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The study included the screening of 9857 drivers in 8 Indian states at automative shops and transit hubs.

New study reveals majority of commercial drivers in India have never had vision tested

Specifically, the study found that the muscle that controls eyelid movement, or the orbicularis oculi, “contracts in complex patterns that vary by action and move the eyelid in more than just a simple up-and-down motion."

New research uncovers pathway for blink-assisting prostheses development

The campaign provides Generation Z insights, comprehensive practice resources, and PRECISION contact lens portfolio rebates.

Alcon launches back-to-school campaign to introduce more students to contact lenses

A few tweaks to outdoor exercise routines can bring great relief.

Managing ocular discomfort from allergies in patients with active lifestyles

Optometry Times delivers clinical news, practice insights, and research updates by optometrists for optometrists to advance care and patient outcomes.

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Howard Purcell, OD, FAAO, sat down with Optometry Times®' assistant managing editor Emily Kaiser to talk about her role on the founding board of Latinos en Optometry (LEO).

Meet the LEO founding board: Dr Howard Purcell

ODs don't seem to care as much about the science behind spectacle lenses as that of medications and contact lenses. But they should, says Essilor's Howard Purcell, OD, FAAO, and here's why.

Knowing the science behind spectacle lenses

A recent longitudinal prospective study revealed that electroretinography (ERG)/pupillometry outperforms structural imaging in identifying patients at the highest risk of progressing to vision-threatening complications over 1 year. The study was published in 

and provided a post hoc analysis of 56 parameters from 4 testing modalities obtained in a multicenter US trial (NCT03197870), according to a news release.

 Eighteen of these parameters were from the RETeval device’s diabetic retinopathy (DR) Assessment protocol, graded by manufacturer LKC Technologies, which was found to be the strongest predictor of DR progression.

“The DR score, based on a combination of ERG and pupillometry, offered the best predictive capability.… These results suggest it is possible to improve the DR staging system, which in turn may enable better allocation of health care resources,” the study authors, led by C. Quentin Davis, PhD, of LKC Technologies, stated.

“This publication is a significant advancement in the quest to identify high-risk patients earlier and improve clinical outcomes,” said Dina Dubey, CEO of LKC Technologies, in the release. “The prospective study included patients with moderate to severe non-proliferative diabetic retinopathy (NPDR) and no center-involved DME at baseline and it revealed that a single number – known as the DR Score – is the most powerful predictor of progression from NPDR to vision-threatening complications, including proliferative diabetic retinopathy, diabetic macular edema, or treatment.”

The trial used in the post hoc analysis for data collection was the prospective, double-masked, randomized, placebo-controlled TIME-2b study that evaluated the safety and efficacy of 48 weeks of subcutaneous AKB-9778 (a Tie2 activator) in patients with moderate to severe NPDR. Every 12 weeks, patients underwent a comprehensive ocular assessment including a dilated slit lamp biomicroscopy, intraocular pressure, dilated indirect ophthalmoscopy, spectral-domain OCT, and 7-field FP. FA was conducted at weeks 0, 24, and 48. ERG/pupillometry, OCTA, and UWF-FA were performed using commercially available equipment at a subset of the 44 sites included in the study based on availability.

The DR Score of 26.9 demonstrated a relative risk of 5.6 for progression to vision-threatening conditions (

<.0001), surpassing other predictors including ultra-widefield fluorescein angiography (UWF-FA), optical coherence tomography angiography (OCTA), and fundus photography (FP). Comparatively, the UWF-FA total ischemia index ≥ 0.125 had a relative risk of 5.3 (

<.0001), the OCTA foveal avascular zone area ≥ 0.295 mm

<.05), and the fundus photograph-based diabetic retinopathy severity scale ≥ 27 had a relative risk of 2.1 (

<.05), each still proving statistical significance.

“There is mounting evidence that DR's effects on retinal neurons occur earlier and can progress somewhat independently of changes in retinal vasculature,” the study authors stated. “Thus, it is likely that combining measures of neuronal function with structural vascular information should enhance prediction of DR progression.

“This research suggests that the ERG provides value in defining how DR is staged and monitored, supporting mounting evidence that functional changes in the retina can precede observable vascular abnormalities,” said Mitchell Brigell, PhD, one of the study authors, in the release. “The findings clearly show the value of integrating objective functional testing into the management of diabetic retinopathy. This is also reflected in the inclusion of ERG in the American Academy of Ophthalmology’s Preferred Practice Pattern Guidelines for Diabetic Retinopathy.”

Limitations of the study include its unequal number of subjects across modalities, with fewer eyes tested with OCTA, UWF-FA, and ERG/pupillometry than FP due to equipment availability, in addition to the binary classification of high or low risk, according to study authors.

 “Thus, performance differences may reflect sampling variation, although the reported uncertainties account for differences in sample size,” the authors stated.

Study identifies RETeval DR Score as the strongest predictor of diabetic retinopathy progression. LKC Technologies. August 4, 2025. Accessed August 12, 2025.

Davis CQ, Waheed NK, Brigell M. Predicting progression to vision-threatening complications in diabetic retinopathy. 

2025;5(6). doi:10.1016/j.xops.2025.100859

Data used in the post hoc analysis were from 56 parameters from 4 testing modalities obtained in a multicenter US trial (NCT03197870).

Study finds electroretinography/pupillometry as strongest predictor of DR progression, vision-threatening complications

 published by Harvard researchers focused on enrollment by veterans who receive benefits from the Department of Veterans Affairs (VA) in Medicare Advantage insurance. While about 10% of veterans enrolled in Medicare Advantage have no Medicare services paid for annually by Medicare Advantage,

 Medicare Advantage receives about $12,000 in capitated payments per enrollee annually,

 raising concerns about duplicative federal spending, according to first author Adam L. Beckman, MD, MBA, and colleagues. He is from Brigham and Women’s Hospital, Department of Medicine, Division of General Internal Medicine, Harvard Medical School, Boston.

Beckman was joined in this research by investigators from the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, and the Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, both in Boston.

The investigators contend that the use of and spending for these services among veterans enrolled in Medicare Advantage compared with traditional Medicare are poorly understood.

In light of that, they conducted a cross-sectional study with the goal of identifying veterans with VA coverage enrolled in Medicare using the 2018-2021 Medical Expenditure Panel Survey.

The researchers compared the risk-adjusted visits and spending on dental and vision services, and adjusted for age, sex, self-reported race and ethnicity from fixed categories, and chronic conditions that included heart disease, stroke, emphysema, cancer, diabetes, and asthma.

A total of 468 veterans were enrolled in Medicare Advantage (675 person-years) and 651 veterans enrolled in traditional Medicare (1097 person-years) between 2018 and 2021, representing 1,551,863 and 2,359,268 veteran-years, respectively, after survey weighting. The 2 groups did not differ from each other in age, sex, or race.

The investigators found that both the total number of risk-adjusted dental visits and the total risk-adjusted yearly spending did not differ between veterans enrolled in Medicare Advantage compared with traditional Medicare. However, they did report that although Medicare spending on dental services for Medicare Advantage veterans was $81.8 and $0.1 for traditional Medicare veterans, the veterans in traditional Medicare incurred higher spending through other private insurance. The total annual spending on dental services was similar between the 2 Medicare programs.

Similarly, both the total number of risk-adjusted vision visits and the total risk-adjusted yearly spending did not differ between the 2 programs. The authors found that Medicare spending on vision aids was slightly higher for veterans enrolled in Medicare Advantage compared with the traditional program.

“Although the Medicare Advantage plans offer and directly market supplemental benefits for dental and vision services,

 the veterans enrolled in Medicare Advantage used these services with the same frequency as veterans enrolled in traditional Medicare. Moreover, Medicare Advantage plans spent only modestly more on dental services and vision services for veterans than traditional Medicare, including for emergency dental services. After accounting for private insurance plans used by traditional Medicare enrollees and out-of-pocket spending, the total spending on dental services was no different for veterans in Medicare Advantage vs traditional Medicare. These data are consistent with recent research examining the broader Medicare Advantage and traditional Medicare populations,

The investigators pointed out that these findings suggested that paying Medicare Advantage plans current annual capitated payment rates to cover veterans whose medical care is primarily paid for by the VA may not be fully justified by supplemental vision and dental care benefits.

“To address this potentially duplicative spending,” they advised, “federal policymakers could reform Medicare Advantage and VA reimbursement to better align with the care veterans receive.”

Beckman AL, Dai D, Elani HW, Cai CL, Orav EJ, Figueroa JF. Dental and vision services among veterans in Medicare Advantage vs traditional Medicare. 

 2025;334:538–540. doi:10.1001/jama.2025.7753

Ma Y, Phelan J, Jeong KY, et al. Medicare Advantage plans with high numbers of veterans: enrollment, utilization, and potential wasteful spending. 

Ramsay C, Jacobson G, Findlay S, Cicciello A. Medicare Advantage: a policy primer, 2024 update. The Commonwealth Fund. January 31, 2024. Accessed February 24, 2025. 

https://www.commonwealthfund.org/publications/explainer/2024/jan/medicare-advantage-policy-primer

Maremont M, Weaver C, McGinty T. Insurers collected billions from Medicare for Veterans who cost them almost nothing. 

. December 2, 2024. Accessed February 24, 2025. 

https://www.wsj.com/health/healthcare/veterans-medicare-insurers-collect-billions-bfd47d27

Dorneo A, Ma Y, Garrido MM, et al. Characteristics and benefit design of veteran Medicare Advantage Affinity plans. 

Simon L, Cai C. Dental use and spending in Medicare Advantage and traditional Medicare, 2010-2021. 

Dental and vision services for veterans in Medicare Advantage under the microscope

Allen, OD, FAAO, Dipl ABO, plans to talk all things ocular surface for optometrists and ophthalmologists alike.

EyeCon 2025: Dr Joseph Allen on bringing a fresh, relevant perspective to his first EyeCon meeting

With EyeCon 2025 right around the corner, Joseph Allen, OD, FAAO, Dipl ABO, founder of Doctor Eye Health, discussed his upcoming participation in the conference at the Margaritaville Hollywood Beach Resort in Hollywood, Florida. The conference runs from September 26 to 27. As a first-time attendee and faculty member on the educational committee, Allen expressed enthusiasm about EyeCon's strong reputation and the opportunity to contribute to relevant, practical education that attendees can apply directly to patient care. Allen will be presenting 2 key sessions. The first, "Orbiting the Globe: A Comprehensive Tour for the Comprehensive Optometrist/Ophthalmologist," will cover hot topics in optometry, including anterior segment care, dry eye management, new medications affecting the ocular surface, and emerging red light/photobiomodulation technologies. He's particularly excited about new presbyopia medications that differ from previous options and cutting-edge contact lens technologies. 

His second presentation focuses on the ocular surface and cornea, emphasizing that every eye care practitioner must understand tear film and corneal health. Allen highlights recent advances in dry eye pathophysiology understanding through the DEWS III report, new treatment options, and the importance of better patient communication. He notes that patients often don't connect visual difficulties, like the inability to read for extended periods, to dry eye rather than prescription issues. 

What distinguishes EyeCon from other conferences, according to Allen, is its full integration of optometry and ophthalmology, reflecting the strong collaboration between these professions. This integration provides diverse perspectives and deep educational content from both specialties. For residents, Allen emphasizes the value of hands-on workshops covering advanced skills like scleral lens fitting, punctal plugs, and amniotic membrane procedures - techniques he learned post residency that transformed his practice. The conference offers residents access to leading specialists and practical training opportunities often unavailable during residency programs.

Conference

Dry eye is an everyday occurrence in optometry practices. The problem is that dry eye occurs at such a high prevalence that it almost becomes routine for doctors to the point that it is overlooked. Worse yet, because so many of our patients have complaints of dry eye, there is a tendency for doctors to trivialize the symptoms and undertreat these patients. The fact is that dry eye or symptoms of dry eye are ubiquitous in an optometric practice. And to the patients presenting with these conditions, the symptoms are not merely a nuisance but are very bothersome. They likely present to our practices because of these very symptoms, and if we do not address their condition, they most assuredly will find another eye doctor who will.

The American Optometric Association has stated that 1 in 4 optometric patients report symptoms of dry eye. The American Academy of Ophthalmology has published that, other than blurry vision, symptoms of dry eye were the most common reason people sought eye care in 2022.

Additionally, more than 150,000 dry eye procedures were performed that same year. The fact that more than $1 billion has been spent on 1 dry eye drug

(Restasis; AbbVie) screams of the demand that dry eye creates. Due to our aging population and increased use of digital devices, the incidence is expected to continue to grow.

Not only is dry eye continuing to affect more people, but the severity of the disease seems to be worsening. On average, patients experienced dry eyes for 6.5 years, with 26% saying they have been affected for more than 10 years. Overall, the majority (76%) of patients report that their dry eye worsened over time (Data on file, Allergan), and 82.9% of those patients reported that their symptoms affected their ability to perform normal daily activities a great deal of the time or very often. Patients with moderate dry eye, as defined by mild corneal staining, report that their symptoms affect their quality of life to nearly the same level as patients who experience moderate angina.

 For our patients who experience dry eye, it is not just dry eye

Rather than seeing patients with dry eye as nuisances, we should view them as an opportunity to grow our practice and help a great deal of people. But how do we go about this (

The best way to identify patients with dry eye is within the context of a comprehensive examination, specifically, the pre-exam workup as performed by our technicians. Techs should be trained to ask specific questions about dry eye and listen for certain buzzwords that indicate symptoms of dry eye disease (

If a patient utters any of these buzzwords or has specific complaints around dry eye, our technicians should be trained to perform some type of dry eye questionnaire, such as the SPEED or OSDI test. Additionally, create a standing order in your practice whereas if a patient raises certain complaints consistent with dry eye, then a technician should be enabled to administer both a hyperosmolarity and MMP-9 test on said patient. As an aside, both of these tests can and should be billed to the patient’s medical insurance using the proper CPT and ICD-10 codes.

Armed with these subjective and objective data, the doctor’s level of suspicion for dry eye should be raised. After completing the examination, the likelihood of dry eye will be confirmed (or rejected based on the exam results).

Earlier in this article, I stated that a comprehensive examination is the perfect vehicle to identify candidates for dry eye therapy. However, I do not believe that all patients with dry eye should be treated at that visit. In my opinion, the comprehensive exam should open the gate for a discussion about the patient’s symptoms and the differential diagnosis possibilities. The perfect scenario would be to reschedule the patient for a dedicated dry eye exam during which the doctor will not only be able to confirm a diagnosis, but, more importantly, posit an etiology for the condition.

A “dedicated” dry eye exam consists of a few elements. A thorough history must again be undertaken, asking very specific and probing questions centered around the dry eye symptoms. MMP-9 and osmolarity testing should be repeated by the techs as well. The doctor should perform a detailed slit lamp examination, looking for signs that will clarify the diagnosis. Lissamine green and sodium fluorescein dye strips should be applied to help gauge the severity of the condition. Tear break-up time (TBUT) also needs to be assessed, and the lids and lashes must be examined. At the completion of this exam, the doctor should have a much clearer idea of the most accurate diagnosis, a working hypothesis as to the etiology, and a specific treatment plan designed for this particular patient’s condition. Lastly, a detailed discussion should take place with your patient.

Although I do not recommend starting therapy at the initial comprehensive exam, there are a few exceptions to that “rule.” The first is if they have extreme discomfort and corneal involvement. I will prescribe a steroid at least QID for at least 2 weeks and schedule the dry eye exam 2 weeks later. Secondly, if I believe that the patient will need chronic therapy, I will provide a sample of preservative-free artificial tears (or recommend a specific type in the absence of samples) and schedule for the dry eye workup for 2 weeks. I do this because many of the chronic therapies require the use and failure of artificial tears before they will be approved. By using the artificial tears for 2 weeks, you have already satisfied that requirement.

Secondly, I recommend discontinuing contact lens wear if possible before the dry eye examination as a diagnostic tool. If the patient’s symptoms improve in the absence of the contact lenses, then you know that the contacts are exacerbating the issue and will allow you to treat the patient more aggressively.

Dry eye disease and its many variants offer tremendous opportunities for your practice. Proper planning and a proper workup should greatly improve your diagnostic acumen and make for a more targeted and specific treatment. These tips should transform these patients with dry eye from being a pain in your side to a key portion of your practice.

Hakim FE, Farooq AV. Dry eye disease: an update in 2022. 

. 2022;327(5):478-479. doi:10.1001/jama.2021.19963

Kandel H, Stapleton F AO, Downie LE, et al. The impact of dry eye disease on patient-reported quality of life: A Save Sight Dry Eye Registry study. 

. 2025;37:11-23. doi:10.1016/j.jtos.2025.02.005

Due to ubiquity, optometrists tend to undertreat patients with dry eye.

Embracing dry eye

An investigative team led by first author Xuena Pang, MD, reported their experience with the use of red light in children with myopia. They reported that 6 months of treatment showed that repeated low-level red light (RLRL) application was more effective than 0.01% atropine for controlling axial elongation and myopic progression in myopic children.

Pang and colleagues, from the Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China, reported their findings in 

“Myopia is more than just a common refractive error; it constitutes a vision-threatening condition. Myopia usually develops rapidly during childhood and, if left unmanaged, may further evolve into other serious eye conditions.

 It is vital to find an efficacious treatment for myopia to control its development, given that the condition is associated with an upward trend in prevalence, younger age, and severity,

Low-dose atropine effectively stops progression of myopia

 as does increased exposure to natural light.

Only one randomized controlled trial of atropine vs RLRL has been performed,

 showing that RLRL was superior to 0.01% atropine for myopia control. However, that study did not measure the choroidal parameters. The current study evaluated the impact of RLRL on managing children with myopia by examining the effectiveness disparity between RLRL and 0.01% atropine over 6 months and explored the potential mechanism of RLRL and 0.01% atropine in delaying myopia progression in choroidal thickness and choroidal blood flow, Pang and colleagues explained.

Prospective, randomized, and single-blind controlled trial

This investigation included 91 children aged 6 to 12 years. The inclusion criteria were a spherical equivalent refraction (SER) of -5.0 diopters (D) and −0.75 D or lower after cycloplegia bilaterally, astigmatism lower than 2.00 D, best-corrected visual acuity of 20/20 or better in monocular vision, and intraocular pressure of 21 mmHg or lower, the authors recounted.

The children were randomized to treatment for 6 months with either RLRL or atropine 0.01%. The primary outcomes included changes in the axial length (AL), SER, and choroidal parameters that included the foveal, parafoveal, and perifoveal choroidal thickness and the foveal, parafoveal, and perifoveal choroidal vessel volume.

The primary outcomes were the changes in the AL, SER, and choroidal parameters after 6 months.

The children treated with atropine received 1 drop of the drug at night before bedtime. Those treated with RLRL received a device, Eyerising (Suzhou Xuanjia Photoelectric Technology), that uses a semiconductor laser diode to emit red light with a 650 ± 10 nm wavelength, illuminating from the pupil to the fundus at an illuminance level of 1600 lx, including a light spot diameter of 10 ± 3 mm at the exit peephole and mean energy of the light source is 2.0 ± 0.5 mW. The children received the light treatment twice daily for 3 minutes each time with a minimum of 4 hours between treatments. The parents/guardians administered the light treatment.

Pang and colleagues reported that at the 6-month evaluation, the respective changes in the children randomized to RLRL and atropine 0.01% in the AL were − 0.09 mm (− 0.18, 0.01) compared to 0.13 mm (0.05, 0.24) (

 < 0.001) and in the SER 0.25 D (0, 0.50) compared to − 0.25 D (− 0.53, 0) (

In the children treated with RLRL and atropine 0.01%, the respective changes in the foveal, parafoveal and perifoveal choroidal thicknesses were 36.38 µm (14.05, 65.39), 31.04 µm (4.09, 59.35), and 28.48 µm (5.35, 55.15), compared to 0.94 µm (− 9.20, 9.36), 3.52 µm (− 10.24, 14.45), and 6.14 µm (− 5.21, 15.69) (

In addition, the respective foveal, parafoveal, and perifoveal choroidal vessel volume changes with the two treatments were 0.01 μm

The investigators suggested that the RLRL therapy enhances the choroidal blood flow, which improves the oxygen supply and nutrient availability to the scleral hypoxia and delays axial growth. They advised that studies are required to comprehend the exact mechanisms of RLRL therapy.

The authors concluded, “Among children with myopia aged 6 to 12 years in the central plains of China, RLRL was found to be more effective than 0.01% atropine in preventing the axial elongation and myopia progression. Furthermore, RLRL does not result in any functional or structural damage to the eyes. The foveal, parafoveal, and perifoveal choroidal thicknesses and foveal, parafoveal, and perifoveal choroidal vessel volume increases in the RLRL group were significantly higher than those in the 0.01% atropine group.”

Pang X, Fu A, Zheng G, et al. The effect of repeated low-level red light versus 0.01% atropine treatment on axial length and choroidal parameters in children with myopia. 

https://doi.org/10.1007/s40123-025-01169-0

Pan CW, Ramamurthy D, Saw SM. Worldwide prevalence and risk factors for myopia. 

. 2012;32:3–16. https://doi.org/10. 1111/j.1475-1313.2011.00884.x.

Wu PC, Huang HM, Yu HJ, Fang PC, Chen CT. Epidemiology of myopia. 

 2016;5:386–93. https://doi.org/10.1097/APO.0000000000000236.1752

Holden BA, Fricke TR, Wilson DA, et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. 

. 2016;123:1036–42. https://doi.org/10.1016/j.ophtha.2016.01.006.

Morgan IG, Ohno-Matsui K, Saw SM. Myopia. 

 2012;379(9827):1739–48. https://doi.org/10.1016/S0140- 6736(12)60272-4.

Haarman AEG, Enthoven CA, Tideman JWL, Tedja MS, Verhoeven VJM, Klaver CCW. The complications of myopia: a review and meta-analysis. 

 2020;61:49. https://doi.org/10.1167/iovs.61.4.49.

Wu J, Lu AD, Zhang LP, Zuo YX, Jia YP. Study of clinical outcome and prognosis in pediatric core binding factor-acute myeloid leukemia. 

 2019;40:52–7. https://doi.org/10.3760/cma.j.issn.0253-2727.2019.01.010.

Huang J, Wen D, Wang Q, et al. Efficacy comparison of 16 interventions for myopia control in children: a network meta-analysis. 

 2016;123:697–708. https://doi. org/10.1016/j.ophtha.2015.11.010.

Rose KA, Morgan IG, Ip J, et al. Outdoor activity reduces the prevalence of myopia in children. 

 2008;115:1279–85. https://doi.org/10.1016/j.ophtha.2007.12.019.

French AN, Ashby RS, Morgan IG, Rose KA. Time outdoors and the prevention of myopia. 

 2013;114:58–68. https://doi.org/10.1016/j.exer.2013.04.018.

He M, Xiang F, Zeng Y, et al. Effect of time spent outdoors at school on the development of myopia among children in China: a randomized clinical trial. 

Howard Purcell, OD, FAAO

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