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Catch up on the top stories in optometry during the week of June 16-June 20.

Takeaways from this week in optometry: June 16 - June 20

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EssilorLuxottica and Meta team up to launch Oakley Meta, a line of performance AI glasses

A recent $1 million gift will aid in broadening access to emotional support services, including social workers, peer connections, and multimedia content include videos and podcasts.

Hadley’s Donahoe Center for Support expanding emotional and social resources for patients with vision loss

The Ontario Health Coalition has gathered evidence such as proof of payment and patient reports from 50 patients for the formal complaint.

Canadian patient advocates file formal complaints, citing illegal fees charged at private clinics

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Dr. Miller: What I wish I knew before entering optometry

Know the legal aspects of myopia control 

Professional courtesy, waiving all or part of professional fees, now has become a field day for lawyers and third-party carriers-and an unwary trap for the well-intentioned doctor.

Pros and cons of offering professional courtesy

There is no question that our profession is undergoing rapid change as well as significant challenges. As a profession, we are faced with the dual responsibility of protecting our patient and maintaining our proficiency. Both of these also fall under the legal jurisdiction of the State Board of Optometry in the states in which we are licensed. Some state boards have already acted, but most have not. One that has not is California.

The underlying concern of online refractions

One of the first lessons doctors learn once they actually get into practice is that we are all in business. The business aspect of optometric practice is comprised of multiple layers and elements that are challenging at best.

Top 5 ways you break the law in your practice

There is always a balance when it comes to acquiring new technology for an optometric office. Practitioners have to consider the clinical value of new technology, its cost and reimbursement level (if any), as well as space and time constraints in the office. Although that is already a lot to weigh, I would suggest that most clinicians do not pay enough attention to their medicolegal risks in making these decisions. There is a misconception that newer technology might introduce medicolegal risk and that doing what you have always done is the safe path. In fact, the opposite may be true.

As physicians, we have a duty to provide our patients with high-quality care. There is a strong legal precedent for this concept in eye care. In a 1974 court case, 

, the Washington State Supreme Court ruled in favor of a woman who developed severe vision loss due to glaucoma. At that time, IOP was not typically measured in patients younger than 40 years.

 Over the course of a decade, her physicians had never checked her IOP, instead attributing her visual complaints to complications of rigid contact lens wear. The court recognized that even if a given practice (eg, IOP measurement in younger patients) is not universally followed, a duty of care can still exist if the failure to perform a simple test leads to serious harm.

This case is the reason we now test IOP in patients of all ages, but its broader implications are sometimes ignored. For example, we have technology (corneal topography) that can detect changes in the cornea indicative of keratoconus, a sight-threatening disease. As corneal topography has become more affordable and accessible, with built-in algorithms that make it easier to interpret, the argument for integrating it into routine eye examinations has become stronger. In my practice, I use the multifunctional Topcon KR-1W, which combines aberrometry, topography, keratometry, pupillometry, and autorefraction in a single unit. All the data are captured during the pretest process for every patient, but the topography is only uploaded for me to review and interpret when there is some clue to keratoconus, such as high cylinder or a significant power differential between the 2 eyes. If I cannot refract the patient’s vision to 20/20 or if I find something else of concern during my examination, I can acquire the corneal topography report with just a few clicks. This capability helps me to uncover diseases earlier than I would otherwise (

For example, I can detect keratoconus earlier and monitor for progression, including seeing young patients with suspicious findings in a few months instead of a full year to repeat the topography. Once there is any sign of progression, I can refer the patient for corneal cross-linking (iLink; Glaukos) to halt the progression and stabilize the cornea before vision is permanently lost. I find that having a single, integrated device makes me more efficient, and it ensures we are screening all patients effectively. Some practices rely on a standalone topographer and order testing when indicated, but using the topographer more broadly might help to uncover more issues. At minimum, optometrists need to refer for topography when there are red flags. Ignoring those red flags because the technology to investigate further is not available in the office is not acceptable.

Similarly, we have a duty to carefully evaluate any patient with cataracts to determine whether they also have ocular hypertension or any signs of glaucomatous damage. If so, they should be offered minimally invasive glaucoma surgery at the time of cataract surgery because it is a one-time opportunity to address IOP with a combination procedure.

Retinal optical coherence tomography (OCT) and a dark adaptometer are other indispensable tools in my practice for earlier diagnosis of retinal disease. Retinal OCT devices such as Optomap (Optos) or Spectralis OCT (Heidelberg Engineering) are now valued by most optometry clinics for their ability to facilitate a quick assessment of the optic nerve, macula, retinal vasculature, and more. Dark adaptation testing, performed with a wearable device such as Prime (Heru) or AdaptDx Pro (LumiThera) (

), is an easy test that measures impaired rod function, an early sign of age-related macular degeneration (AMD). By detecting AMD before there are clinical signs, we can put patients on the right path to preventing progression of AMD.

In my view, optometrists can and should embrace advancements in technology such as these that allow us to detect, diagnose, and intervene early, when the impact of intervention is the greatest. That does not mean it is malpractice not to have these specific technologies. No court would expect every physician to obtain every possible diagnostic device. However, I believe we all need to think about ways to integrate newer technologies into our clinical protocols so that we are providing the highest level of care for our patients.

 was that the physicians in this case had failed to explore the reasons for their relatively young patient’s vision problems. Any time a patient has reduced vision, we need to determine whether the cornea, lens, optic nerve, or retina is the source of the problem. If you cannot solve the puzzle yourself or do not want to invest in the resources to do so, a referral should be made to someone else who has more advanced diagnostic technology. Skipping this diagnostic step may negatively affect patient treatment outcomes as well as result in practice litigation.

A busy schedule is not a reasonable excuse. “I didn’t have time” is not going to be a very satisfactory answer to a patient who has suffered vision loss—let alone at a deposition for a malpractice case. If you do not have time to effectively screen for a wide array of ocular conditions and diseases, consider how to restructure your schedule or use technology or staffing changes to help you become more effective in the same amount of time. For instance, including topography in all eye examinations may only add 30 seconds to a pretest. For most offices, this may be more efficient than having to schedule separate topography when there is some concern during the examination.

For me, the answer to the perennial time crunch is to have staff collecting all the testing data for me. I have established clear guidance for abnormal values that should be flagged or should generate additional testing. I use advanced imaging not only for diagnosis but also for effective communication with patients and the other physicians to whom I refer. I have invested time in drafting referral templates so that my busy schedule does not become an unnecessary barrier to needed care.

We all want to avoid the emotional and financial costs of a medical malpractice case. Embracing technology and practicing to the highest level of care is a great way to protect yourself while providing optimal patient care.

, 83 Wn2d 514, 519 P2d 981 (Wash 1974). Accessed April 18, 2025. https://law.justia.com/cases/washington/supreme-court/1974/42775-1.html

Embracing new technology is good for patients and provides protection against malpractice claims.

Making the most of advanced technology

The Tear Film and Ocular Surface Society (TFOS) DEWS III Digest Report, published in June 2025 in

has identified key research published since the 2017 TFOS DEWS II Workshop reports in the form of sex, gender, and hormones; epidemiology; pathophysiology; tear film; pain and sensation; iatrogenic; and clinical trial design.

 The report was compiled in an effort to support evidence cited in the TFOS DEWS III Diagnostic Methodology and Management and Therapy reports, and included input from 80 experts in 18 countries, according to TFOS.

Study authors, led by Fiona Stapleton, PhD, MSc, of the School of Optometry and Vision Science, UNSW Sydney in NSW, Australia, outlined advancements in tear film research, a clarification of pathophysiological distinctions between aqueous deficient dry eye (ADDE) and evaporative dry eye (EDE), and ocular pain perception, among others.

For sex, gender, and hormones, study authors focused on studies published after July 1, 2017, and cited significant sex-related differences in the lacrimal gland, meibomian gland, cornea, eye lid blinking, corneal thickness, sensitivity, re-epithelization, pain assessment, hormonal regulation of the ocular surface and adnexa, and dry eye disease (DED)-induced damage, among others.

“There have been significant research advances linking sex, hormones, and gender to DED. Aging, cancer, and hormone therapy increasingly broaden the interdisciplinarity in this field over time,” the report authors stated. “Despite the significant impact of gender-affirming hormone therapy on the entire endocrine system and its effects on physical and mental health, there is limited information on its impact on ocular health. Variations in age, health profile, gender-affirming hormone therapy [adherence], and barriers to accessing regular health care limit the documentation of [adverse] effects. Clinicians and future research should consider these variations, as recommended in a recent systematic review on the medical aspects of the transgender and gender diverse population.”

For epidemiology, DED was found to increase with age and was more common in women than men; signs and symptoms were more common in women with higher rates in younger and older adults. Some of the outstanding questions that remain from the research are issues concerning disease severity, geographic considerations, the generalizability of prevalence measures for DED in children and adults under 40 years of age, and a need for appropriately powered studies to determine risk factors in patients under 40. Researchers noted that a limited number of studies exist that explore the prevalence, risk factors, or natural history by disease severity.

Opportunities for future research concerning tear film were identified in the needed exploration of the relationship between disordered lipids that result in spreading and increased elasticity as compared to ordered lipids that lead to improved resistance to evaporation. Researchers also called for a more detailed understanding of whether tear biomarkers can be used to differentiate subtypes of DED and referenced the society’s recent Diagnostic Methodology report.

“Analyses of microbiome changes across individuals of different ethnicities and countries of residence may provide further insights into its potential role in DED pathogenesis or as a marker for the disease,” the study authors noted. “Understanding the potential role of different microRNAs in DED pathogenesis, DED subtype or as biomarkers could be a highly promising area for future investigation.”

Recommendations for DED management were also suggested by the study authors under iatrogenic, particularly regarding DED implicated in a variety of antiglaucoma topical drugs, preservatives and excipients, antibiotics, and hormone replacement therapy, among others.

“The first step is to investigate which medication is causing DED and try to stop its use. This subtraction can be challenging when discontinuing the treatment, which presents a risk to the eye's health,” the study authors noted. “Sometimes, multiple drugs and components are involved, or adverse effects appear long after treatment initiation, making identification of which is causing DED even more difficult.”

Stapleton F, Argüeso P, Asbell P, et al. TFOS DEWS III Digest Report. 

https://doi.org/10.1016/j.ajo.2025.05.040

TFOS dry eye workshop (DEWS) III: completed! Tear Film and Ocular Surface Society. News release. June 10, 2025. Accessed June 18, 2025. 

https://www.tearfilm.org/dettnews-tfos_dry_eye_workshop_dews_iii_completed/7450_16/eng/

The report categorizes research into 7 categories: sex, gender, and hormones; epidemiology; pathophysiology; tear film; pain and sensation; iatrogenic; and clinical trial design.

New TFOS DEWS III Digest Report highlights relevant research on management, treatment of DED

Nonprofit organization EyeCare4Kids has named Maggie Cline, MPH, its new CEO. Having been promoted to the position earlier this month, Cline initially joined the organization in 2022 and served as Executive Director Utah, where she oversaw the delivery of more than 50,000 vision services annually at school clinics, community centers, and other underserved areas in the state, according to a news release.

Cline succeeds Joseph Carbone, who founded the organization in 2001 and will transition to a role focused on international development.

“The mission of EyeCare4Kids is both professional and personal for me because I used to be one of those kids whose family faced challenges and anxiety navigating the complicated US health and education systems. That’s why I understand how important it is when 1 person or 1 organization offers a hand-up, potentially offering a life-changing impact with one act of kindness,” said Cline in the release. “I look forward to expanding the reach of EyeCare4Kids and thank Joseph Carbone for founding, growing, and leading the organization for so many years.”

As Executive Director Utah, Cline aided in increasing the patient volume at the Midvale clinic owned by EyeCare4Kids and supported the launch of a new clinic in Ogden. She also worked to expand the mobile outreach team and fostered partnerships with school districts, homeless shelters, refugee centers, and other organizations across the state.

In the transition, Carbone also has his own plans for expanding the organization’s reach in Africa. EyeCare4Kids has a goal of providing 1 million vision services to African children by 2030, and currently has a fully operational clinic in Kenya with plans to open another clinic in South Africa this year. Carbone will specifically work to create partnerships in Africa with different countries’ government departments, other NGOs that specialize in vision care, optometrists, clinics, lens manufacturers, universities, and schools. The goal is to develop a collaborative network to support children’s vision health across Africa and to build infrastructure to manufacture, cut, and fit lenses into frames.

“Over the past twenty years, I’ve seen how our work in Africa helps children to see better, do better in school, and set up opportunities to improve their quality of life. I’m very much looking forward to my next chapter when I can focus on building long-lasting relationships that extend the impact of EyeCare4Kids,” said Carbone in the release. “I also congratulate Maggie Cline on her well-deserved promotion. Her hard work, dedication, and resourcefulness, combined with her compassion, will serve EyeCare4Kids well in the future.”

EyeCare4Kids names Maggie Cline as new CEO. News release. EyeCare4Kids. June 4, 2025. Accessed June 17, 2025. 

https://eyecare4kids.org/2025/06/04/eyecare4kids-names-maggie-cline-as-new-ceo/

Maggie Cline, MPH, initially joined the organization in 2022 and served as Executive Director Utah.

EyeCare4Kids appoints new CEO, transitions founder into international development role

Aldeyra Therapeutics has resubmitted a new drug application (NDA) to the FDA for topical ocular reproxalap for the treatment of signs and symptoms of 

Previously, Aldeyra had received 2 complete response letters (CRL) from the FDA in 

 In the CRL at the end of 2023, the FDA identified no safety or manufacturing issues with reproxalap but noted the NDA did not demonstrate “efficacy in treating ocular symptoms associated with dry eyes” and that “at least 1 additional adequate and well-controlled study to demonstrate a positive effect on the treatment of ocular symptoms of dry eye” should be conducted.

In the NDA issued in April 2025, again the FDA found no manufacturing or safety issues with reproxalap but noted the NDA “failed to demonstrate efficacy in adequate and well-controlled studies in treating ocular symptoms associated with dry eyes” and that “at least 1 additional adequate and well-controlled study to demonstrate a positive effect on the treatment of ocular symptoms of dry eye” should be conducted, mirroring the prior CRL.

Additionally, in the most recent CRL, the FDA noted that it had identified “concerns with the data from the trial submitted to the NDA [in November 2024] that may have affected interpretation of the results,” which the FDA stated may be related to methodological issues, including a difference in baseline scores across treatment arms.

The most recent NDA includes new clinical data from the 

 The dry eye chamber trial was statistically superior to the vehicle in terms of ocular discomfort, and although the field trial missed statistical significance for the primary end point, the company noted it was consistent with previous field trials.

 the FDA accepts chamber trial results per its draft guidance for dry eye drug development, but they are rare for dry eye clinical trials. Also called a challenge-model trial, this trial design uses a controlled chamber to regulate temperature, airflow, humidity, and other environmental factors.

 All other dry eye disease therapeutics on the market today have used a more traditional environmental exposure study, marking Alderya’s trials as particularly unique.

Todd C. Brady, MD, PhD, president and CEO of Aldeyra, commented on the resubmission in a news release from the company.

“Consistent with a number of clinical trials that suggest the potential of reproxalap to rapidly improve the symptoms of dry eye disease, we believe the clinical trial results included in the resubmission announced today are robust,” said Brady. “Based on the lack of notable baseline differences across treatment arms and the highly statistically significant achievement of the prespecified primary end point in favor of reproxalap over vehicle, in conjunction with recent FDA discussions, we believe that previous concerns raised by the FDA have been addressed.”

The Prescription Drug User Fee Act target guidelines for NDA resubmissions include acknowledgment of acceptance for review within 30 days of submission by the FDA and completion of submission review within 6 months.

Aldeyra Therapeutics Resubmits Reproxalap New Drug Application for the Treatment of Dry Eye Disease. Published June 17, 2025. Accessed June 17, 2025. 

https://ir.aldeyra.com/news-releases/news-release-details/aldeyra-therapeutics-resubmits-reproxalap-new-drug-application-0

FDA issues Complete Response Letter to Aldeyra Therapeutics for resubmitted New Drug Application of reproxalap. Published April 3, 2025. Accessed June 17, 2025. 

https://www.ophthalmologytimes.com/view/fda-issues-complete-response-letter-to-aldeyra-therapeutics-for-resubmitted-new-drug-application-of-reproxalap

Maharjan EK. Aldeyra Therapeutics hits primary end point in 1 of 2 phase 3 trials for reproxalap. Published May 7, 2025. Accessed June 17, 2025. 

https://www.ophthalmologytimes.com/view/aldeyra-therapeutics-hits-primary-end-point-in-1-of-2-phase-3-trials-for-reproxalap

Canonical

Aldeyra submits third reproxalap new drug application for the treatment of dry eye disease

Practice management and electronic health records software company Eyefinity has integrated with Arrellio, a contact lens ordering and e-commerce platform, in order to help practices maximize contact lens sales and recover potential lost revenue.

 The integration will allow practices to automatically identify patients who are due for contact lens refills and send them personalized reorder reminders via text and email, according to a news release.

Additionally, patients can place orders directly through links that connect back to their practice.

“We continue to expand the Eyefinity Encompass ecosystem with digital tools that enhance patient experiences while driving more efficient workflows for eye care professionals," said Eyefinity President Charlie Biegel in the release.

 "This integration with Arrellio addresses a real challenge — helping practices recapture contact lens sales that might otherwise go to online competitors.”

Eyefinity Encompass users are currently able to benefit from the new integration. The platform already works to integrate with other third-party applications for cloud-based practice management and electronic health records software solutions.

 Eyefinity, a VSP Vision company, is able to provide VSP eligibilities and authorizations, contact lens ordering, image management, and industry-standard equipment through its Encompass software. Eyefinity digital marketing services, marketing-led data reports and review, and Ring analytics and artificial intelligence (AI) allow for business growth opportunities through the platform. As for improving patient care, Encompass provides an Eyefinity PatientNavigator and automatic eyewear-ready messaging. The software is protected with SOC 2 Type 2 certification, Amazon Web Services, 24/7 antivirus monitoring, and EHNAC, accredited since 2004.

As for Arrellio, patients are provided price quotes driven by data, which improves sales flows for practices, according to the company.

 A success story from a practice that utilizes Arrellio’s software is Dr. Torrey J. Carlson & Associates, which operates out of 8 locations across Tennessee. Since integrating Arrellio, the practice has documented a 26% increase in contact lens sales compared with the previous year without the software, in addition to over 1300 incremental patient orders and a 4% increase in contact lens fits.

“We were seeing more and more patients choose online retailers for their contact lenses,” said Torrey J. Carlson, owner of Dr. Torrey J Carlson & Associates, in a statement to Arrellio.

 “With Arrellio, we’re able to keep contact lens revenue within the practice.”

Another recent integration completed by Eyefinity was with Zocdoc in April. Zocdoc is a health care marketplace that helps patients find and book appointments online with health care providers, according to a news release.

“Our strategic partnership with Zocdoc creates a seamless connection between patients seeking eye care and our network of providers, reinforcing our commitment to driving practice growth and patient satisfaction,” said Biegel in the release.

 “This integration empowers practices to expand their digital presence, attract new patients, and optimize their scheduling efficiency—ultimately helping providers see a measurable return on their technology investment.”

Eyefinity also began offering its digital marketing services in April as powered by EyeCarePro, which allows eye care practices to choose from customized solutions, including a fully managed website, SEO, email marketing, online reviews, and reputation management, among others, according to a news release.

“Knowing the importance of marketing, we strive to offer fully managed services cultivated specifically for the optometric industry,” said EyeCarePro Marketing Director Liezel van der Merwe in the release.

 “We’re excited to collaborate with Eyefinity to bring our expertise to more practices and help them thrive in an increasingly competitive marketplace.”

Eyefinity partners with Arrellio to help eye care practices recapture lost contact lens revenue. News release. VSP Vision. June 16, 2025. Accessed June 16, 2025.

Meet Eyefinity Encompass. Eyefinity. Accessed June 16, 2025. 

https://www.eyefinity.com/products/solutions/eyefinity-encompass.html

Automated contact lens ordering and ecommerce that integrates with your EHR. Arrellio. Accessed June 16, 2025. 

Eyefinity announces integration with Zocdoc. News release. Eyefinity. April 21, 2025. Accessed June 16, 2025. 

https://www.eyefinity.com/blog/news/eyefinity-and-zocdoc-partnership

Eyefinity now offering digital marketing services powered by EyeCarePro. Eyefinity. News release. April 15, 2025. Accessed June 16, 2025. 

https://www.eyefinity.com/blog/news/eyefinity-now-offering-digital-marketing-services-powered-by-eyecarepro

The Encompass platform works to integrate with other third-party applications for cloud-based practice management and electronic health records software solutions.

Eyefinity integrates Arrellio platform to its Eyefinity Encompass portfolio

Mae Gordon, PhD, and colleagues identified an association between the diagnosis of primary open-angle glaucoma and a decrease in patients’ mental health scores. She is from the Department of Ophthalmology and Visual Sciences and the Institute for Informatics, Data Science and Biostatistics, Washington University School of Medicine, St Louis. They reported their findings in 

They pointed out that some patients can experience stress when they are diagnosed with glaucoma and advised that clinicians should be aware of the accompanying potential for a decrease in the patient’s mental health status.

This cohort study was an outgrowth of the phase 1 and 2 Ocular Hypertension Treatment Study (OHTS).

 This post hoc analysis included the prospective data from the OHTS trial obtained from patients with ocular hypertension who developed early POAG and had completed the National Eye Institute’s Visual Function Questionnaire-25 (VFQ) within 2 years before and within 2 years after the POAG was diagnosed. Patients completed the questionnaire every 2 years between January 2001 and December 2008. A control group was comprised of propensity-matched participants with ocular hypertension who did not develop POAG during the same period.

The study’s main outcome measure was the change in the VFQ mental health score before and after POAG was diagnosed in the group of patients with POAG compared with changes during the same period in the controls who did not develop POAG.

The investigators reported that 50 participants (21 women; 17 Black patients; mean age, 67.9 years) with POAG were included in the study. The control group included 100 OHTS control participants (37 women; 34 Black patients; mean age, 66.6 years).

Based on the questionnaire results, the investigators reported that among the participants who developed POAG, the means ± standard deviations of the mental health scores before and after development of POAG were, respectively, 94.5 ± 8.6 and 88.0 ± 13.6; this translated to a mean change of −6.5 ± 11.3. In the matched control group, the mean changes in the mental health scores before and after development of POAG were, respectively, 93.3 ± 8.9 and 92.6 ± 8.0, ie, a mean change of −0.7 ± 8.3. The mean difference in the mental health scores between and after the development of POAG in the POAG and control groups was −5.8 ± 9.4 (95% confidence interval, −9.05 to −2.60; 

The authors concluded, “These findings support the need for further studies to confirm the association between the diagnosis of POAG and a decrease in the mental health score and to develop strategies to inform patients about their POAG diagnosis without that information causing undue distress, anxiety, and depression.”

of Portuguese and Spanish researchers led by first author Jennifer Jesus, MD, found “a high occurrence of psychiatric pathologies among individuals with glaucoma.” She is from the Unidade Local de Saúde de Entre o Douro e Vouga, Santa Maria da Feira, Portugal.

She and her colleagues conducted a systematic review of 6 databases (CINAHL, MEDLINE, PsycINFO, Web of Science, Scopus, and the Cochrane Library) and one gray literature source (Google Scholar), covering the period from 2013 to 2024.

They identified 29 studies that included 13,326,845 subjects. “Depression and anxiety were the most common conditions identified, with depression rates ranging from 6.6% to 57% and anxiety from 12.11% to 49%. Other less frequent but still significant conditions like sleep disorders, psychosis, dementia, and posttraumatic stress disorder also were observed,” the investigators reported.

In addition, they found that the psychiatric severity was affected by sociodemographic factors, glaucoma severity, and treatment duration.

Jesus and colleagues commented, “Given the high occurrence of psychiatric pathologies among individuals with glaucoma, it is essential to develop comprehensive care strategies that address both eye and mental health needs. Multidisciplinary collaboration among ophthalmologists, psychiatrists, psychologists, and primary care physicians is crucial for developing personalized treatment plans that effectively manage both the ocular and psychological aspects of the disease.”

Gordon MO, Gao F, Burkland J, et al. for the Ocular Hypertension Treatment Study Group. Diagnosis of primary open-angle glaucoma and mental health status. 

Published online June 5, 2025. doi:10.1001/jamaophthalmol.2025.1374

Gordon MO, Kass MA, for the Ocular Hypertension Treatment Study G. The Ocular Hypertension Treatment Study: design and baseline description of the participants. 

The study was an outgrowth of the phase 1 and 2 Ocular Hypertension Treatment Study (OHTS).

Pamela J. Miller, OD, FAAO, JD, FNAP

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