“Warm New Year Wishes to the TNOA–TJOSR community worldwide, as we begin another year of clinically relevant academic dialogue.” The beginning of a new year invites reflection that is practical rather than ceremonial, an opportunity to reassess priorities, refine standards, and stay aligned with the realities of contemporary ophthalmic practice. It is in this context that we present the January–March 2026 issue of TNOA Journal of Ophthalmic Science and Research. SEEING BEYOND THE SILENT IRREVERSIBLE DISEASE “The only thing worse than being blind is having sight but no vision.” —Helen Keller This issue coincides with World Glaucoma Week (March 8–14, 2026) and appropriately brings together a substantial body of glaucoma-related work. Glaucoma remains uniquely challenging, not because of diagnostic complexity alone, but because of its often-unapparent progression and lifelong implications. The burden of this silent disease lies equally in what is missed as in what is seen. TEN NEW WAYS WE SEE GLAUCOMA DIFFERENTLY Contemporary glaucoma management is increasingly defined by earlier detection, better risk stratification, and sustained long-term control, rather than late intervention alone. Advances in diagnostic technology, therapeutics, and surgical innovation have collectively reshaped how glaucoma is identified, monitored, and treated across its continuum Figure 1. In countries such as India, where disease burden is high and care is delivered across diverse practice settings, these shifts have clear relevance for routine clinical decision-making, as seen in the ten developments that follow:Figure 1: Collage of contemporary glaucoma surgical devices. Shown are the iStent Inject W, Hydrus Microstent, Endoscopic Cyclophotocoagulation Probe, Aurolab Aqueous Drainage Implant-250 (AADI-250), Ahmed ClearPath ST, and Paul Glaucoma Implant Bruch’s Membrane Opening-Minimum Rim Width (BMO-MRW)Earlier structural evaluation relied on parameters such as BMO-Horizontal Rim Width (HRW), which measured the horizontal width of the neuroretinal rim and was influenced by disc tilt, torsion, and inter-observer variability. BMO-MRW represents an objective advance, because it measures the shortest distance between the Bruch’s membrane opening and the internal limiting membrane-providing a truer estimate of the remaining neuroretinal rim tissue. This anatomically anchored metric improves early detection of structural loss and strengthens confidence in longitudinal progression analysis, especially in early and pre-perimetric glaucoma.1 BMO-MRW analysis is available within contemporary spectral-domain optical coherence tomography platforms, like the SPECTRALIS Glaucoma Module Premium Edition (Heidelberg Engineering, Germany), reflecting the broader transition toward anatomically grounded structural assessment in routine glaucoma practice.Electrophysiological TestingComplementing structural imaging, electrophysiological testing has re-emerged as a functional adjunct in glaucoma assessment. By detecting retinal ganglion cell dysfunction before standard automated perimetry reveals definitive change, these tests prompt reflection on how often newer investigative tools are influencing day-to-day clinical decisions rather than remaining confined to research settings.2 Pattern and visual evoked potential systems incorporated into contemporary platforms, such as the RETeval System (LKC Technologies, USA) and Diopsys® NOVA (Diopsys Inc., USA), illustrate how electrophysiology is increasingly accessible within routine clinical environments rather than limited to specialised laboratories.Portable Automated PerimetryA growing shift toward portable, tablet-based visual field assessment is exemplified by platforms such as Melbourne Rapid Fields (MRF) (Vision Research, Australia). These systems extend functional testing beyond conventional static perimetry by providing structured threshold algorithms in a handheld, easily deployable format. Their shorter test duration, user-friendly interface, and adaptability across diverse clinical environments support decentralised functional monitoring-particularly useful in settings where standard automated perimetry is not consistently available.Optimising Medical Therapy and AdherenceMedical therapy, including stepwise escalation to maximally tolerated medical therapy (MMT) when clinically indicated, remains the cornerstone of glaucoma care, with contemporary practice placing equal emphasis on therapeutic efficacy and sustained long-term adherence.3 By consolidating multiple agents into a single formulation, such strategies address one of the most persistent challenges in glaucoma management, namely long-term adherence, without compromising therapeutic intent. Parallel developments in sustained-release intraocular drug delivery platforms further underscore a growing recognition that durable success in glaucoma care depends not only on pharmacological potency, but also on treatment persistence, patient behaviour, and real-world usability.4Direct Gonioscopy: Hands-Free Visualization in SurgeryDirect visualization of the anterior chamber angle remains fundamental to intraoperative decision-making in glaucoma care. Recent refinements in gonioscopy have focused not only on image quality, but also on ergonomic integration into surgical workflow. Hands-free gonioscopy systems, such as the GONIO ready (OCULUS, Germany), allow stable angle visualization, while freeing both hands for surgery. By eliminating the need for manual lens stabilization, such systems enhance surgeon control, reduce dependence on assistants, and facilitate smoother execution of angle-based procedures, particularly during minimally invasive glaucoma surgery.Minimally Invasive Glaucoma Surgery (MIGS) Stenting DevicesWhen medical therapy alone is insufficient or poorly tolerated, surgical options are increasingly considered earlier in the disease course, particularly in eyes with mild to moderate glaucoma. MIGS has assumed a defined role in such settings.5,6 Trabecular bypass devices such as the iStent inject W (Glaukos Corporation, USA), designed with a wider inlet flange compared with earlier inject iterations, illustrate how incremental refinements in device architecture are being translated into more reliable trabecular engagement, and clinically meaningful IOP reduction.7Canal-Based MIGS Scaffolding DevicesScaffold-based systems designed to dilate and support Schlemm’s canal offer sustained modulation of conventional aqueous outflow. Devices such as the Hydrus Microstent (Alcon, USA/Switzerland) extend and maintain canal patency over a longer segment, illustrating how targeted intervention within the outflow pathway can deliver consistent, and durable IOP reduction when integrated thoughtfully into surgical planning.8Endoscopic Cyclophotocoagulation (ECP)Alongside outflow-based strategies, controlled reduction of aqueous production remains relevant. Endoscopic cyclophotocoagulation provides targeted ciliary process treatment under direct visualization and is often considered in combination with cataract surgery, while preserving conjunctival tissue for future intervention. Current ECP systems, such as the Endo-Optiks® platform (BV Medical, USA), enable visualization-guided, selective aqueous suppression, while preserving conjunctival anatomy.Advances in Glaucoma Drainage Device (GDD): Optimised Plate Geometry and Valve-Free Flow RegulationFor eyes with advanced, refractory, or complex glaucoma, GDDs remain indispensable. Recent design refinements have focused on reducing plate size, and optimizing implant geometry to facilitate implantation in eyes with limited conjunctival reserve, prior surgery, or paediatric anatomy. Devices such as the Ahmed ClearPath ST (New World Medical, USA), which incorporates a shorter tube and a reduced plate profile compared with earlier designs, allow controlled aqueous outflow while improving surgical flexibility in anatomically constrained eyes.9 Devices developed within the Indian context further reflect adaptation of drainage implant design to diverse clinical scenarios. The Aurolab Aqueous Drainage Implant-250 (AADI-250) (Aurolab, India), with a smaller plate surface area than the 350-mm² variant, is well suited for eyes with limited conjunctival space, including paediatric cases, and has been widely applied across a spectrum of refractory glaucoma presentations.10Newer non-valved glaucoma drainage designs reflect incremental progress toward improved flow regulation, and long-term IOP stability. Devices such as the Paul Glaucoma Implant (Advanced Ophthalmic Innovations, USA) expand surgical choice in advanced glaucoma, while balancing efficacy and safety.11Artificial Intelligence (AI) in Glaucoma CareBeyond the operating room, post-intervention monitoring and long-term disease surveillance are undergoing quiet transformation. AI is beginning to influence how clinicians interpret imaging, detect progression, and integrate multimodal data over time. While widespread clinical adoption demands robust validation and ethical oversight, AI-driven tools offer a potential response to variability, scale, and longitudinal complexity—challenges that have historically constrained glaucoma care.12 As these options become increasingly visible in practice, one is prompted to ask: which of these devices have found a place in your operating room and clinical armamentarium? And what difference, if any, has that experience made to routine glaucoma decision-making? GLAUCOMA ARCHIVE: FROM THEN TO NOW AND BEYOND “We are what we repeatedly do. Excellence, then, is not an act, but a habit.” — Aristotle While the journal continues to engage with current and emerging work, it also offers small reminders of how long certain conversations have been part of our collective thinking. A glance back at the journal’s early identity as the Journal of the Madras State Ophthalmic Association, seen alongside the archival TJOSR 2009 Issue, where glaucoma was explicitly foregrounded as a thematic focus, underscores how the disease has remained central to ophthalmic discourse, even as its understanding, investigation, and management have steadily evolved over time Figure 2. It is interesting how these discussions resurface across decades, even as scientific reasoning, clinical practice, and technology steadily evolve. The journal’s evolution mirrors that of ophthalmology itself, becoming progressively more data driven, precise, and collaborative.Figure 2: Hardcopy cover page of the Journal of the Madras State Ophthalmic Association, Vol. XIX, No. 1 (November 1981), shown alongside the cover of TNOA Journal of Ophthalmic Science and Research, Volume 47, Issue 4 (December 2009), both glaucoma-focused issuesIKIGAI OF THE CURRENT ISSUE: PURPOSE IN PRACTICE “The end of knowledge is not knowledge, but action.” —Thomas Huxley The articles in this issue engage with glaucoma as it is encountered in real-world clinical practice, addressing ocular hypertension, secondary glaucoma, contemporary management approaches, surgical experience, and the contribution of imaging to understanding structural change. This includes a Guest Editorial by Dr. Sirisha Senthil on secondary glaucoma following uncomplicated cataract surgery with premium hydrophobic intraocular lenses, alongside another Guest Editorial by Dr. Vanita Pathak Ray on the journey of MIGS: an Indian perspective.13,14 The issue also features contributions by TNOA President, Dr. Sujatha Mohan, and Glaucoma Society of India (GSI) President, Dr. Sathyan Parthasarathi, contributing important insights. The issue also features a Current Ophthalmology contribution by Dr. Alokesh Ganguly, offering a focused review on the treatment of ocular hypertension.15 Collectively, these contributions reflect how evolving evidence, technological refinement, and accumulated clinical experience are shaping contemporary glaucoma care, without oversimplifying a disease that demands long-term vigilance and measured clinical judgement. This issue also launches the TJOSR Videos (TV) section, expanding the journal’s multimodal academic engagement. It further introduces the new section Career Predestination: Academic Trajectories, highlighting avenues for career and academic growth. The breadth of perspectives is further reflected in the diversity of contributing authors. Building on the previous issue, which included work from India, Bangladesh, Malaysia, and Turkey, the present edition continues this broader engagement with contributions from India, the United States of America, the United Arab Emirates, and Maldives.16-19 This geographic spread brings practical context from varied healthcare settings, reinforcing the journal’s aim of presenting clinically relevant scholarship that remains applicable across diverse practice environments. The editorial board acknowledges the continued support of its industry partners, whose engagement enables sustained academic outreach and reflects shared confidence in the journal’s editorial direction. In the present publishing cycle, this support draws on a partner base of 13 organisations across recent issues, with 11 partners contributing to the current edition and several continuing their association across successive publications. STEWARDING THE PRESENT FOR POSTERITY—THE LONG VIEW “What is now proved was once only imagined.” — William Blake The debut issue, October–December 2025 (Volume 63, Issue 4), marked the first publication of the current editorial team and was released ahead of schedule in the final week of November through the collective effort of the Editorial Board. We thank the Reviewers, Authors, and the Production Team for working together with openness and mutual trust during this phase. The ease of transition reflects the strength of a group committed to the journal rather than to individual roles. The journal’s digital reach this season has been particularly heartening. Over the recent analytics cycle (1 October 2025 – 31 January 2026), TJOSR recorded an impressive 51,365 full-text views, reflecting growing curiosity and trust in our content Figure 3. Reader engagement remained remarkably strong, with an 82.83% engagement rate, signalling that visitors are not just arriving but truly staying, exploring, and learning. It is also uplifting to see our readership map continue to broaden, while India contributed 44.30% of sessions, a vibrant stream of readers joined us from the United States, Indonesia, the United Kingdom, China, Malaysia, and Australia, reaffirming TJOSR’s evolving global footprint, which resonates with our tagline.Figure 3: Overview of TJOSR website engagement (1 October 2025 – 31 January 2026), showing key performance indicators including sessions, full-text views, engagement rate, and country wise readership distribution“Strong Roots, Clear Vision, Empowered Members, Global Impact”. Financial support and sponsorship The author declares that there are no non-financial interests or personal relationships that could have influenced the work reported in this manuscript. Conflicts of interest There are no conflicts of interest to declare.
Prasanna Venkatesh Ramesh (Thu,) studied this question.