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Paul Levine, OD, FAAO, FIAOMC, details a pediatric case of high myopia in which the patient's prescription had increased from –5.75 DS OU to OD –7.00 DS, OS –6.75 DS within a year.

A case of orthokeratology for high myopia

The first-in-class, twice-daily topical formulation is intended for the treatment of non-proliferative diabetic retinopathy and diabetic macular edema. 

Exonate plans to initiate phase 2b CLEAR-DE trial for EXN407 topical formulation for NPDR

A total of $7000 in scholarships was awarded to 3 optometry students as part of the National Optometric Student Association (NOSA) scholarship program.

National Vision awards scholarships to optometric students during NOA Convention 2025

The primary objective of the study was to demonstrate that LUMIFY Preservative Free redness reliever eye drops is non-inferior to LUMIFY redness reliever eye drops in reducing ocular redness. 

Phase 3 study assessing LUMIFY Preservative Free and LUMIFY eye drops meets primary end point

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Denise A. Valenti, OD, FAAO, gives key takeaways from her AAOpt 2022 discussion on the impact of marijuana use and driving.

New technology will allow roadside simulation for research on cannabis use and driving

Denise A. Valenti, OD, FAAO, shares key highlights from her AOA 2022 presentation, "Marijuana and Driving: Your Retina and Brain."

Retinal response to cannabis use

 caught my attention with the provocative title

Impact of bodyweight loss on type 2 diabetes remission: a systematic review and meta-regression analysis of randomised controlled trials.” The authors define “complete remission of diabetes” as a glycated hemoglobin level (HbA

) less than6.0% and/or a fasting glucose level less than100 mg/dL with no use of glucose-lowering drugs at one year after weight loss. They define “partial remission” as HbA

less than6.5% and/or fasting glucose less than126 mg/dL with no glucose-lowering drugs, again one year after initial weight loss.

After evaluating 2847 eligible subjects in 22 randomized controlled trials for diabetes remission as a function of weight loss from baseline, the authors found that, on average across all trials, subjects with less than 10% of body weight loss achieved total remission (TR) and partial remission (PR) rates of 0.7% and 5.4%, respectively. For subjects with a 10% to 19% weight loss, PR rates were 48.4% (no studies analyzed considered TR for this range of weight loss). TR and PR rates were 49.6% and 69.3%, respectively, for a 20% to 29% weight loss and 79.1% and 81.5% for subjects losing more than 30% of their baseline body weight. Of note, every one percentage point decrease in body weight increased the probability of TR by 2.17% and the probability of PR by 2.74%; these effects were not impacted by age, gender, race, diabetes duration, baseline body mass index (BMI), HbA

level, insulin use, or type of weight loss intervention (eg, pharmacotherapy, caloric restriction, bariatric surgery or a combination of interventions).The most interesting finding is the exponentially increased success of weight loss for purposes of diabetes remission with the degree of weight loss achieved, with a threshold weight loss greater than10% required for meaningful population levels of remission, signaling “a robust dose-response relationship between bodyweight loss and diabetes remission.”

Remission of diabetes should be of considerable interest to all health care providers, including optometrists, because studies show that even brief periods of remission (ie, 6 months) significantly reduce the risk of vascular diabetes complications by 11% to 35%, including major adverse cardiovascular events (eg, stroke, heart attack, congestive heart failure and cardiovascular death) as well as incidence of diabetic retinopathy (DR) and nephropathy.

 Though some studies have shown that sudden reductions in mean blood glucose levels may exacerbate preexisting retinopathy (eg, with bariatric surgery, initiation of insulin therapy or potent glucagon-like peptide [GLP-1] receptor agonist drugs such as semaglutide),

 this phenomenon, sometimes referred to as diabetic reentry retinopathy or early worsening phenomenon, is typically short-lived, and the long-term benefits of primary DR prevention via diabetes remission will almost certainly yield a massive public health benefit if remission can be sustained.

All this begs the question: How realistic is achieving diabetes remission with currently available weight loss strategies? Specifically, can sufficient weight loss be achieved to induce meaningful population-level reductions in overweight and obesity and thus type 2 diabetes prevalence? Bariatric surgery results in a greater than 10% weight loss in virtually all patients, with mean body weight reductions of 15% to 30%, depending on baseline patient characteristics and the specific procedure chosen. However, it does carry surgical risk as well as increased risk of nutrient malabsorption.

Bariatric surgery is typically covered by insurance for type 2 diabetes only when the BMI is above 35 kg/m

 Nonetheless, roughly 60% to 70% of patients with obesity with type 2 diabetes mellitus (T2DM) experience remission after 5 years, including those with a BMI less than 35 kg/m

GLP-1 or dual GLP/glucose-dependent insulinotropic polypeptide (GIP) therapies typically result in 5% to 10% reductions in body weight, depending on the specific drug, but a majority of patients regain weight after drug cessation.

 The most effective currently available medication is tirzepatide (marketed as Mounjaro for type 2 diabetes and as Zepbound for overweight/obesity; Eli Lilly). Three-year data from the SURMOUNT-1 trial (

) of 2359 subjects with obesity (40% with prediabetes) showed 12.3%, 18.7%, and 19.7% reductions in body weight with weekly tirzepatide injections of 5 mg, 10 mg, and 15 mg, respectively, compared with a 1.3% mean weight loss in the placebo group.

Pooled analysis showed that tirzepatide increases the likelihood of type 2 diabetes remission (defined as HbA

less than 5.7%) by 16-fold, though there is no evidence that remission is extended without ongoing drug therapy.

GLP-1 therapy is relatively expensive and has been linked to both worsening DR (especially in patients using insulin) and increased risk of non-arteritic anterior ischemic optic neuropathy, particularly with large, rapid reductions in mean blood glucose

; GLP-1s also are associated with excess muscle loss (sarcopenia). One analysis found a 30% or more loss of muscle fiber volume with semaglutide.

 Recently, the SURMOUNT-3 MRI substudy found that tirzepatide did not cause excess sarcopenia compared with that seen with conventional weight loss strategies, such as diet, exercise, and/or bariatric procedures.

What about fasting regimens? Meta-analysis comparing alternate daily fasting (ADF), 5:2 fasting (no food intake 2 days/week with a typical diet 5 days/week), caloric restriction (typically less than 750 kcal/day), and time-restricted eating (usually a “feeding window” of 8 hours) shows that each of these typically results in a 5% to 12% weight loss, with most data favoring ADF to achieve a more than 10% weight loss.

 A Chinese study of the 5:2 diet in T2DM showed superior reductions in weight loss (4 kg or 8.2 lb difference) and HbA

level (- 0.3% to 0.4% difference) compared with metformin or empagliflozin over 16 weeks, but did not report on diabetes remission.

Meaningful population-wide remission of type 2 diabetes appears to exponentially correlate with the degree of weight loss, with a 15% reduction in body weight required to achieve one-year partial or total remission rates approaching 50%. Various strategies are available to achieve this end, with bariatric surgery being most effective, followed by potent GLP-1/GIP therapy, followed by caloric restriction/intermittent fasting, based on my review of available evidence. Primary prevention with a focus on environmental contributors to diabetes

 (eg, food insecurity, taxation policies that discourage consumption of sugar-laden foodstuffs, particulate air pollution, neighborhood walkability, etc) is ideal, but awareness of and education about remission strategies to help patients currently living with type 2 diabetes are within our reach.

Kanbour S, Ageeb RA, Malik RA, Abu-Raddad LJ. Impact of bodyweight loss on type 2 diabetes remission: a systematic review and meta-regression analysis of randomised controlled trials. 

. 2025;13(4):294-306. doi:10.1016/S2213-8587(24)00346-2

Dambha-Miller H, Hounkpatin HO, Stuart B, Farmer A, Griffin S. Type 2 diabetes remission trajectories and variation in risk of diabetes complications: a population-based cohort study. 

. 2023;18(8):e0290791. doi:10.1371/journal.pone.0290791

Bain SC, Klufas MA, Ho A, Matthews DR. Worsening of diabetic retinopathy with rapid improvement in systemic glucose control: a review. 

. 2019;21(3):454-466. doi:10.1111/dom.13538

Lupoli R, Lembo E, Saldalamacchia G, Avola CK, Angrisani L, Capaldo B. Bariatric surgery and long-term nutritional issues. 

. 2017;8(11):464-474. doi:10.4239/wjd.v8.i11.464

Eisenberg D, Shikora SA, Aarts E, et al. 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) indications for metabolic and bariatric surgery. 

. 2023;33(1):3-14. doi:10.1016/j.soard.2022.08.013

Zhou X, Zeng C. Diabetes remission of bariatric surgery and nonsurgical treatments in type 2 diabetes patients who failure to meet the criteria for surgery: a systematic review and meta-analysis. 

 2023;23(1):46. doi:10.1186/s12902-023-01283-9

Wilding JPH, Batterham RL, Davies M, et al; STEP 1 Study Group. Weight regain and cardiometabolic effects after withdrawal of semaglutide: the STEP 1 trial extension. 

. 2022;24(8):1553-1564. doi:10.1111/dom.14725

Jastreboff AM, le Roux CW, Stefanski A, et al; 

. Tirzepatide for obesity treatment and diabetes prevention. 

. 2025;392(10):958-971. doi:10.1056/NEJMoa2410819

Fujihara K, Matsubayashi Y, Kitazawa M, et al. Achieving normoglycaemia with tirzepatide: post hoc exploratory analysis of the SURPASS J-mono and J-combo studies. 

. 2024;26(11):5304-5311. doi:10.1111/dom.15887

Vilsbøll T, Bain SC, Leiter LA, et al. Semaglutide, reduction in glycated haemoglobin and the risk of diabetic retinopathy. 

. 2018;20(4):889-897.doi:10.1111/dom.13172

Amini A, Hamann S, Larsen M. Semaglutide and non-arteritic anterior ischaemic optic neuropathy: review and interpretation of reported association

. Published online March 8, 2025. doi:10.1111/aos.17473

Neeland IJ, Linge J, Birkenfeld AL. Changes in lean body mass with glucagon-like peptide-1-based therapies and mitigation strategies. 

. 2024;26(suppl 4):16-27. doi:10.1111/dom.15728

Sattar N, Neeland IJ, Dahlqvist Leinhard O, et al. Tirzepatide and muscle composition changes in people with type 2 diabetes (SURPASS-3 MRI): a post-hoc analysis of a randomised, open-label, parallel-group, phase 3 trial. 

. 2025;13(6):482-493. doi:10.1016/S2213-8587(25)00027-0

Elortegui Pascual P, Rolands MR, Eldridge AL, et al. A meta-analysis comparing the effectiveness of alternate day fasting, the 5:2 diet, and time-restricted eating for weight loss. 

 2023;31(suppl 1):9-21. doi:10.1002/oby.23568

Guo L, Xi Y, Jin W, et al. A 5:2 intermittent fasting meal replacement diet and glycemic control for adults with diabetes: the EARLY randomized clinical trial. 

 2024;7(6):e2416786. doi:10.1001/jamanetworkopen.2024.16786

Chous AP. 5 diabetes truisms that are (at least partially) false. 

 March 25, 2022. Accessed May 20, 2025. https://www.optometrytimes.com/view/5-diabetes-truisms-that-are-at-least-partially-false

What we should be telling our patients about the remission of type 2 diabetes with weight loss.

How much is enough? Seeking remission from type 2 diabetes

indicate that collagen mimetic peptides (CMPs) applied topically to the ocular surface have therapeutic potential for treating ophthalmic diseases by reducing tissue stiffness and integrity caused by ocular stress such as that occurring in myopia. The CMPs bind to and repair disease- and trauma-damaged collagen, according to a press release issued by Stuart Therapeutics Inc.

The company’s PolyCol platform of CMPs is described as synthesized therapeutic polypeptides that target and heal specific areas of collagen damage that are implicated in chronic diseases of the eye. In addition to myopia, the platform also may address dry eye disease, glaucoma, diabetic retinopathy, and recurrent corneal erosion.

The study investigators, led by first author Lauren Wareham, PhD, a research assistant professor at Vanderbilt Eye Institute, Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, explained that several chronic ophthalmic diseases cause the cellular release of matrix metalloproteinases (MMPs), enzymes that degrade and remodel collagen proteins.

The effect of MMPs on helical structures decreases their activity as signaling proteins, leading to a cycle of inflammation and further damage. Healthy collagen structures are required for full and healthy recovery of the affected tissues, they explained.

In this study, the researchers measured how stress induced by elevations in intraocular pressure impacts stiffness of the peripapillary sclera and glial lamina in the rat eye and how this was counteracted by topical treatment of a reparative mimetic of type I collagen.

The results showed that with 4 weeks of elevated intraocular pressure, there was a decrease in scleral stiffness that corresponded to an increase in fragmented, or damaged, collagen. During the same period, the application of CMPs to the ocular surface had a concurrently restorative effect on both scleral stiffness and collagen structure.

David Calkins, PhD, vice president for research at Vanderbilt University Medical Center and lead investigator of the study, commented, “Stress-induced reduction in tissue stiffness and collagen damage occur and facilitate disease progression in many conditions that involve the peripapillary sclera, including myopia. While more research is needed, our results suggest that CMPs, when applied to the ocular surface, could promote the restoration of tissue stiffness and integrity challenged by degraded or remodeled collagen, thus helping the eye maintain its ability to respond to disease-related ocular stress.”

The researchers concluded, “We have demonstrated the potential of CMPs to repair intraocular pressure-induced decreases in tissue stiffness, presumably due to fragmented collagen. Since collagen damage in the eye may be evident early in conditions such as myopia and glaucoma, the use of CMPs to repair collagen damaged by tissue strain or stress may be an effective preventive or restorative intervention.”

They believe that the implications of treatment with CMPs to restore scleral stiffness are significant, considering the high percentages of individuals worldwide who are myopic. (Patients with high myopia, defined as -6.0 diopters and higher, are more likely to have retinal detachments, macular degeneration, glaucoma, and other ocular health problems. “A well-tolerated and effective therapeutic for myopia would provide welcome relief to a very large population,” they said.

Wareham LK, Ghanem GOB, Clark KL, Schlumpf E, Del Buono BJ, Calkins DJ. Topical application of a collagen mimetic peptide restores peripapillary scleral stiffness reduced by ocular stress. 

New research reveals collagen mimetic peptides may effectively restore ocular tissue stiffness, offering hope for myopia and other eye diseases.

Pipeline

Healing damaged collagen in the eye with topical polypeptides in patients with myopia 

Versant Health’s fourth annual Vision Wellness Study recently found that as many as 3 in 4 US citizens are disrupted in their daily activities by poor eyesight or eye health; however, over half of surveyed patients stated that they delay or avoid eye care because it doesn’t “feel urgent.”

 Survey participants cited cost concerns, perceived inevitability, and deprioritization as obstacles to receiving eye care, according to a news release.

“A vision benefit isn’t just an add-on – it can be a cornerstone of comprehensive care,” said Neelam Gor, MD, chief clinical officer at Versant Health, in the release. “Our study highlights how vision benefits can serve as an essential bridge to regular eye care, but only when the coverage is understood and perceived as valuable.”

The survey included 3045 US adults 18 years and older who must share responsibility for health care decisions or “be the primary decision maker in their household,” according to the release. Data were collected from 42 interviews with US consumers, eye care professionals, employee benefits brokers, health plan executives, and HR decision makers in small, midsize, and large businesses. Surveys, interviews, and analysis were conducted by global strategy, insights, and analytics group STRAT7.

Over half (53%) of patients who get their eyes tested less than once every 2 years stated that cost concerns or a lack of access to vision care benefits were the main reasons why they weren’t receiving more regular examinations. Additionally, 66% of patients stated that they viewed deteriorating eye health as an inevitable part of aging, negating the need for regular examinations. A majority of survey participants (63%) stated that they were prioritizing other aspects of their health over their eyes, with Gen Z at 69% and millennials at 70%.

The survey results also found significant knowledge gaps related to eye care and vision benefits, according to the release. About half (55%) of patients can correctly define the difference between a comprehensive eye examination and a vision screening. Additionally, only 30% of patients confidently know that an eye examination can help diagnose diabetes, with 25% confidently knowing its role in hypertension detection. However, about 9 in 10 patients (86%) reported that they are more likely to schedule an eye examination once they understood how these examinations can aid in the early detection of serious medical conditions, including diabetes, heart disease, and high blood pressure.

“Overcoming these barriers and the low sense of urgency is imperative for improving eye health outcomes. Our research shows that access to vision benefits, combined with an understanding of how the coverage works, are key drivers of seeking eye care,” said Meredith Ryan-Reid, Versant Health CEO, in the release. “When carriers, vision care providers, and employers help connect vision care with overall health, 4 in 5 people enrolled in vision benefits are more likely to use them.”

Patients also displayed a desire for more engagement and direction from vision and health care carriers, with 71% stating that they are likely to seek advice about eye health from carriers, 75% are looking to their eye care providers to share advice on how nutrition can improve eye health, and 86% of parents are seeking eye care advice for their children.

Patients also voiced an interest in better understanding their vision benefits and how to choose and use them. As many as 67% of patients offered vision coverage through their employer or health plan state that the benefit’s value hasn’t been clearly explained, or they report that it is confusing for them to select the right plan. Over 60% of patients also stated that a clearer explanation of how their plan works, including what is covered, out-of-pocket costs, and available discounts, would make them more likely to enroll in vision benefits.

Despite majority of Americans struggling with the impact of poor eyesight and eye health on daily life, more than half are delaying or avoiding eye care. News release. Versant Health. July 1, 2025. Accessed July 21, 2025. 

https://versanthealth.com/press-releases/fourth-annual-vision-wellness-study/

Survey participants cited cost concerns, perceived inevitability, and deprioritization as obstacles to receiving eye care.

Survey finds majority of US patients delaying eye care despite experiencing poor eyesight, eye health

The Puerto Rico Manufacturers Association (PRMA) has recognized CooperVision’s Juana Diaz manufacturing facility for its achievements in sustainability and occupational health and safety.

 For the 13th consecutive year, the company was honored during the 2025 Puerto Rico Manufacturers Association Awards, which presented the company with the PRMA President’s Award, Platinum Recycling Award, and recognitions in Leadership in Environmental Performance, according to a news release.

“Year after year, these awards are a celebration of our team’s longstanding dedication to maintaining high standards and consistently raising the bar,” said Rolando Torres, chief operations officer at CooperVision, in the release. “The PRMA’s continuous focus on progress keeps us moving forward and making a positive impact on our workplace, our community, and the planet.”

The President’s Award recognized CooperVision for maintaining a workplace injury and illness rate below the national average for other comparable industrial operations. The Platinum Recycling Award recognizes a company for diverting more than 90% of nonhazardous waste from landfills.

For the Leadership in Environmental Performance recognition, CooperVision received the Eco Label Certification and the Eco Label LEED Gold Certification. The Eco Label Certification was given to the company for achieving LEED Gold certification from the US Green Building Council and Zero Waste Facility Program Certification through SCS Global Services. The latter certification is in recognition of compliance, operations, conservation, and environmental protection, in addition to partnerships with Environmental Excellence Programs, including the EPA Energy Star, LEED, Zero Waste to Landfill, Zero Liquid Discharge, and other awards that are evaluated and granted by an independent agency.

Previously, CooperVision won an award in 2024 for its Combined Heat and Power Plant (CHP) project in Juana Diaz. This project utilized more efficient generators than conventional on-site diesel, natural gas, or propane-powered generators. The CHP is natural gas-fueled, which captures and reuses excess heat and avoids distribution losses, according to CooperVision.

The company also commits to sustainability efforts in conserving natural resources with renewable options, collecting manufacturing waste and giving it new life by way of recycling, and offsetting waste from products and packaging that cannot be reclaimed. CooperVision partners with Plastic Bank in order to offset a portion of the company’s plastic footprint, in addition to purchasing ISCC PLUS-certified plastic.

 In April 2025, the company announced that its partnership with Plastic Bank had prevented the equivalent of more than half a billion plastic bottles from entering oceans on an international scale. These products that were collected and recycled in part of the initiative, which began in 2021, include soft contact lenses and blister and packaging components.

CooperVision honored for sustainability and occupational safety excellence at 2025 Puerto Rico Manufacturers Association Awards. News release. CooperVision. July 24, 2025. Accessed July 25, 2025.

A brighter tomorrow starts with all of us, today. CooperVision. Accessed July 25, 2025. 

https://coopervision.com/about-us/coopervision-sustainability

CooperVision’s plastic neutrality initiative reaches remarkable half-billion bottle milestone. News release. CooperVision. April 17, 2025. Accessed July 25, 2025. 

https://coopervision.com/our-company/news-center/press-release/coopervisions-plastic-neutrality-initiative-reaches-remarkable-half-billion

The company was presented with the PRMA President’s Award, Platinum Recycling Award, and recognitions in Leadership in Environmental Performance.

CooperVision recognized during 2025 Puerto Rico Manufacturers Association Awards

As threats continue in the US to slash federal medical and vision funding and to consolidate the National Institutes of Health’s (NIH) National Eye Institute (NEI) into the broader Institute on Neurosciences and Brain Research, eye care providers, researchers, and vision organizations are working together to launch a campaign to protect vision research.

 The American Academy of Ophthalmology (AAO), Association of University Professors of Ophthalmology (AUPO), American Academy of Optometry (AAOptom), Association for Research in Vision and Ophthalmology (ARVO), National Alliance for Eye and Vision Research (NAEVR), and Alliance for Eye and Vision Research (AEVR) are collaborating to oppose any proposal to consolidate the NEI with the launch of the #SeeWhatMatters campaign, according to a news release.

The educational and grassroots advocacy effort will work to elevate the profile of federally funded vision research, reinforce the need to keep the NEI independent, and illustrate the human impact of vision science. The campaign provides tools to patients, researchers, clinicians, industry, and advocates to tell their stories advocating vision research.

“The National Eye Institute plays an irreplaceable role in advancing the science that drives better patient outcomes, informs clinical practice, and fuels innovation in vision care,” said Trish Shomion, CEO of the AAOptom, in the release. “Defending and strengthening the NEI is not only about protecting research – it’s about safeguarding the vision health and independence of millions of Americans. Our community stands united to ensure that this vital organization continues to lead progress in preventing blindness and improving quality of life for people across the country.”

The release provided a handful of examples as to why the campaign proves necessary and vision research is crucial to the health of patients, including NEI research that has powered the development of ocular coherence tomography (OCT) that “has revolutionized treatment of several blinding eye diseases and saved both Medicare and patients billions of dollars.” NEI funding also paved the way for the first vision-restoring treatment for age-related macular degeneration (AMD) in the anti-VEGF class of drugs. NEI-supported scientists have also been able to use gene therapy to partially restore vision to those diagnosed with Leber congenital amaurosis, in addition to being an early investor in backing the artificial intelligence (AI) platform LumineticsCore that has the potential to prevent vision loss in patients with diabetes.

The campaign also cites that NEI trials have demonstrated that laser surgery, blood glucose control, and lipid-lowering therapies can aid in the slowing of vision loss caused by diabetic retinopathy. For AMD, NEI studies have shown that antioxidant and zinc supplements can reduce the risk of advanced AMD-related vision loss. Research on glaucoma has identified effective medications for lowering intraocular pressure to aid in the prevention of blindness. Additionally, other trials have shown that eye patching and drops can improve vision in the weaker eye of children with amblyopia. NEI research has also unveiled that an oral antiviral can reduce the recurrence of corneal stromal keratitis, a severe herpes-related eye disease.

The #SeeWhatHappens campaign urges researchers, clinicians, patients, and advocates to contact US Congress representatives to illustrate the need for vision research through the NEI. A campaign toolkit is available on the campaign’s website to aid in call-to-action resources, social media advocacy avenues, and more.

Nation’s eye physicians, researchers launch campaign to protect America’s standing as world leader in vision research. News release. American Academy of Optometry. July 23, 2025. Accessed July 23, 2025. 

https://aaopt.org/about-us/news/#toggle-id-1

Stand Up for Sight-Saving Science. #SeeWhatMatters. Accessed July 23, 2025. 

https://www.seewhatmatters.org/#resources

The campaign provides tools to patients, researchers, clinicians, industry, and advocates with tools to tell their stories that advocate for vision research.

Denise A. Valenti, OD, FAAO

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