In this Season 3 premiere of The History of Eyecare, host Dr. Morgan Micheletti is joined by Tom Burns, Chairman and CEO of Glaukos, for a wide-ranging conversation about company building, category creation, and the evolution of modern glaucoma care. Burns’ career has crossed several major chapters in ophthalmic innovation. Before joining Glaukos, he held leadership roles at SmithKline Beckman, Allergan, Chiron Ophthalmics, Bausch + Lomb, and EyeTech, giving him a rare perspective across pharmaceuticals, refractive surgery, surgical devices, retina therapeutics, and venture-backed ophthalmic startups. The conversation begins with Burns’ early career and his love of building companies from the ground up. He describes how his experience at Chiron shaped his understanding of startups, how EyeTech gave him a front-row seat to a new retina market, and how Bill Link eventually recruited him to a small company called Glaukos. At first, Burns admits he was skeptical. A tiny glaucoma stent sounded like a mini-shunt in a conservative, late-stage surgical category. But when he saw the device, he immediately recognized the possibility of something different: a simple intervention that could help reduce dependence on topical therapy and open the door to what he calls the “birthright” of Glaukos — interventional glaucoma. From there, Dr. Micheletti and Burns explore what glaucoma treatment looked like in the early 2000s, when therapy was still dominated by topical drops, lasers were often viewed as second- or third-line options, and surgery was largely reserved for advanced disease. Burns explains how the original iStent pathway ultimately moved through cataract surgery, not because that was the original strategic intent, but because it became the viable regulatory path for introducing a new class of glaucoma intervention. A major theme of the episode is that MIGS was not just a device innovation — it was a mindset change. Burns discusses the challenge of educating both glaucoma specialists and cataract surgeons, many of whom initially viewed glaucoma intervention as outside the scope of routine cataract practice. Over time, Glaukos helped build the educational infrastructure, clinical evidence, and surgeon confidence needed to make MIGS part of modern anterior segment surgery. The episode also goes deep into the development of iDose TR and the broader idea of procedural pharmaceuticals. Burns describes the scientific, chemical, regulatory, and manufacturing challenges involved in creating a sustained intracameral drug delivery platform. From early questions about prostaglandin potency and elution rates to hand-filling tiny devices for early trials, building a dedicated manufacturing facility, navigating combination product review, and receiving FDA approval, the story captures the unseen work required to turn an idea into a clinically available technology. Burns also shares several moments that tested the company’s resilience: early FDA uncertainty, venture financing challenges, a difficult PMA panel, CMS reimbursement threats, and even a fire that came dangerously close to the company’s San Clemente manufacturing facility. Through each of these stories, he returns to the importance of culture — a team that can “hit curve balls,” adapt quickly, and stay committed to building something meaningful. Looking ahead, Burns offers a vision for glaucoma care over the next decade: more SLT, more procedural pharmaceuticals, longer-duration therapies, greater use of combination mechanisms, and a growing role for interventional glaucoma specialists. In his view, the field is moving away from passive, drop-dependent management and toward proactive, 24/7 pressure control designed to preserve vision over the lifetime of the “forever patient.” This episode is a story about Glaukos, but it is also a broader story about ophthalmology: how innovation happens, how categories are built, how surgeons learn to adopt new ideas, and how persistence, culture, and timing can reshape the standard of care. Key Topics: Tom Burns’ early career at SmithKline Beckman, Allergan, Chiron Ophthalmics, Bausch + Lomb, and EyeTech The founding era of Glaukos and the early vision for interventional glaucoma What glaucoma care looked like before MIGS Why the original iStent regulatory pathway moved through cataract surgery The challenge of introducing a new surgical category to glaucoma specialists and cataract surgeons The evolution from the original iStent to iStent inject and iStent Infinite Surgeon education and the cultural shift toward treating glaucoma earlier Why drop adherence remains one of the central problems in glaucoma care The development story behind iDose TR and procedural pharmaceuticals Manufacturing risk, clinical trial challenges, and FDA combination product review The San Clemente fire and other moments that tested Glaukos’ resilience Glaukos’ “we’ll go first” culture and investment in future technologies The future of glaucoma care over the next 10–20 years Why Burns believes interventional glaucoma may become as common as cataract surgery Chapter markers: 00:40 — Welcome to Season 3 and introduction to Tom Burns01:34 — From history major to SmithKline Beckman, Allergan, and Chiron05:07 — EyeTech, aptamers, and early retina therapeutics06:18 — What glaucoma care looked like before MIGS07:22 — Joining Glaukos in 2002 and the “strip mall of hope”08:19 — Why the first iStent pathway moved through cataract surgery11:37 — Creating a new category: manufacturing, safety, skepticism, and surgeon adoption15:38 — From the original iStent to iStent inject17:23 — iStent Infinite and the path toward standalone glaucoma intervention19:12 — The safety profile of MIGS and the importance of education20:52 — Interventional glaucoma and the “forever patient”25:25 — The adherence problem and why glaucoma care needs a paradigm shift26:57 — Procedural pharmaceuticals and the origin of iDose TR31:26 — Manufacturing, early clinical trials, and building the San Clemente facility34:00 — FDA approval and the “joyous all-nighter”35:19 — The fire that nearly threatened the manufacturing facility36:55 — “We’ll go first”: culture, reinvestment, and building new markets40:18 — The meaning behind the Glaukos logo and the company’s focus areas41:30 — Preserving mission clarity with a growing pipeline42:31 — The future of glaucoma care over the next 10–20 years45:09 — What Burns is most proud of at Glaukos47:11 — Resilience, FDA challenges, CMS pressure, and “hitting curve balls”50:21 — The most important innovations in ophthalmology52:07 — Closing thoughts and sponsor acknowledgment
