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Myopia- Management

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Proper screenings, treatment, management needed for this increasingly prevalent disease.

PDR: public health considerations  

The patient’s ocular history was significant for severe nonproliferative diabetic retinopathy (NPDR) in the right eye (OD) and mild NPDR in the left eye (OS), which had been diagnosed 4 years previously at his last eye exam. 

Case study:  Patient presents with severe PDR history 

Chinese researchers found that repeated therapy using low-level red light (RLRL) is a potential intervention to control myopia progression in children; however, the investigators found decreases in cone density, particularly within 0.5 mm of the retinal fovea, with abnormal drusen-like lesions detected in some cases,

 reported Xinyi Liao, MD. She is from the Department of Ophthalmology, and the Beijing Key Laboratory of Ocular Disease and Optometry Science, Peking University People’s Hospital; and the College of Optometry, Peking University Health Science Center, all in Beijing, China.

Liao and colleagues explained that RLRL therapy is being evaluated for its ability to inhibit myopia progression in children and adolescents.

 This therapy uses a wavelength of 650 ± 10 nm, with an optical power of at least 0.29 mW entering the 4-mm pupil, complying with the international safety standard for laser use.

 However, it has been reported that continuous irradiation may induce a photothermal effect and, therefore, cause retinal damage, despite adhering to international standards.

 The investigators cited a study of retinal damage associated with RLRL treatment that raised concerns about the potential harm to users.

The investigators used adaptive optics scanning laser ophthalmoscopy (AOSLO) in the current study because it enables high-resolution retinal imaging to measure cone cell density in vivo. In this study, they compared the changes in the cone photoreceptors in RLRL users with those in children with myopia aged 5 to 14 years who never underwent RLRL therapy.

 They obtained cone density measurements from the AOSLO images of the superior, inferior, nasal, and temporal meridians from the central fovea vicinity to approximately 4° retinal eccentricity to compare the differences in cone density and structure between cohorts, they described.

The study included 99 children with myopia. The RLRL group included 52 children (27 girls; 97 eyes; mean age, 10.3 years), and the control group included 47 children (25 boys; 74 eyes; mean age, 9.8 years).

“The RLRL users showed decreased cone density within 0.5-mm eccentricity from the foveal center, most notably in the temporal region. At 0.3-mm temporal eccentricity, the RLRL group showed a mean difference of −2.1 × 10

 compared with the controls (95% confidence interval [CI], −3.68 to −0.59 × 10

They also found that 11 eyes had abnormal low-frequency, high-brightness signals near the fovea. The odds ratio of abnormal signals in the patients who used RLRL compared with the controls was 7.23 (95% CI, 1.15-303.45; Fisher’s exact test, 

 = .02). One child had relatively small cystoid abnormalities in the ganglion cell layer seen on optical coherence tomography; these abnormalities resolved 3 months after the RLRL therapy was discontinued.

Liao and colleagues commented, “RLRL therapy administered for at least 1 year was associated with reduced cone density in the paracentral fovea and other subtle retinal abnormalities in some children receiving this therapy for myopia control compared with evaluation of nonusers of RLRL therapy. Although RLRL therapy might control the progression of myopia, further studies are needed to provide more definitive information regarding longer-term efficacy and safety. The AOSLO findings from this investigation support further evaluation of the risk-benefit balance of RLRL therapy in pediatric patients with myopia and potentially the inclusion of additional studies that include AOSLO evaluations as part of the efficacy and safety of RLRL therapy.”

Liao X, Yu J, Fan Y, et al. Cone density changes after repeated low-level red light treatment in children with myopia. 

 2025; Published online April 24. doi:10.1001/jamaophthalmol.2025.0835

Wang W, Jiang Y, Zhu Z, et al. Axial shortening in myopic children after repeated low-level red-light therapy: post hoc analysis of a randomized trial. 

He X, Wang J, Zhu Z, et al. Effect of repeated low-level red light on myopia prevention among children in China with premyopia: a randomized clinical trial. 

Jiang Y, Zhu Z, Tan X, et al. Effect of repeated low-level red-light therapy for myopia control in children: a multicenter randomized controlled trial. 

Chen Y, Xiong R, Chen X, et al. Efficacy comparison of repeated low-level red light and low-dose atropine for myopia control: a randomized controlled trial. 

Youssef MA, Shehata AR, Adly AM, et al. Efficacy of repeated low-level red light (RLRL) therapy on myopia outcomes in children: a systematic review and meta-analysis. 

Zhou L, Tong L, Li Y, Williams BT, Qiu K. Photobiomodulation therapy retarded axial length growth in children with myopia: evidence from a 12-month randomized controlled trial evidence. 

Xiong R, Zhu Z, Jiang Y, et al. Sustained and rebound effect of repeated low-level red-light therapy on myopia control: a 2-year post-trial follow-up study. 

LIA. American National Standard for Safe Use of Lasers home page. Accessed April 20, 2024. 

Ostrin LA, Schill AW. Red light instruments for myopia exceed safety limits.

Liu H, Yang Y, Guo J, Peng J, Zhao P. Retinal damage after repeated low-level red-light laser exposure.

Merino D, Loza-Alvarez P. Adaptive optics scanning laser ophthalmoscope imaging: technology update. 

Wynne N, Carroll J, Duncan JL. Promises and pitfalls of evaluating photoreceptor-based retinal disease with adaptive optics scanning light ophthalmoscopy (AOSLO). 

Researchers found that repeated therapy using low-level red light (RLRL) is a potential intervention to control myopia progression in children.

Changes in cone density after low-level red light treatment in children with myopia 

A new optical laboratory is now available for opticianry students at Seneca Polytechnic.

 The HOYA Vision Care Eyeglass Dispensing Lab at Seneca’s Newnham Campus provides an immerse learning experience for students to develop their skills through hands-on experiential learning in a space that replicates a high-end retail optical dispensing and vision testing environment, according to a news release.

“We are thankful to HOYA for the generous donation that made our new Dispensing Lab possible,” said David Agnew, president of Seneca Polytechnic, in the release. “Students are already benefitting tremendously from this new facility and its sophisticated equipment, ensuring that they transition seamlessly from education to employment.”

The laboratory is equipped with professional-grade technology, which allows students to practice skills including taking precise measurements, selecting appropriate frames, and ensuring proper fittings of eyewear. The space will be available for students in Seneca’s opticianry diploma program, which will authorize them to dispense contact lenses, eyeglasses, and subnormal vision devices.

“HOYA is proud to support the next generation of opticians through our sponsorship of Seneca Polytechnic and our commitment to the optical industry in Canada,” said Steven Haifawi, president of HOYA Vision Care, Canada, in the release. “We are ensuring that future eye care professionals have the skills, knowledge, and resources needed to provide great service to their communities.”

Seneca’s 2-year diploma program is offered in a hybrid delivery format, with some coursework that can be completed online and others to be completed in person. Students can choose from in-person, hybrid, and flexible formats. Courses are available in winter, summer, and fall semesters.

Students who graduate from the program have options for careers in retail optical dispensaries, contact lens clinics, medical clinics, and a health care delivery team. In Canada, registered opticians prepare work orders that give ophthalmic laboratory technicians information to prepare lenses for a frame. Some opticians prepare and finish lenses themselves. Opticians also work to verify the product is completed to the specifications ordered after the design is completed and the eyeglasses are made.

Some opticians in Canada specialize in fitting contact lenses, artificial eyes, or cosmetic shells to cover blemished eyes. Opticians will measure the eye, selecting contact lens material type, and preparing work orders. After delivery, opticians will assist with insertion and will inspect the patient’s eyes, corneas, lids, and contact lenses, and will provide insertion, removal, and care education to patients about their contacts, cosmetic shells, or artificial eyes.

Seneca Polytechnic launches new opticianry lab through gift from HOYA Vision Care. News release. Seneca Polytechnic. April 22, 2025. Accessed April 23, 2025. 

https://www.senecapolytechnic.ca/news-and-events/media-releases/2025/seneca-polytechnic-launches-new-opticianry-lab-through-gift-from-hoya-vision-care.html

Opticianry (OPTC). Seneca Polytechnic. Accessed April 23, 2025. 

https://www.senecapolytechnic.ca/programs/fulltime/OPTC.html

Scope of practice. NACOR. Accessed April 23, 2025. 

https://nacor.ca/about/opticians/scope-of-practice/

The laboratory is equipped with professional-grade technology and replicates a high-end retail optical dispensing and vision testing environment.

New HOYA Vision Care Eyeglass Dispensing Lab available for Seneca Polytechnic opticianry students

Arkansas Optometric Association legislative cochairs Matt Jones, OD; Matt Burns, OD; and Joe Sugg, OD, discuss their involvement in their bill and provide context for its relevance. 

Arkansas Optometric Association outlines its latest legislature success in HB 1353

Starting in August 2025, with additional provisions to roll out based on plan renewals, contract changes, or by January 1, 2026, the relationship between optometrists and vision benefits managers (VBMs) will be changing in the state of Arkansas. HB 1353 will work to rebalance providers’ interactions with VBMs by expanding regulations and implementing more extensive reimbursement requirements. Joe Sugg, OD; Matt Jones, OD; and Matt Burns, OD; legislative cochairs with the Arkansas Optometric Association (ArOA), sat down with 

to discuss the new legislation. They emphasized how the association provides a unified platform for optometrists to address industry challenges collectively. 

The key motivations behind the bill stem from long-standing issues in vision care contracts. Optometrists have been facing increasingly restrictive "contracts of adhesion" with vision plans, where providers have minimal negotiation power. These contracts have consistently squeezed independent practitioners, particularly regarding reimbursement rates that have remained stagnant despite rising operational costs. Sugg and Jones, who have both been private practice owners since 2009, detailed how vision benefit managers have been vertically integrating the market by consolidating frames, labs, electronic health records, and e-commerce platforms. This consolidation creates significant pressure on small business owners and limits their competitive capabilities. 

The bill's development involved collaboration with the American Optometric Association (AOA) and leaders nationwide. Their goal was to create legislation that would protect eye care providers and improve patient access. The speakers noted similar legislative efforts in states like Texas and Oklahoma, expressing hope that the Arkansas bill might inspire nationwide reform. When presenting the bill to legislators, they found surprising receptivity. Lawmakers quickly understood the parallels with pharmacy benefit manager regulations and recognized the need to protect small businesses. The bill's core principles seemed inherently logical to legislators – advocating for provider rankings based on quality of care rather than product sales. Jones highlighted the bill's consumer-friendly nature, arguing it would steer patients toward practices based on medical care quality instead of product sales. He also pointed out the stark reality that service reimbursement rates haven't increased since vision plans' inception, despite exponential increases in operational costs. 

Nationally, Jones and Sugg expressed optimism about potential federal legislation like the DOC Access Act, which could address similar issues in vision and dental insurance markets. Jones, Sugg, and Burns ultimately portrayed the bill as a critical step in protecting optometric practices and ensuring fair, patient-centered health care delivery.

Bausch + Lomb has announced that its ONE by ONE Recycling and Biotrue Eye Care Recycling programs have collected a total of 103,169,500 units, or 625,026 pounds, of used contact lenses, eye care, and lens care materials in the US.

 That weight is the equivalent of approximately 600 concert grand pianos, according to a news release.

“These award-winning recycling programs continue to drive a positive environmental impact, offering eye care professionals, patients, and consumers a way to properly recycle used eye health materials,” said Amy Butler, vice president of global environment, health, safety, and sustainability at Bausch + Lomb, in the release.

Contact lenses, eye care, and lens care materials are often inefficiently processed in standard recycling facilities due to their small size and the type of plastic used to manufacture them. Thus, they are disposed of in landfills or end up in waterways. In the US, an estimated 6 to 10 metric tons of disposed contact lenses end up in wastewater each year.

“The ONE by ONE and Biotrue Eye Care Recycling programs allow my practice and patients to responsibly recycle eye health items—something that wasn’t possible until these programs became available," said Jennifer Tsai, OD, of LINE OF SIGHT in New York, in the release. "We’re proud to collect these materials and contribute to a cleaner environment and healthier planet.”

The ONE by ONE Recycling program has collected over 101 million used contact lenses, blister packs, and top foils since the program’s launch in November 2016. For the Biotrue Eye Care Recycling program, 1.3 million eye drop single-dose units, lens cases, lens solution caps, and all Biotrue-branded eye drop bottles have been collected since the program’s April 2021 launch. Additionally, for every 10 lb collected for the ONE by ONE program, a $10 donation is made to Optometry Giving Sight. Bausch + Lomb also has a similar contact lens recycling program in Canada called Every Contact Counts.

The company works to measure its environmental metrics with its FEWW initiative, or fuel, energy, water, and waste.

Eye care practice providers are able to become a TerraCycle public drop-off point by requesting to join the program on TerraCycle’s 

. The company’s administrators will review applications, and volunteer administrators will manage the drop-off points. The administrators will also choose the location, hours, and accepted waste streams. Participants in the program also receive TerraCycle Recycling Rewards for the trash sent in, which can be redeemed as a cash donation to a school, charity, or nonprofit of your choice. To manage a drop-off site, the location needs to be monitored to ensure proper usage, and when boxes are filled, materials then need to be sealed and sent out with prepaid labels. There are no direct costs associated with managing a drop-off location.

After a shipment is sent out and arrives at a material recovery facility, the shipment information, date, weight, and material are recorded. After inspecting and sorting the packages, various material types are sent to third-party partners to recycle all accepted waste. The recycled trash is then made into new products, including outdoor furniture, plastic pellets, tubing for construction applications, and playground surface covers, among others.

Bausch + Lomb reports more than 100 million units of contacts lenses, lens care, and eye care materials collected through ONE by ONE and Biotrue Eye Care Recycling programs. News release. Bausch + Lomb. April 21, 2025. Accessed April 22, 2025. 

https://www.bausch.com/newsroom/news/?id=255

Bausch + Lomb ONE by ONE free recycling program (drop-off). TerraCycle. Accessed April 22, 2025. 

https://www.terracycle.com/en-US/brigades/bauschrecyclesinoffice#@40.77027075200147:-95.93705549677736zoom:4

Find a TerraCycle drop-off point. TerraCycle. Accessed April 22, 2025. 

https://www.terracycle.com/en-US/about-terracycle/drop_off_locations#@40.77027075200147:-95.93705549677736zoom:4

The ONE by ONE Recycling and Biotrue Eye Care Recycling programs have collected a total of 103,169,500 units.

Bausch + Lomb recycles a total of over 625,000 pounds of contact lenses and eye care products

Representatives from The Vision Council visited the White House in Washington, DC, to meet with Robin Colwell, deputy assistant to the president and deputy director of the National Economic Council, to discuss vision care and challenges posed by current trade policies.

 A group of representatives from several vision care organizations and companies met to emphasize how tariffs are increasing the cost of eyewear and vision products, many of which are considered Class I medical devices and essential to children, older patients, veterans, and low-income patients, according to a news release.

“We appreciated the opportunity to meet with the White House and share how foundational vision is to Americans’ everyday lives,” said Ashley Mills, CEO of The Vision Council. “This conversation allowed us to highlight both the essential nature of vision care and the impact that rising tariffs are having on our industry and the consumers we serve.”

Other industry leaders present for the meeting were Scott Shapiro, executive director of Industry Relations and former CEO of Europa Eyewear; Brandon Butler, president and CEO of Artisan Lab Network and PAL; Jamie Rosin, owner of Rosin Optical; and Ken Bradley, president and CEO of Eschenbach Optik of America. Shapiro outlined how his US-based manufacturing facility has faced challenges with imported components. He also provided background on how restrictive “Made in USA” labeling regulations can limit a company’s ability to accurately represent domestically assembled products. Butler underscored challenges faced by optical labs in reshoring production, particularly the lack of production in US-made machinery, and the financial strain that tariffs are causing on raw materials. Rosin highlighted the downstream health impacts on patients, particularly children and older adults, when rising costs delay access to care. Bradley stated that increased costs affect publicly funded programs like Medicare, Medicaid, and Veterans Affairs, which raises taxpayer burdens while reducing patients served.

The Vision Council also “presented constructive policy ideas aimed at supporting the administration’s goals while easing the pressure on providers and patients,” according to the release. Some of those ideas included revisiting the “Made in USA” labeling standards for products assembled domestically with imported components, regulatory parity with other Class I medical devices in the case that an exemption process is opened, and broader incentives to support domestic manufacturing and supply chain development.

“Our members are committed to strengthening US manufacturing while ensuring that vision care remains affordable and accessible,” Mills added. “We look forward to continuing the conversation and identifying practical solutions together.”

Currently, plastic eyeglass frames, over-the-counter reading glasses, complete eyeglasses, safety glasses, and goggles imported from China are among the products that would be most affected by tariffs, subject to a combined tariff rate of approximately 64% if reciprocal tariffs are rolled out next month. Sunglasses imported from China will be taxed at 63.5%. Additionally, a variety of eyeglass cases, lens processing equipment, and other optical machinery originating from China could face combined duty rates between 80% and 90%.

The Vision Council advocates for the vision industry during White House meeting. News release. The Vision Council. April 22, 2025. Accessed April 22, 2025. 

https://thevisioncouncil.org/blog/vision-council-advocates-vision-industry-during-white-house-meeting

Joy J. Optimism persists among eye care providers despite looming tariffs. 

April 10, 2025. Accessed April 22, 2025. 

https://www.optometrytimes.com/view/optimism-persists-among-eye-care-providers-despite-looming-tariffs

Vision care organizations and companies met to emphasize how tariffs are increasing the cost of eyewear and vision products.

Eye care industry leaders met at the White House to discuss tariff implications

Dana Shannon, OD, FAAO, detailed a lecture she gave at the NOA Midwestern Symposium earlier this month.

NOA Midwestern Symposium 2025: Hypotony-related complication post-trabeculectomy

Dana Shannon, OD, FAAO, detailed a presentation from the 2025 Midwestern Symposium, sponsored by the National Optometric Association and cohosted by Indiana University, on April 5. Shannon focused on hypotony, specifically its relationship to trabeculectomy, a surgical procedure designed to lower eye pressure in patients with glaucoma. Trabeculectomy creates a new drainage pathway in the eye by making an incision in the conjunctiva and sclera, establishing a bleb (fluid collection area) typically located at 12 o'clock underneath the eyelid. While intended to manage eye pressure, this procedure can lead to various complications, particularly hypotony. Hypotony is defined both statistically (eye pressure below 6.5 mm Hg) and clinically, with the clinical definition being more significant for optometrists. Shannon outlined several potential complications associated with low eye pressure:

Corneal changes: Scleral collapse can cause corneal edema and endothelial compromise.

Choroidal effusions: Fluid-filled dome-shaped packs develop in the suprachoroidal space, potentially mimicking retinal detachment.

Hypotony maculopathy: The choroid and retina can wrinkle and buckle, detectable through OCT scans.

Lens nutrient disruption: Reduced aqueous humor can lead to cataract development.

Optic disc edema: More likely in patients with intact nerve fibers.

Anterior chamber shallowing: Potential flattening that could cause the cornea to touch the iris or lens.

Notably, Shannon emphasized that these complications can occur years after the initial surgery, not just in the immediate postoperative period. Two case studies highlighted hypotony developing 4 to 5 years after trabeculectomy, underscoring the importance of long-term monitoring. For optometrists, Shannon recommended several management strategies, including the use of diagnostic tools like OCT scans and retinal photos, employing bandage contact lenses to manage bleb leaks, using cycloplegic drops and topical steroids to manage choroidal effusions, conducting thorough, extended examinations of posttrabeculectomy patients, and promptly referring patients to ophthalmologists when complications are detected.

The ultimate goal is to help optometrists recognize and address subtle clinical findings, ensuring comprehensive patient care and preventing potential long-term eye health complications.

Bhagya Segu, OD, MPH, FAAO

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