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New research reveals how low blood sugar can damage the retina in diabetes, highlighting potential treatments targeting specific proteins to prevent vision loss.

Hypoglycemia may promote a breakdown of the blood-retinal barrier, study finds

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Susana Marcos, PhD, discusses the implications her research presents for the role optical coherence tomography (OCT) could play in presbyopia and myopia accommodation efforts.

ARVO 2025: Lens thickness as a significant biomarker for accommodation in presbyopia

The novel intraocular lens works to restore dynamic range of vision following cataract surgery.

US FDA gives Atia Vision go-ahead to begin clinical study of the OmniVu Lens System

The OTC eye drops contain low-dose brimonidine tartrate 0.025%.

Bausch + Lomb launches LUMIFY Preservative Free redness reliever eye drops in US

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An overview of a case of SLK treated with complete ocular lavage facilitated by an irrigating eyelid retractor.

Case report: Superior limbic keratoconjunctivitis

New studies supported by the National Institutes of Health’s (NIH) National Eye Institute (NEI) Intramural Research Program suggest that the drug reserpine, approved for high blood pressure in 1955, has the potential of treating retinitis pigmentosa in the form of a small molecule therapy. Currently, no therapy exists for the inherited retinal disease (IRD).

 The studies were published in a singular report in 

“The discovery of reserpine’s effectiveness may greatly speed therapeutics for retinitis pigmentosa and many other inherited retinal dystrophies, which can be caused by one of more than a thousand possible mutations affecting more than 100 genes. Reserpine’s neuroprotective effect is independent of any specific underlying gene mutation,” said the study’s lead investigator, Anand Swaroop, PhD, senior investigator at NIH’s National Eye Institute, in the release.

In the latest study, researchers evaluated the therapeutic potential of reserpine for autosomal dominant retinitis pigmentosa, a dominant form of the disease caused by a mutation in the visual pigment gene rhodopsin, by using a P23H-1 rat model and performing a series of assays to evaluate the response to reserpine treatment on retinal pathology. Reserpine was administered via intraperitoneal injection, with data collected through optokinetic tracking; ERG recordings; fundus imaging and optical coherence tomography; immunohistochemistry; RNA extraction and library preparation; and RNA-seq and data analysis.

Evidence from the studies showed that reserpine improves survival of photoreceptor cells, the light-detecting retinal neurons that die due to retinitis pigmentosa and other retinal dystrophies. Compared to untreated rates, reserpine preserved the process in which photoreceptors convert light that enters the eye into electrical signals that are sent to the brain to produce vision, known as phototransduction, in rod photoreceptors.

 “The neuroprotective effect of reserpine was achieved, at least in part, through the restoration of the balance between autophagy and the ubiquitin-proteasome system, the stress-response pathways maintaining cellular proteostasis,” the study authors stated.

Additionally, reserpine produced better protective effects for rod photoreceptors in female rats in comparison to male rats. Researchers also noted that significant preservation of cone photoreceptors was found more often in female rats compared to male rats.

“We can only speculate about these sex-specific differences. However, future research would benefit from teasing out these differences and understanding them to lay a foundation for personalized approaches to retinal disease therapy,” Swaroop said in the release.

Swaroop and his research team are also developing additional and more potent reserpine-related drugs to be used as options to treat late-onset or slowly progressing IRDs. These drugs may also be able to stall vision loss in different types of aggressive retinitis pigmentosa until more effective treatments are developed that can reverse said vision loss.

Although reserpine is no longer being used for treating high blood pressure due to its adverse effects, researchers hope that the low required dosage for treating retinal degeneration would quell said effects, according to the release.

Researchers note that the molecular target of reserpine in the retina remains unknown, while acknowledging the possibility for a different association in the retina. The reasons for biological sex bias in drug response must also be investigated, particularly whether retinas in female and male rats are predisposed differently to retinal pathology and interventions. “Overall, our findings highlight the broader application of small molecules derived from unbiased large-scale screening and underscore the importance of considering sex-specific differences in the development of treatments for IRDs,” the study authors stated.

Repurposing a blood pressure drug may prevent vision loss in inherited blinding diseases. News release. National Institutes of Health. April 15, 2025. Accessed May 6, 2025. 

https://www.nih.gov/news-events/news-releases/repurposing-blood-pressure-drug-may-prevent-vision-loss-inherited-blinding-diseases

Song HB, Campello L, Mondal AK, et al. Sex-specific attenuation of photoreceptor degeneration by reserpine in a rhodopsin P23H rat model of autosomal dominant retinitis pigmentosa. 

The drug was previously approved for high blood pressure in 1955.

Reserpine has potential to be repurposed as treatment for retinitis pigmentosa, studies suggest

Neda Shamie, MD; Selina McGee, OD, FAAO, Dipl ABO; and Jacob Lang, OD, FAAO; provided their insights during CIME 2025 on May 4.

CIME 2025: What you missed in presbyopia tips, tricks, and updates

A plethora of topics were discussed from a collaborative care perspective at this year's annual Controversies in Modern Eye Care (CIME) conference in Los Angeles, California. From lenses to eye drops, presbyopia was a particularly hot topic on May 4. Neda Shamie, MD; Selina McGee, OD, FAAO, Dipl ABO; and Jacob Lang, OD, FAAO, detail key takeaways on presbyopia from CIME 2025.

Pharmacological presbyopia treatment is definitely something that we've been thinking about for a long time. It is a kind of a holy grail of eye care. Everyone over the age of 45 develops presbyopia, so to have a solution to bridge those patients until they develop cataracts or significant symptomatic changes of their vision, it's really important to think about solutions for our patients and eye drops. Presbyopia drops are a fantastic option for the right patient. It's ideal for that niche patient, the one who's between 45 and about 55 who is starting to have presbyopia. 

An ideal patient would be an emmetrope who's really enjoyed excellent vision for a long time and is starting to have difficulty with their near vision. There's really no surgical grade option for them. Definitely, spectacles are great. Contact lenses with mono vision are great, but then drops offer an additive, or kind of a complementary option for these patients. What's exciting are all the improvements in the presbyopia drop kind of options that we have available. Thus far, we have had the 1.25% pilocarpine, which has been great and some patients really respond nicely to it. But because of the higher concentration of the pilocarpine, there are [adverse] effects associated with it. 

So now recently, there was a new eye drop the pilocarpine 0.4% that has been FDA approved and available to us. Really exciting, lower concentration of pilocarpine, less [adverse] effect profile and yet equal response. The vehicle of this drop is soothing to the ocular surface. And really it's 2-in-1 in a sense. And many of these patients really have ocular surface disease that contributes to their visual problems. And so the new 0.4% pilocarpine offers ocular surface soothing effect with a vehicle together with a lower dose of pilocarpine.

Presbyopia is one of those really frustrating conditions for patients, and they don't understand all their options. They don't even understand that they can have multiple options. And I think that's the biggest key, is we want to prescribe for specific situations, and that might be a pair of spectacles and a therapeutic drop, it might be contact lenses and spectacles and a therapeutic drop, it might be a surgical option and a therapeutic drop. So I think we have to get out of this mindset. And our patients certainly don't understand this, that there's more than one option, and they're allowed to have more than one option, and so I think it's just really important that we give patients all of the available therapies and all the available technologies we have great candidates for therapeutic interventions with presbyopia are patients that are motivated.

Ultimately, it's not finding the right exact prescription or the right exact pupil size. It's more about is the patient motivated to try something different and be less dependent on their current technology. When you are examining your patient and you're talking about pharmaceutical options for presbyopia, you're going to do everything that you already do. It's going to make sure that the patient is a good candidate for the prescription therapy, and that means looking at their retina, whether it's a wild field photo or it's a dilated eye exam, as long as you can look and make sure they don't have any retinal pathology or anything else that would preclude them from being able to use it. It's the things that you and I already do. So just make sure that patient's had a comprehensive eye exam and then move forward with your therapies from there.

What excites me most about pharmacological correction for presbyopia is really a new option. The flexibility that pharmacological options give our patients to use it when they need it, and be able to give them some freedom, flexibility and lifestyle options for their busy lives and busy careers through these busy presbyopic years is really what excites me most. 

Some of the barriers that patients run into with regard to pharmacologic correction and presbyopia, I think one of the biggest ones is their providers. [It] is actually the doctors not knowing what options are out there with regards to pharmacologic correction and how those pharmacologic options might benefit their patients in their chairs. So furthering their education, embracing new things. I think that's the biggest thing and the biggest barrier to patients getting access to these options. When we're thinking about our patients and taking care of our patients, if we're prescribing any sort of treatment option, we want to do the best for our patients first, right? Do no harm. So we've got to take care of our patients from tea to green, from ocular surface to retina, optic nerve, we've got to take care of the entire patient. And that's why it's so important that we're the doctor, that this is really, you know, we're talking about presbyopia correction with pharmaceuticals. This is an eye drop in an eye drug. And so eye doctors need to take the role there and be the doctor. Take care of the entirety of the globe, the entirety of their ocular health from front to back.

Neda Shamie, MD; Selina McGee, OD, FAAO, Dipl ABO; and Jacob Lang, OD, FAAO, provided their insights during CIME 2025 on May 4.

Conference

. I’m big on semantics and will debate them with you ad nauseam. Our clinical lifetimes are lifetimes of practicing what we do, and it takes practice. With that notion in mind, this issue’s column will be comprised of several facts about glaucoma that I have picked up along the way.

Your patients are not taking their medications like they say they are. Neither are mine. Adherence issues are at or near the top of avoidable barriers to proper glaucoma treatment. I will not bore you by rattling off study after study, but a simple search of the world’s peer-reviewed literature will yield substantial evidence supporting the fact that adherence remains an issue. For this reason, I have gotten away from adding a third drop to a patient’s regimen. Adherence tends to go down significantly when that third drop is added. I typically consider a prostaglandin analogue or facsimile thereof at night and a combination drop twice a day for maximum medical therapy. If the target IOP is not achieved, we are heading toward a consultation for selective laser trabeculoplasty (SLT) and/or minimally invasive glaucoma surgery. More on this later.

Visual field studies stink. They always have, and they always will. However, I do not foresee a time in my clinical lifetime when we are not performing them. Patients are either trigger-happy or asleep at the wheel. Furthermore, there is no holy grail visual field analyzer for all stages of glaucoma. Yes, frequency-doubling technology does seem to pick up glaucomatous defects earlier at times. However, there is no visual field analyzer that is optimal for all stages of glaucoma. With that said, as much as visual field studies stink, they need to be repeated. If you take nothing else from this column, remember to repeat the visual fields study. Reliable and repeatable defects are part of what drives treatment in one direction or another.

A decent number of patients with glaucoma—even younger ones—will present with normal IOPs. In fact, the contemporary definition of glaucoma does not mention IOP. It’s just a risk factor (thankfully, a modifiable one because it is the No. 1 risk factor). When a teenager comes in with suspicious optic nerve heads and IOPs of 11 mm Hg, a workup is still necessary. You are getting a snapshot of that patient’s IOP throughout the course of a day. I am not saying you need to spend the day with that patient, but I am saying you should consider bringing the patient back at a different point in the day over several visits to perhaps detect an overall trend. One IOP reading does not make or break a glaucoma diagnosis, regardless of patient age.

There will be patients with glaucoma whom you do not treat. I can promise you that. I have one patient who had to take a lot of prednisone over the course of her life. When she had a curative surgical procedure, she no longer needed steroids. Another optometrist referred her to me as suspicious for glaucoma, and I am convinced that she was a steroid responder and acquired moderate glaucomatous damage from it. Her IOPs are low, and results from serial visual field studies, optical coherence tomography studies, and optic nerve evaluations have shown no progression. I eventually went from seeing her every 3 months to every 6 months and have been doing so for 12 years now.

Patient history is as important as they taught you it was in optometry school—maybe even more so. Some favorite questions of mine that I always ask during an examination are the following: Do you get headaches around your eyes (IOP spiking)? Do you ever see halos around lights (transient angle closure)? Did you ever get really sick in the past and require hospitalization or coma (history of hemodynamic crisis)? Did you ever have to take steroids for an extended period (this damage may be old news)? Do any of your blood relatives have glaucoma? That last one requires a follow-up question if the answer is yes. I want to know about a family history of glaucoma, but I also want to know how that family member is doing. A grandfather who takes a prostaglandin analogue, lives independently, and has great vision represents a much different scenario from a sister who has to hold onto walls to get around. That follow-up question will likely play a role in your treatment of the patient.

Finally, put yourself in your patient’s shoes. Since I have started to make a concerted effort to do this, it has changed my perception of myself—specifically my delivery of information. I have also asked myself what I would do if I found out that I had glaucoma, and the very likely scenario is that I would be in line for SLT. I would want to avoid medical therapy if at all possible. This (thankfully) hypothetical question has garnered more support over the past few years, as we now have good evidence that SLT is safe, effective, and cost-effective when compared with medical therapy (insert plug for state political action committee contribution here).

This list is intended to be progressive in nature. Help me add to it! What tangible information have you picked up along the way? Let’s compare and contrast with the goal of advancing the collective consciousness surrounding glaucoma.

Knowing the truths concerning patient adherence and history and visual field tests can make a difference in care quality.

What to keep in mind when diagnosing and treating glaucoma

At ARVO 2025, Mark Bullimore, MCOptom, PhD, emphasized the need for more accurate, condition-specific tools in evaluating myopic eye growth and treatment efficacy.

ARVO 2025: Rethinking centile growth curves in myopia management with Mark Bullimore, MCOptom, PhD

At the 2025 ARVO conference in Salt Lake City, Mark Bullimore, MCOptom, PhD, of the University of Houston College of Optometry shared a compelling critique of the current use of centile growth curves for axial length in myopia management. Speaking directly to optometrists, Bullimore emphasized the need for more accurate, condition-specific tools in evaluating myopic eye growth and treatment efficacy.

The problem with conventional growth curves

Centile growth curves—long used in pediatrics to track height and weight—are increasingly being applied to axial length measurements in children. According to Bullimore, this is where the utility of these curves begins and ends in the context of myopia.

"These curves are based on data from all children, not just myopic ones," he explained. "So they substantially underestimate axial elongation in myopic children."

This limitation has 2 major consequences:

 The curves fail to reflect how fast a myopic child's eye is likely to elongate.

 They hinder clinicians from accurately determining whether myopia control treatments are working.

Bullimore also cautioned against relying on axial length alone to predict myopia onset. While it has some predictive value, "cycloplegic refractive error is far more accurate," he said.

To manage myopia effectively, Bullimore recommends using data derived solely from myopic children. This would allow practitioners to assess the expected axial elongation in untreated cases and compare it meaningfully against treated ones.

“What you want is to know how quickly the average untreated myopic child’s eye will grow,” he said. “And ideally, you’d have confidence intervals or centile ranges 

By separating myopic from nonmyopic data, clinicians can gain a more realistic benchmark and better evaluate the success of interventions like orthokeratology or low-dose atropine.

Bullimore’s insights at ARVO underscore the importance of precision in pediatric myopia care. As the prevalence of childhood myopia continues to rise, refining the tools we use to monitor progression and assess treatment outcomes is more critical than ever.

Biopharmaceutical company Perfuse Therapeutics has announced positive 24-week results from its phase 1/2a trial of PER-001, a first-in-class endothelin antagonist intravitreal implant for glaucoma.

 Data from the completed trial were presented at the Association for Research in Vision and Ophthalmology (ARVO) meeting earlier this week, according to a news release.

“Our mission is to develop the first disease-modifying treatment for glaucoma, the leading cause of irreversible global blindness with no approved therapies,” said Sevgi Gurkan, MD, CEO and founder of Perfuse Therapeutics, in the release. “These data are very promising, with PER-001 improving vision in glaucoma patients. We plan to advance the clinical development of PER-001, with initiation of an adaptive phase 2b trial in glaucoma in the second half of 2025 that we believe could serve as one of 2 pivotal studies required for registration.”

The phase 1/2a clinical trial was a multicenter, 2-part trial that assessed the safety and tolerability of the PER-001 intravitreal implant in patients with glaucoma. Other exploratory objectives of the study included pharmacodynamic (optic nerve head blood flow), functional (visual field), and structural (optical coherence tomography [OCT] retinal nerve fiber layer [RNFL]) effects of PER-001.

The phase 1 portion of the trial was a first-in-human, open-label, single ascending dose (SAD) study that assessed the safety and tolerability of 2 doses in a single PER-001 administration in 6 patients with advanced glaucoma (n=3 per dose). Phase 2a was a randomized, patient and reading center masked study that evaluated PER-001 low and high doses against sham control in patients with progressive mild-to-moderate glaucoma (n=approximately 8 for each of the low dose, high dose, and sham control groups). Both portions of the study included 33 participants who were followed for 24 weeks after dosing.

Data from the trial demonstrated that when added to existing standard of care intraocular pressure (IOP) reducing therapies, the single intravitreal administration of PER-001 aided in increasing ocular blood flow and improved both visual function and anatomic structure with registrable outcomes measured by visual field sensitivity and OCT RNFL thickness. Specifically, improvement in visual field mean deviation from baseline was +1.5 and +1.1 decibel (dB) per year at 24 weeks for high dose and low dose, respectively. The increase in RNFL thickness from baseline was +7.7 and +2.4 microns per year for low and high dose, respectively, as measured by OCT at 24 weeks in phase 2a. The study also demonstrated a strong and linear relationship between functional and structural improvements (Pearson Correlation Coefficient = 0.721; 

The trial also demonstrated that PER-001 was safe and well-tolerated over the 6-month period. The 2 drug-related adverse events noted were both mild, intermittent, and self-resolved vitreous floaters. No instances of endophthalmitis, intraocular inflammation, uveitis, or retinal vasculitis were reported.

“For decades, glaucoma treatments have focused on lowering intraocular pressure (IOP). Yet, many patients still experience vision loss and progress to blindness,” said Steven Mansberger, chief of ophthalmology and director of glaucoma services at Legacy Devers Eye Institute, investigator of the study, and presenter of the ARVO presentation, in the release. “What is particularly remarkable is that treatment with PER-001 led to improvements in ocular blood flow, optic nerve structure, and visual function. These findings suggest a potentially transformative approach for the treatment of glaucoma by targeting the endothelin pathway, a well-established mediator of vascular dysfunction in the disease. Notably, this represents the first time endothelin antagonism has been studied in the human eye, marking the potential start of an exciting new era of treatment for patients with glaucoma.”

Perfuse Therapeutics announces positive results from the completed phase 1/2a clinical trial of PER-001 intravitreal implant in patients with glaucoma. News release. Perfuse Therapeutics. May 6, 2025. Accessed May 8, 2025. 

https://perfusetherapeutics.com/perfuse-therapeutics-announces-positive-results-from-the-completed-phase-1-2a-clinical-trial-of-per-001-intravitreal-implant-in-patients-with-glaucoma/

The first-in-class endothelin antagonist intravitreal implant aided in increasing ocular blood flow and improved both visual function and anatomic structure, according to the company.

ARVO 2025: Perfuse Therapeutics announces positive results from phase 1/2a trial of PER-001, an intravitreal implant for glaucoma

Prevent Blindness has vocalized its full support of the recent reintroduction of the Early Detection of Vision Impairments for Children Act (EDVI), or HR 2527, in the US House of Representatives.

 The bipartisan legislation would work to establish grants for states and communities to apply for and access for the implementation of new approaches and improved public education regarding children’s vision, early detection of vision concerns, referrals for eye examinations, and follow-up mechanisms, among other initiatives, according to the release.

“Far too many children in the United States face unnecessary barriers to essential vision care,” said Jeff Todd, president and CEO of Prevent Blindness, in the release. “The EDVI Act brings us closer to a future where every child has access to the vision screenings, eye exams, and treatment they need to see clearly and thrive. We are proud to support this critical legislation that prioritizes children's eye health and educational success.”

The EDVI Act was first introduced in the House in May 2024 and was reintroduced on March 31, 2025. The bill has maintained the same cosponsors in the Congressional Vision Caucus cochairs, Rep Gus Bilirakis (FL-12), and Rep Marc Veasey (TX-33). Companion legislation to the bill is expected to be introduced in the US Senate in the near future.

 Dozens of public health organizations have also voiced their support for the EVDI Act, including the American Optometric Association, the American Academy of Optometry and Ophthalmology, Lighthouse Guild, The Vision Council, World Council of Optometry, and many others.

If passed, the EDVI Act would allow the US Department of Health and Human Services’ Health Resources and Services Administration to award grants and cooperative agreements to eligible states and communities.

 The act would also work to “establish a coordinated public health system for vision health and eye care diagnosis and treatment, develop state-based data collection and performance improvement systems, and promote wrap-around services for children who experience vision loss,” according to the release.

“As an American who has suffered from poor vision since childhood, I have a firsthand understanding of how critical early detection and treatment is when it comes to ensuring that all children have the best possible start in life,” said Bilirakis in the release. “The EDVI Act, reintroduced this year, will ensure all children get the screening and care they need at the right age by creating the first-ever federally funded program to address children’s vision and eye health. This legislation will empower states and communities, like mine, to improve systems of care for our youngest citizens and their families.”

The EVDI Act would also provide resources through the Centers of Disease Control and Prevention for technical assistance and guidance for new children’s vision systems of care, in addition to aiding the conducting of research. Current resources to provide information to help legislators and advocates further the act include Prevent Blindness’ 

, which breaks up children’s vision issues and needs, state-level regulations, and prevalence of vision impairment and blindness by geographic location. The organization also has a state-specific 

 with brief overviews of early intervention efforts by state based on data from the 2022 National Survey of Children’s Health that is free to download.

“When I was in elementary school, I struggled to see the board, and it made learning incredibly difficult. It wasn’t until I had a vision screening and got the right pair of glasses that everything changed for me,” said Veasey in the release. “I know from personal experience that vision issues can hold a child back, and how something as simple as a pair of glasses can unlock their potential. No child should fall behind simply because they can’t see. With the reintroduction of The Early Detection of Vision Impairments for Children Act, we can all work together to ensure all children, in Texas and across the country, have access to the screenings they need to see clearly and reach their full potential.”

For those interested in the advocacy process, Prevent Blindness and the National Center for Children’s Vision and Eye Health at Prevent Blindness will be hosting a free 

Prevent Blindness applauds reintroduction of Early Detection of Vision Impairments for Children Act. News release. Prevent Blindness. May 6, 2025. Accessed May 6, 2025.

Early Detection of Vision Impairments for Children (EDVI) Act. Prevent Blindness. Accessed May 6, 2025. 

https://advocacy.preventblindness.org/edvi-act-of-2024/

The Early Detection of Vision Impairments for Children Act (EDVI), or HR 2527, would allow the federal government to award grants and cooperative agreements to eligible states and communities for children's vision care initiatives. 

Gillian Barach, BS

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