Sponsored by ViaLase
An incision-free, image-guided option aims to move interventional glaucoma beyond the operating room.
At the edge of every breakthrough lies the leap from vision to reality. At ESCRS 2025’s iNovation session in Copenhagen, delegates were invited to imagine a different future for glaucoma care: one where interventional options move out of the operating room and into the clinic.
Known for spotlighting disruptive technologies, the iNovation stage has often been where new categories are born. This year, the spotlight turned to glaucoma, a field where durable, noninvasive solutions have long remained elusive.
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On stage, Shawn O’Neil (United States), newly appointed CEO of ViaLase, Inc. (Aliso Viejo, CA, United States), introduced FLIGHT, the first and only incision-free femtosecond laser image-guided high-precision trabeculotomy for glaucoma.
“Let’s not talk about where we are. Let’s talk about where we’re going,” he said, outlining how the procedure uses femtosecond laser precision and real-time imaging to create a drainage channel without incisions, implants or blebs.
Why a femtosecond laser for glaucoma
Femtosecond technology has already reshaped two areas of surgical ophthalmology, corneal refractive and cataract surgery. It refined corneal flaps in refractive surgery, enabled precise capsulotomies in cataract surgery and facilitated corneal transplantation with minimal disruption. ViaLase believes the same precision can finally unlock a new chapter in glaucoma care.
Long known as the scalpel of light, femtosecond energy carves tissue with micron-level restraint while sparing what surrounds it. ViaLase has now redirected that precision toward glaucoma, pairing it with ultra high-definition gonioscopic and optical coherence tomography (OCT) imaging.
According to Mr. O’Neil, this dual view “gives confidence that doctors can identify the proper landmarks and place the treatment exactly where they want it, each and every time, with no damage to adjacent tissue.” Real-time OCT also confirms the aperture as it forms, giving surgeons direct visualization of the trabecular meshwork during treatment.
Unlike incisional angle-based approaches limited by a corneal incision, FLIGHT can be placed in any of the four quadrants of the eye. This flexibility also means repeat treatments can be performed if needed, helping to maintain results over time and extending the utility of the procedure across the patient journey.
READ MORE:Fueling FLigHT: Vialase’s Novel Incision-Free Glaucoma Solution
Addressing the gaps in glaucoma care
Glaucoma has long been managed through a sequence of compromises. Topical medications are plagued by adherence issues and ocular surface toxicity. Selective laser trabeculoplasty (SLT) is increasingly first-line, yet around one-third of patients are nonresponders, and efficacy often wanes within a year. Minimally invasive glaucoma surgery (MIGS) lowers pressure but still requires cutting into the eye, usually during cataract surgery. Filtration surgery remains a last resort, invasive and prone to long-term failure.
FLIGHT offers a different path: a noninvasive, image-guided, trabecular bypass performed in an outpatient setting, designed to be safer and more durable than existing options.
Early clinical signals
At Copenhagen, Mr. O’Neil presented 24-month results from 18 eyes treated with a single 500 × 200 micron channel without medication washout. He reported that no serious adverse events occurred at any point, while intraocular pressure (IOP) was reduced by 34.6% and sustained over two years.
This durability, Mr. O’Neil noted, matters as much as the initial pressure drop. A safe, noninvasive treatment that continues to work for years could reduce the need for additional interventions, ease the treatment burden and give patients confidence that their disease is being managed consistently.
For a condition where progression often feels inevitable, durability is a promise that resonates deeply with both doctors and patients. Here, femtosecond precision delivered not only safety, but lasting function without scarring or channel closure.
Complementary to SLT
Because both FLIGHT and SLT are laser-based, the obvious question is how the two fit together. Mr. O’Neil explained that the procedure “creates an aperture in the trabecular meshwork—a bypass like we’re familiar with from other incisional trabecular bypass procedures.
That makes it well-suited as a follow-up when SLT falls short, or as a practical first-line option in clinics where SLT is not already available. This flexibility is central to the ViaLase vision: tailoring the mechanism to the patient rather than forcing a one-size-fits-all sequence.
READ MORE: ViaLase Joins Forces with John A. Moran Eye Center to Advance Glaucoma Treatment
The patient experience
Beyond the data, Mr. O’Neil emphasized the patient journey. Receptivity of more than 200 patients who have now undergone FLIGHT has been “strikingly positive.” With no anesthesia required, patients lie down, undergo treatment and resume daily activities.
Many are astonished at the simplicity of it all with some asking, “Is that really all there was?” while others want to know when they can have their second eye treated. The lack of injections, sutures and downtime aligns with the broader shift toward IG that is clinic-based rather than operating room-bound.
Panel perspectives
The panel, chaired by Prof. Dr. Ike Ahmed (Canada) and Dr. Ziad Khoueir (Lebanon), emphasized that adoption barriers lie less in evidence than in workflow and reimbursement. As Prof. Dr. Gus Gazzard (United Kingdom) noted, “We feel awkward if we’re not at least offering laser[s] as our primary therapy, because we now know that we’re denying patients the opportunity of drop-free disease control.”
Prof. Dr. Miriam Kolko (Denmark) highlighted the importance of patient well-being beyond IOP: preserving the ocular surface, maintaining visual function and minimizing side effects. The panel also discussed the role of patient advocacy and education in driving demand for interventional options, a theme echoed in Mr. O’Neil’s emphasis on patient satisfaction and repeat demand.
Together, these points reinforced the consensus that for IG to scale, it must be accessible, repeatable and valued by patients as much as physicians.
READ MORE: A New Interventional Glaucoma Consensus Protocol Has Arrived
The runway ahead
Every new technology in glaucoma faces the same gauntlet: evidence, workflow, reimbursement and patient acceptance. FLIGHT enters that arena not as another variation on surgery, but as a different species altogether: the first and only incision-free, image-guided femtosecond laser treatment for glaucoma, designed for the clinic rather than the operating room.
With early data showing durable safety and efficacy, and patients themselves asking for the procedure in their second eye, ViaLase is positioning FLIGHT to become not just an innovation, but a new standard in interventional glaucoma.
Editor’s Note: The 43rd Congress of the European Society of Cataract and Refractive Surgeons (ESCRS 2025) is being held from 12-16 September in Copenhagen, Denmark. Reporting for this story took place during the event. This content is intended exclusively for healthcare professionals. It is not intended for the general public. Products or therapies discussed may not be registered or approved in all jurisdictions, including Singapore.