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Catch up on the top stories in optometry during the week of August 11-August 15.

Takeaways from this week in optometry: August 11 - August 15

Videos

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

Articles

The committee will work to help the organization increase awareness and early identification of diabetes-related eye diseases, improve access to eye care treatment, policy development, research, and surveillance.

Prevent Blindness implements Diabetes + the Eyes Advisory Committee to combat diabetes-related eye diseases

The study explored the use of DMSt, used in OptiLIFT, in enhancing eyelid muscle function, improving blink dynamics, and consequently alleviating dry eye symptoms. 

Study demonstrates Lumenis's DMSt effectivity in addressing lower lid laxity, improving blinking quality

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At the 2025 ASCRS meeting, Mitch Shultz, MD, presented compelling new findings from a 12-week clinical trial investigating the impact of lotilaner 0.25% ophthalmic solution on meibomian gland function.

Extended lotilaner 0.25% therapy shows meibomian gland benefits

Ophthalmology Times® spoke with Mitch Shultz, MD at ASCRS 2023 in San Diego where he shared insights from his presentation comparing patient results of the Hydrus stent and the iStent inject W with or without ABiC (or ab-interno canaloplasty).

ASCRS 2023: Comparing outcomes of 2 diﬀerent trabecular MIGS devices with or without ab interno canaloplasty for patients with glaucoma

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. 

 2015;314:1142–8. https://doi.org/10.1001/jama.2015.10803.

Wu PC, Chen CT, Lin KK, et al. Myopia prevention and outdoor light intensity in a school-based cluster randomized trial. Ophthalmology. 2018;125:1239–50. https://doi.org/10.1016/j.ophtha.2017.12.011.

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. 

2022;11:33. https://doi.org/10.1167/tvst.11.10.33.

New study compares the effects of low-level red light with 0.01% atropine treatment on axial length and choroid in myopic children

My journey into anterior segment care began while leading the specialty contact lens clinic at the Naval Medical Center in San Diego, California. There, I treated complex corneal conditions and postsurgical complications in patients from around the globe. Later, I transitioned into private practice, taking over a specialty clinic from a retiring optometrist who had spent decades treating patients with corneal transplants or keratoconus.

Today, with mounting financial pressures on private practice optometry, many clinicians are searching for sustainable ways to maintain profitability and purpose. Specializing in anterior segment care has allowed me to build a distinctive brand, offer high-value services, and meet a critical need in my community while preserving revenue in an increasingly challenging environment.

Over the years, my clinic has become one of the leading providers of keratoconus care in the country. I’ve learned firsthand that developing a niche offers multiple advantages, such as the following:

Stronger brand identity in a crowded market

Ability to command premium pricing for expert care

Increased referrals from general optometrists and ophthalmologists

Higher patient retention due to trust and specialization

Advancements in imaging have significantly improved the precision of anterior segment disease detection. Technologies such as swept-source optical coherence tomography, corneal topography, and corneal tomography now allow for earlier and more accurate diagnosis of corneal irregularities such as keratoconus. These tools help clinicians map the shape, curvature, and biomechanical properties of the cornea with unprecedented precision, enhancing diagnostic accuracy.

Recently, I incorporated the Anterion multidisciplinary imaging platform by Heidelberg Engineering into my practice. This system captures ultra-high resolution, 3D images of the anterior segment, giving me the power to identify subtle degenerative changes, diagnose complex corneal conditions, and tailor treatment plans to each patient’s individual needs.

Early detection of keratoconus is critical: It opens the door to timely intervention with specialty scleral lenses or proactive treatments that may slow disease progression. Modern scleral lenses incorporate advanced technologies, including wavefront-guided and digitally molded designs. Pairing these innovations with high-quality diagnostics increases clinical efficiency and gives me confidence in the initial diagnosis and long-term monitoring.

Patients also respond positively to this technology. High-resolution imaging builds trust and reinforces the perception of precision and cutting-edge care. For many, it becomes a reason to stay with our clinic.

The ability to diagnose and manage complex cases with confidence has transformed my practice into a destination for advanced eye care. Tools that provide multidisciplinary diagnostics do more than improve clinical outcomes; they also differentiate the practice in a crowded market and create a pathway to sustained profitability.

These cases aren’t easy. Many of these patients have already seen multiple providers and carry a history of frustration and failed solutions. But therein lies the opportunity to make a real impact, change lives, and create loyal patients who become advocates for your expertise.

Anterior segment technology also enhances other areas of care. Orthokeratology, for instance, has become a widely embraced specialty within optometry. Imaging is key in tracking corneal changes and evaluating treatment success. For me, investing in a comprehensive platform that integrates topography, biometry, and epithelial mapping was the right decision not only for my practice, but for my patients. Having that full-picture view of each patient’s cornea has truly transformed my clinical approach.

For optometrists interested in anterior segment specialization, I encourage investing in ongoing education. Attend hands-on workshops, enroll in clinical courses, and seek mentorship opportunities from experienced specialists. Observing in high-level clinics and training with advanced instrumentation can dramatically accelerate your growth and confidence in managing complex cases.

You can also enhance your professional presence by contributing to academic journals, publishing case reports, and participating in relevant conferences. Staying connected to current research and cultivating peer networks opens doors to collaborative learning and innovative patient care. At my practice, we function as a teaching facility because we believe in investing in the future of our profession through education and mentorship.

Optometrists who commit to anterior segment specialization and embrace state-of-the-art imaging technology can redefine their value to patients and referring providers. By creating a high-impact niche, you not only weather the pressures of declining reimbursements and rising costs, but you also position yourself as a leader in advanced vision care.

In a climate of shrinking reimbursements and rising costs, finding your niche isn’t just smart—it’s essential.

Grow your practice through anterior segment specialization

A recent market analysis and forecast evaluating the global and regional landscape of the myopic macular degeneration market over the next decade predicts that the market will experience steady growth driven by advancements in treatment technologies, growing awareness of the condition, and efforts to enhance patient outcomes.

 The report, “Myopic Macular Degeneration Market – A Global and Regional Analysis: Focus on Regional Country Analysis: Focus on Regional and Country Analysis – Analysis and Forecast, 2025-2035,” was released in May 2025 and is now available for purchase through ResearchAndMarkets.com, according to a news release.

The market assessed in the report includes diagnostic tools, therapeutic innovations such as anti-vascular endothelial growth factor (VEGF) therapies, and supportive technologies to manage vision loss.

“The continued focus on early diagnosis, treatment, and managing complications from myopic macular degeneration is crucial in addressing the increasing number of individuals affected by this condition,” the report stated. “Increased awareness, improved health care infrastructure, and enhanced accessibility to treatment options are fueling the growth of this market.”

The report attributed the estimated growth in the market to the rising global incidence of myopia. Research currently indicates that high myopia is the fastest-growing type of myopia and could increase to over 1 billion cases globally by 2050. This then correlates to the rise of myopic macular degeneration cases, according to the report.

However, anti-VEGF therapies hold significant power in impacting the treatment landscape for myopic macular degeneration, thus fueling the market’s growth. As more anti-VEGF treatments are approved and combination therapies are utilized, the report suggests that treatments will become more accessible and improve patient outcomes. The anti-VEGF therapies work by preventing the growth of abnormal blood vessels in the retina, which is one of the key causes of myopic macular degeneration.

Challenges projected to impact the myopic macular degeneration market include the high cost of treatments, particularly for patients in developing countries or underserved regions.

 “The high costs of both medication and surgeries related to myopic macular degeneration treatment can limit patient access, which in turn hampers the growth of the market. Health care systems are often challenged to allocate funds for myopic macular degeneration treatments, given the competitive pressures from other conditions that also demand funding,” the report stated.

Companies including Regeneron Pharmaceuticals, F. Hoffmann-La Roche, and Bayer AG were cited in the report as “leading players in the global myopic macular degeneration market” in their investments into research and development in order to develop solutions that cater to market growth. The report also cites the increasing need for specialized care that can aid in the development of new treatment technologies.

“As the myopic macular degeneration market continues to evolve, emerging trends such as the development of more targeted and personalized therapies, the increasing use of digital health technologies for early detection and monitoring, and the growing focus on prevention and patient education are expected to shape its future landscape,” the report stated. “The rising prevalence of myopic macular degeneration, especially in aging populations and regions with high myopia rates, will fuel demand for more accessible, effective, and affordable treatment options. Additionally, the increasing investment in innovative drug development, development of ophthalmic drug delivery devices, and surgical techniques will present significant growth opportunities for key stakeholders in the coming years.”

Last year, DelveInsight’s report titled “Myopic Macular Degeneration Market Insights, Epidemiology, and Market Forecast – 2034” also studied the myopic macular degeneration landscape across the US, Germany, France, Italy, Spain, the UK, and Japan. The analysis anticipated the market growing from about 734 million USD in 2022 to almost 837 million USD by 2034, mostly fueled by anti-VEGF therapies and standard of care. The company found that Japan currently accounts for the highest prevalence of diagnosed myopic macular degeneration cases, with 49% of total cases in the 7 MM in 2022. The US contributes about 27% of diagnosed cases.

The report cited YESAFILI, OPUVIZ, AHZANTIVE, ENZEEVU, and PAVBLU as key biosimilar players that have the potential to contribute to improved affordability and accessibility of anti-VEGF therapy. Particularly, ENCELTO’s approval by the FDA in March 2025 also “opens the door for potential future gene therapies targeting macular degeneration in myopic patients,” according to the report.

“Looking ahead, the myopic macular degeneration market faces both challenges and opportunities. While the current pipeline remains limited, increased awareness and extensive research indicate a gradual market expansion. The projected introduction of VABYSMO for mCNV treatment is anticipated to propel the overall market growth, promising a future characterized by more effective management protocols for this vision-threatening condition,” the report stated.

Myopic Macular Degeneration Market Analysis and Forecast Report 2025-2035 with Regenron Pharmaceuticals, F. Hoffman-La Roche, and Bayer Leading Innovations – ResearchAndMarkets.com. News release. Businesswire. July 21, 2025. Accessed July 28, 2025. 

https://www.businesswire.com/news/home/20250721433467/en/Myopic-Macular-Degeneration-Market-Analysis-and-Forecast-Report-2025-2035-with-Regeneron-Pharmaceuticals-F.-Hoffmann-La-Roche-and-Bayer-Leading-Innovations---ResearchAndMarkets.com

Myopic macular degeneration market to reach USD 837 million by 2034, driven by high myopia prevalence and anti-VEGF therapies | DelveInsight. News release. ABNewswire. July 24, 2025. Accessed July 28, 2025. 

https://www.openpr.com/news/4119286/myopic-macular-degeneration-market-to-reach-usd-837-million

Diagnostic tools, therapeutic innovations such as anti-vascular endothelial growth factor (VEGF) therapies, and supportive technologies to manage vision loss form the myopic macular degeneration market.

Myopic macular degeneration market analysis estimates significant growth in the next decade 

A recent exploratory analysis has identified key predictive factors of improved best-corrected visual acuity (BCVA). The study found these factors a year and a half after patients with Leber hereditary optic neuropathy (LHON) (caused by mt-ND4) received GenSight Biologics’ investigational gene therapy lenadogene nolparvovec (Lumevoq), which was administered at least 6 months after disease onset.

Better BCVA values and baseline thicker ganglion cell layer (GCL) and retinal nerve fiber layer (RNFL) at optical coherence tomography (OCT) measurements were found to be the key factors. The analysis was published in 

Investigational Ophthalmology and Visual Science.

“By linking structure and function, [this exploratory study] improves our understanding of the factors influencing vision recovery after lenadogene nolparvovec administration in patients with MT

ND4 LHON, showing that better baseline BCVA values and thicker baseline OCT retinal layers in the dynamic phase of the disease, particularly the outer segments of macular GCL, are the key predictive factors associated with better BCVA 1.5 years after treatment in patients who received gene therapy at least 6 months after disease onset,” stated study authors, led by Robert C. Sergott, MD, from the Departments of Ophthalmology and Neurology at Wills Eye Hospital and Thomas Jefferson University, as well as the head of the Central Reading Center at William H. Annesley, Jr, EyeBrain Center.

 “This relationship between preservation of retinal structures and response to treatment strongly supports an effect of lenadogene nolparvovec on [retinal ganglion cell, or] RGC survival and function. These findings should facilitate optimization of patient selection for future clinical trials.”

Better best-corrected visual acuity values and baseline thicker ganglion cell layer and retinal nerve fiber layer at ocular coherence tomography measurements were found to be the key predictive factors.

Mitch Shultz, MD

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