AGS 2025: A look at Gemini and the MIGS revolution with Mona Kaleem, MD

Mona Kaleem, MD, highlighted findings from the Gemini study, which evaluated the Omni surgical system for up to 3 years in patients with primary open-angle glaucoma, pseudoexfoliation glaucoma, and pigmentary glaucoma, at the 2025 American Glaucoma Society (AGS) Annual Meeting, held February 26 to March 2 in Washington, DC. The procedure combined 360-degree canaloplasty with 180-degree goniotomy to enhance aqueous outflow.

At 1 year, patients experienced an average IOP reduction of 8.2 mmHg (34%), with 82% medication-free. By year 2, 77% remained medication-free, and at year 3, 74%, highlighting the procedure’s durability and its ability to reduce medication burden and improve quality of life, said Kaleem, who is an associate professor of ophthalmology at the Wilmer Eye Institute, Johns Hopkins University.

The safety profile was favorable, with minimal adverse events. Some patients had mild hyphema, prolonged inflammation, or transient IOP spikes, but no significant complications were reported. The findings reinforce the Omni device as a safe and effective option for managing glaucoma, Kaleem noted.

Future research could explore its use in uveitic, angle-closure, and pediatric glaucoma and conduct head-to-head comparisons with other MIGS devices. As the MIGS revolution continues to evolve, early surgical intervention is transforming glaucoma care by reducing reliance on medications and avoiding complex surgeries.

Kaleem emphasized the need for greater diversity in clinical trials to better represent the broad spectrum of patients affected by glaucoma.