on a firm document based on a paper that was published last year, a consensus protocol on the subject, that defines interventional glaucoma as a procedure-first approach that utilizes drops now as a bridge or supplemental therapy, only as opposed to, in the past, a primary therapy.

So drops are not just used intermittently to help patients versus the primary therapy. And what response have you been hearing about eye dose and interventional glaucoma? The response towards interventional glaucoma has been incredible, especially at this meeting. It's a subject that's been growing and growing.

And it really feels like it's reached a tipping point here this week. Personally, I've spoken to several hundred doctors in the last several days. Every single one of them has been very much in favor of trying to transition their practice from the historical standard of care to a much more interventional procedural approach to glaucoma care. 

And in terms of iDose specifically, that's a critical tool enabling doctors to transition to a procedural approach. It's got a very high responder rate. It is very safe and very effective.

And it bridges that gap that many of them didn't feel like they had in the past of, A, being able to use outside of cataract surgery. And what do I do? Many doctors are using it first line. And even those that are using SLT first line, I think they had a lot of questions about what do I do next, especially if there was not a cataract necessary.

And iDose is a very, very, very strong solution for that. So for our listeners that might not be ultimately familiar with the device, can you give us a brief description of how it works and maybe which glaucoma patients would make a good candidate for the procedure? Yeah. So first in terms of which glaucoma patients are good candidates, eye dose has a very broad label.

And it's actually approved for all forms of open angle glaucoma, from ocular hypertension all the way through severe. So any patient that is in need of something additional is a candidate for iDose. As far as what it is, it's a procedural pharmaceutical, a micro canister that's just a little bit longer than a millimeter, implanted intracamerally into the eye that elutes prostaglandin.

It's the canisters filled with an incredibly pure form of prostaglandin oil that slowly elutes over two plus years and typical duration of the procedure, still early days. But right now the FDA label shows duration that three years or beyond, duration of effect. And is there the possibility of a repeat procedure? There is a possibility of repeat procedure. 

So we were just, iDose TR is the first injectable implantable device to be approved for re-administration. Okay. At about three year intervals or varies by patients? It varies by patient depending on need.

The label requires one year in between administrations. Excellent. Where do you see eye dose fitting into the glaucoma treatment algorithm? We're, the market's very, very excited about iDose.

It's being very widely adopted, very quickly and growing, frankly, at or beyond our expectations. And doctors are using it in three places. First line therapy, immediately after SLT, and very often as a combo with cataracts as well.

Well, I know your booth has been busy. I know this has been talked about through several meetings. There was a big session at the US meeting yesterday morning, but the questions we keep getting, of course, because we're reimbursement focused, our claims payment.

So is there anything in particular practices need to navigate or avoid any tips to getting the claims more smoothly through the process? So the nice thing about our products, specifically iDose, is we have seen consistent coverage across all three payer channels. And what I mean by that is Medicare fee for service, Medicare advantage, and the commercial payers. In order to help navigate across the professional fee, the drug fee, as well as the facility fee, we have iDose Care Connect, which is our hub, that can help these practices, hopefully save them some time, by conducting the benefit investigation, going through the prior authorization research. 

So they will be able to go back to the office and say, here's who you want to target at the payer for the prior authorization. Here's the documentation that you want to submit. Because the last thing we want is a physician having to go through any type of appeal procedure.

So our hub can certainly help with that. We also have a very large team of field reimbursement liaisons, and they actually go to the accounts, whether it's the provider office or the ASC, and they can help navigate those challenges as well. The one key thing that we want to get across is not only is it important to have a clean claim, so understanding all of the components that go on that claim form, but we also want to make sure that the physician feels and the administrators feel supported.

And so that's one of the things that our reimbursement team can do. And we continue to get updated coverage policies. And so our field reimbursement team can also go out to the accounts and work with the administrators on very specific payers.

Fantastic. Fantastic. Okay, so as we look ahead, how do you see sustained drug delivery and interventional glaucoma shaping the future of glaucoma care over the next several years? I'll start and then I'll turn it over to Tom.

So thankfully, glaucoma treatment continues to evolve to enhance the lives of patients with this site-threatening disease. And in glaucoma, the only treatment approach that has really been proven to slow progression in lowering is lowering the IOP. And we really want to make sure that our patients have consistent IOP medication.

And one of the things that iDose can do is deliver that in a consistent manner, but it also, some of the other treatment modalities, there are complications, there are side effects, and sometimes there isn't a lot of patient compliance. So I feel like as this field continues to evolve, we are going to see guideline committees, national societies, state societies, and the treatment paradigm continue to evolve and shift for a procedural pharmaceutical to be administered first. It certainly sounds logical and you have to take the human element of patients administering eye drops out of it. 

We all know the accuracy there. Yeah, I think at this point it's become inevitable that an interventional procedural approach to glaucoma will become the standard of care very soon. I think we're very far down that path at this time and it's in the very near future.

Like Cynthia mentioned, there's a number of regulatory and reimbursement and coverage hurdles to fall, but we're very confident that that'll be the case. And Mary Pat, as you said, we're just losing too many eyes right now, relying upon the patient to administer their own therapy. And many other diseases have solved the same patient adherence and lost the follow-up challenges, and they've all done it in the exact same approach that we're transitioning to, which is moving away from patient-administered therapy and moving to a long-lasting clinician-administered therapy.

Exciting for glaucoma. It is a very exciting time to be in ophthalmology in general. So, well, thank you both very much for attending.

I hope you had a good meeting otherwise. We did. Thank you very much.

Yes. Thank you very much for your time. Thank you.

It was a pleasure being here. Thank you so much for having us.  

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