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Catch up on the top stories in optometry during the week of June 9-June 13.

Takeaways from this week in optometry: June 9 - June 13

Articles

This new QLS-111 and latanoprost fixed-dose combination (QLS-111-FDC; Qlaris) is in development for the treatment of primary open angle glaucoma, ocular hypertension, and normal tension glaucoma for patients whom optimal intraocular pressure control may remain “unachievable” due to needing to lower episcleral venous pressure.

Qlaris Bio announces development of QLS-111-FDC

Anthem will also be required to conduct quarterly self-audits beginning in July of this year in order to document the correction of the issues stated in the report. 

Anthem agrees to pay $100,000 civil penalty following complaint filed in part by Maine Optometric Association

Videos

Presenters from the Collaborative Care Symposium 2025 give their key takeaways from their presentations.

What you missed in glaucoma, dry eye, myopia, and more at CCS 2025

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Peter Hersh, MD, stated that the key takeaway from a handful of presentations he gave at CCS 2025 is that successfully treating patients with keratoconus is identifying the disease early.

CCS 2025: Identifying keratoconus in patients through successful comanagement

Erin Tomiyama, OD, PhD, FAAO, offers actionable advice for myopia management and perspective for practitioners ready to refine their approach.

CCS 2025: Clinical pearls and forward thinking are the key to success in myopia management

 continues to gain momentum in clinical optometry, and at the Collaborative Care Symposium, Erin Tomiyama, OD, PhD, FAAO, offered actionable advice and perspective for practitioners ready to refine their approach. This session, which Tomiyama copresented with Mark Bullimore, OD, PhD, and Prethy Rao, MD, emphasized the importance of early intervention, lifestyle-informed treatment planning, and growing opportunities in the field.

Practical guidance for treatment selection

Tomiyama stressed that choosing the right myopia management modality requires an individualized approach. Factors such as patient age, rate of progression, lifestyle, and even parental familiarity with certain treatments all play into decision-making.

“For kids who enjoy water sports, orthokeratology (ortho-K) works really well—they get clear vision without needing to wear lenses in the water,” she explained. “Sometimes parents are more comfortable with treatments they’ve used themselves, which can improve [adherence].”

Initial treatment may begin with atropine drops for younger children not ready for contact lenses. As patients mature and seek more independence, transitioning to soft multifocal lenses or ortho-K becomes feasible. Regardless of modality, frequent follow-ups allow optometrists to monitor adherence and treatment efficacy, making adjustments as needed.

Tomiyama expressed excitement about the potential introduction of FDA-approved low-dose atropine and myopia control spectacle lenses in the US. “Spectacles are part of our daily toolkit, and their arrival will help more practitioners feel confident offering myopia management,” she said. “It could broaden access significantly.”

FDA regulation would also reduce variability in compounded atropine formulations, offering more consistency for both clinicians and families.

Artificial intelligence is expected to play a larger role in myopia management, from identifying ideal candidates for specific therapies to tracking progression. “A quick AI-generated summary could save time and support faster clinical decision-making,” Tomiyama noted.

Tomiyama closed with a call to action: “Just practice myopia management. Get started and grow your confidence. We’re shaping long-term outcomes—starting in childhood.”

A group of US senators introduced a bill last month that would work to outlaw certain vision benefit managers’ (VBMs) policies in an effort to combat the possibility of anticompetitive market behaviors. Senators Kevin Cramer, R-ND, Chris Murphy, D-Conn, and Markwayne Mullin, R-Okla introduced the Vision Lab Choice Act of 2025, S 1716 on May 12, which has been backed by the American Optometric Association (AOA), according to a news release from the association.

The bill also complements another similar effort which also promotes VBM reform in the US House, introduced as the Dental and Optometric Care Access (DOC Access) Act, or HR 1521. The bill had almost 90 bipartisan cosponsors and 12 bipartisan cosponsors in the Senate in September 2024.

“Vision benefit managers are often a hurdle to optometrists and eye care specialists providing the best care to their patients,” Cramer stated as cited in the release. “Our bipartisan bill expands consumer choice for patients, ensures autonomy for providers, and allows optometrists to select the best labs and suppliers to meet the needs of their practice.”

Specific plans outlined in the bill would be to “prohibit VBMs from restricting or limiting doctors’ choice of optical laboratories and sources or suppliers of vision materials provided to patients,” as well as “restrict plan-provider contracts for limited-scope vision benefits to 2-year terms with allowance of an extension with agreement from the doctor,” according to the release.

Other advocates for the bill also joined the AOA in a Capitol Hill briefing in September 2024 in order to discuss growing VBM abuses with lawmakers and staff. The special panel included US Senators and House members in the US House Oversight and Accountability hearing room. Representatives from the National Consumers League (NCL) and Patients Rising advocacy groups were also present to advocate for VBM restrictions.

“It’s very concerning when patients can’t get the care that they need to get by just walking in the door,” Sally Greenberg, NCL executive director, said during the briefing.

 “...instead, there’s the lack of transparency, then steering them to their own manufacturers, their glasses makers and then charging them these outrageous prices for what should be a very standard level of care.”

US senators introduce VBM reform bill amid growing plan scrutiny. News release. American Optometric Association. May 15, 2025. Accessed June 10, 2025. 

https://www.aoa.org/news/advocacy/federal-advocacy/us-senators-introduce-vbm-reform-bill-amid-growing-plan-scrutiny

Lawmakers host AOA, patient and consumer advocates for VBM abuse briefing as Congress expands probes. News release. American Optometric Association. September 19, 2024. Accessed June 10, 2025. 

https://www.aoa.org/news/advocacy/federal-advocacy/lawmakers-host-aoa-patient-and-consumer-advocates-for-vbm-abuse-briefing-as-congress-expands-probes?sso=y

The Vision Lab Choice Act of 2025, S 1716 was introduced to the US Senate floor on May 12.

VBM reform efforts continue with latest bill introduction

The optical coherence tomographer (OCT) has established itself as a standard-of-care, must-have device since its introduction over 20 years ago. When it first came to market, the time-domain resolution gave an unprecedented in vivo look at the posterior segment. Since then, OCT technology has evolved just like other ophthalmic instruments have over time. Take the fundus camera, for example. Carl Zeiss wowed the ophthalmic community in 1926 with the first commercially available fundus camera that sported a then eye-popping 20-degree field of view.

 This pales compared with today’s imaging options, which offer a view 10 times this amount.

In a less dramatic fashion, the OCT has also moved outside of the posterior pole. Early stationary devices offered scanning protocols confined to the optic nerve and macula (ie, the most posterior 30 degrees of the retina).

 Later units such as Heidelberg Engineering’s Spectralis came mounted with 4-way swivel capability. This allowed the acquisition of more peripheral scans using a combination steering and gaze-directed technique. The addition of the 55-degree objective lens officially gave the Spectralis widefield OCT status, which is considered 50 degrees by several authors.

 Now, many other instruments offer widefield OCTs, such as the Optos Silverstone, which delivers a swept-source OCT option of any area that is viewable on a non-gaze-directed ultra-widefield (UWF) image.

The reason for obtaining peripheral OCTs (P-OCTs) lies in the clinical question to be answered: Does this apparent full-thickness retinal hole have subretinal fluid? Is this a retinal detachment or a retinoschisis? Historically, a binocular indirect ophthalmoscopy exam combined with scleral depression would help answer these questions. Now, P-OCTs provide an adjunct to this technique. Capturing these scans, however, can be tricky. Here are some tips for using the above-mentioned devices, the principles of which may apply to any instrument. Following this are some insights and lessons learned from years of employing P-OCTs.

One of the main challenges with P-OCTs is preventing image cutoff. This occurs when the B-scan is captured at such a steep scan angle that it reaches the top, flips over, and then comes back into view. This is called a “mirror” or “inverted” artifact (

 Remember that the eye is curved, so a straight-line scan oriented incorrectly will experience this effect. The key is to position the scan appropriately to minimize an inverted scan. To do this, capture the scan circumferentially (ie, horizontal for superior and inferior, vertical for temporal and nasal, and oblique to match the clock hours). The Spectralis allows a 360-degree scan orientation to prevent this from happening. Others, like the Optos Silverstone, only offer a horizontal scan option. In a study by Kurobe et al, over 50% of P-OCT scans experienced inverted artifacts with this device.

, clinical information can still be obtained.

A second consideration involves patient gaze and positioning. This isn’t an issue with the Silverstone as the P-OCT function, unfortunately, turns off for gaze-directed scans. This limits its ability to obtain scans in the most peripheral locations or in areas where artifacts such as lid interference may be present. However, it also streamlines the process. As only straight-ahead images are available, simply capture a non-gaze-directed UWF image and then select the desired OCT scanning protocol.

With the Spectralis, the 4-way pivot expands the scanning options of the retinal periphery. This is the steering and gaze-directed technique where, along with the patient’s gaze directed into the quadrant of interest, the machine swivels or tilts in the opposite direction. For example, have the patient look up if the area of interest is superior and then tilt the machine downward. This combination increases the scan angle (

). Stationary devices only allow for gaze-directed scans. Also, if the positioning stated above puts the eye closer or farther away from the instrument, consider adjusting the OCT control option for axial length. On the Spectralis, the range goes from “S” to “XL.” Therefore, select “S” if the eye is much closer to the instrument and “XL” if it is much farther away. This will enable a successful scan when there is a decreased or increased distance between the scan head and the retina.

Next, start with the instrument farther away from the patient, where the near-infrared image shows a more elliptical pupil due to the patient’s gaze-directed position. Use an external fixation device if available. From here, guide the instrument into the pupil until the scan appears. Once the scan is in position, employ the automatic real-time tracking (ART) option when using the Spectralis, which captures and summates sequential B-scans for enhanced resolution. For poor fixators, this may not be possible, and acquiring scans without ART will still result in readable images. If the patient is employing the “windshield wiper” technique and driving the imager crazy, consider taking the controls and performing a “live scan.” This entails dragging and rotating the line scan as needed to obtain the needed information visually without achieving a saved scan.

Don’t expect the first scans to look straight out of a journal; it takes practice. However, the acquired knowledge will result in valuable insight into peripheral retina pathology such as retinal holes, retinoschisis, lattice degeneration, cystoid degeneration, and retinal tufts, as noted below.

Atrophic holes are not always full thickness

This makes sense when you think about it. A full-thickness “atrophic” hole doesn’t just suddenly appear. Consider the word “atrophy,” which means “wasting away.” This definition implies a timeframe by which this occurs. Therefore, there must be a degenerative process that progresses over time for the atrophic retinal hole to reach full-thickness status. If this were not the case, a more appropriate term might be a focal area of retinal “hypoplasia,” which means “incomplete development” and thus would be present from onset and not go through progressive stages.

 which shows a full-thickness atrophic hole. The worry here is that vitreous fluid now has potential access to the subretinal space, which could result in a retinal detachment. Contrast this to the partial thickness atrophic hole or retinal erosion in 

where a small amount of retinal tissue remains, which is a barrier to any overlying fluid reaching the subretinal space.

The P-OCT appearance of full-thickness retinal atrophic holes varies. Specifically, the hole’s edges may be flat or everted, and sometimes cystoid degeneration surrounds the area.

 When these are located with lattice, they rarely result in a progressive retinal detachment.

 In the American Academy of Ophthalmology’s Preferred Practice Patterns (PPP), asymptomatic atrophic holes fall into the “treatment is rarely recommended” category.

 However, the PPP does not address what the hole looks like on P-OCT. Are elevated edges more at-risk than flat ones? Do cystic spaces infer any risk? As OCT technology continues to evolve, so may its introduction into current PPP.

Not only are retinoschisis more common, so are schisis detachments

After employing P-OCTs, there appears to be a greater number of clinically undetected retinoschisis. The same applies to a schisis detachment, which is when an outer layer break allows intracystic fluid to reach the subretinal space, causing a localized retinal detachment (

 In fact, over 15% of presumed retinoschisis by clinical evaluation showed a retinal detachment with P-OCT.

 Schisis detachments mostly remain stable with outer layer holes alone vs when outer and inner layer holes are present.

 The reason here is that there is a limited amount of intracystic fluid that can reach the subretinal space with an outer layer hole. However, an inner and outer layer hole opens the area up to the more voluminous vitreous fluid. Fortunately, the incidence of inner layer holes is low (4%), with outer layer holes having a prevalence of up to 17%.

Seeing is believing: lattice and vitreoretinal interaction

Lattice degeneration presents in about 10% of patients, with a 50% chance of bilaterality.

 Exaggerated vitreoretinal attachments and overlying vitreous liquefaction tend to occur (

). The vitreous traction can be striking with P-OCT (

). It is no wonder, then, that lattice poses a risk, albeit small, for retinal detachment.

Cystoid: the forgotten peripheral degeneration

Cystoid degeneration is often overlooked, but the entity can have clinical significance. Microcystoid degeneration, which does not involve the entire retina, is thought to be a precursor to the above-mentioned degenerative retinoschisis, where the cystic lesions coalesce (

 It can also occur with a retinal hole, meridional fold, ora serrata pearl, and cystic retinal tuft.

 Contrast this to typical cystoid degeneration, which takes on a “saw-tooth” pattern and spans through the entire retina (

Although noncystic retinal tufts typically do not lead to retinal detachment, cystic retinal tufts can. Retinal tears around cystic retinal tufts are estimated to cause 10% of rhegmatogenous retinal detachments.

 Making this distinction clinically is difficult and is much easier with P-OCT (

As technology continues to advance, it may not be long before the entire peripheral retina can be captured using OCT technology. Therefore, put your OCT to work in the periphery now and stay ahead of the learning curve with interpretation.

Chen A, Dang S, Chung MM, et al. Quantitative comparison of fundus images by 2 ultra-widefield fundus cameras. 

. 2021;5(5):450-457. doi:10.1016/j.oret.2020.08.017

Nissen AHK, Vergmann AS. Clinical utilisation of wide-field optical coherence tomography and angiography: a narrative review. 

. 2024;13(4):903-915. doi:10.1007/s40123-024-00905-2

Choudhry N, Golding J, Manry MW, Rao RC. Ultra-widefield steering-based spectral-domain OCT imaging of the retinal periphery. 

. 2016;123(6):1368-1374. doi:10.1016/j.ophtha.2016.01.045

Kurobe R, Hirano Y, Ogura S, Yasukawa T, Ogura Y. Ultra-widefield swept-source optical coherence tomography findings of peripheral retinal degenerations and breaks. 

. 2021;15:4739-4745. doi:10.2147/OPTH.S350080

Cheung R, Ly A, Katalinic P, et al. Visualisation of peripheral retinal degenerations and anomalies with ocular imaging. 

. 2022;37(5):554-582. doi:10.1080/08820538.2022.2039222

Lewis H. Peripheral retinal degenerations and the risk of retinal detachment. 

. 2003;136(1):155-160. doi:10.1016/s0002-9394(03)00144-2

Flaxel CJ, Adelman RA, Bailey ST, et al. Posterior vitreous detachment, retinal breaks, and lattice degeneration Preferred Practice Pattern. 

. 2020;127(1):P146-P181. doi:10.1016/j.ophtha.2019.09.027

Byer NE. Perspectives on the management of the complications of senile retinoschisis. 

. 2002;16(4):359-364. doi:10.1038/sj.eye.6700191

Cereda MG, Corvi F, Cozzi M, Pellegrini M, Staurenghi G. Optical coherence tomography 2: diagnostic tool to study peripheral vitreoretinal pathologies. 

. 2019;39(2):415-421. doi:10.1097/IAE.0000000000001953

Kim J, Choi KS. Peripheral lattice degeneration imaging with ultra-widefield swept-source optical coherence tomography. 

. 2023;37(6):485-489. doi:10.3341/kjo.2023.0074

Incorporating peripheral OCTs into your practice provides valuable insights which may alter your clinical diagnosis.

Taking your OCT outside of the posterior pole

The June edition of the “Cultural Responsiveness” blog by Latinos en Optometry and sponsored by VSP Vision highlights an article written by Bryce St Clair, OD, MPH, assistant professor of ophthalmology at the Johns Hopkins School of Medicine Wilmer Eye Institute in Baltimore, Maryland.

In his article, St Clair emphasizes the significance of tailoring care to individual patients by considering their cultural and socioeconomic backgrounds. He draws from his firsthand experiences of delivering care to immigrant and refugee communities in Houston, Texas, Columbus, Ohio, and currently in Baltimore, Maryland, to share valuable insights.

"There are so many ways in optometric practice that we customize treatment options to the patient’s age, disease severity, and ocular characteristics," writes St Clair in the blog post. "Similarly, we also need to individualize care by adapting to our patients’ cultural and socioeconomic realities."

St Clair emphasizes the importance of optometrists demonstrating a vested interest in establishing connections with their patients in order to deliver more patient-centered eye care. He believes that building trust in every doctor-patient interaction is essential for patients to adhere to medical recommendations. In his article, he offers several actions optometrists and staff can implement to ensure all patients experience a sense of being welcomed and valued in their care.

Latinos en Optometry has partnered with VSP Vision™ to create the "Cultural Responsiveness" blog series. This collaborative initiative aims to assist current and future practitioners in recognizing the significance of healthcare services that cater to the social, cultural, and linguistic needs of patients. Nonmembers of Latinos en Optometry who are interested in accessing the complimentary blog can subscribe 

Bryce St Clair, OD, MPH, authors the June edition of the Cultural Responsiveness Blog, and urges doctors to consider cultural and socioeconomic backgrounds when caring for patients.

Individualizing optometry care to all patient populations

Researchers have discovered that a long-approved HIV drug has the potential to improve vision in patients with 

 Researcher Jayakrishna Ambati, MD, founding director of UVA Health’s Center for Advanced Vision Science, alongside collaborators at Brazil’s Universidade Federal de São Paulo led by Dr Felipe Pereira and Dr Eduardo Buchele Rodrigues, found that lamivudine could provide an oral option to more effectively treat DME at a lower cost to patients, according to a news release.

“An oral drug that improves vision in DME would be a game changer because it would be more convenient for patients than frequent, often monthly, injections into the eye,” said Ambati in the release.

Researchers enrolled 24 participants with DME in a small randomized clinical trial, which randomly assigned said participants to receive either lamivudine or placebo twice daily, in addition to eye injections of the drug bevacizumab starting after 4 weeks of treatment. Those who received lamivudine showed significant vision improvements in those first 4 weeks before their first eye injections. These patients’ ability to read letters on an eye chart improved by 9.8 letters at 4 weeks, while patients receiving placebo saw their ability decrease by 1.8 letters. Additionally, a month after receiving bevacizumab injections, lamivudine recipients improved by 16.9 letters, with the placebo group increasing by 5.3. Thus, results from the study suggest that lamivudine may work both alone and in conjunction with bevacizumab injections.

Although larger studies that follow patients for longer than 8 weeks will be needed to reinforce these results, Ambati said in the release that lamivudine alone could make a life-changing impact for patients in areas of the world with limited access to specialty doctors or who are unable to afford or travel to monthly eye appointments.

“A $20-a-month or even cheaper oral pill that improves vision as much as or more than therapy with injections into the eye that cost up to $2000 per month could be transformative both for patients and the health care system,” Ambati said in the release.

Researchers hypothesize that lamivudine was effective in the clinical trial against DME because the drug blocks the activity of inflammasomes, which can be implicated in the development of DME.

“The mechanism of action of lamivudine is different from that of existing treatments, so we could also develop combination therapies. This trial demonstrates that blocking inflammasomes can improve vision in DME. We have developed a safer version of lamivudine called K9, which blocks inflammasomes without the potential [adverse] effects of lamivudine,” said Ambati in the release. “So, we are excited by the 

 and planned clinical trials of K9 in DME as well.”

The trial was supported by grants from the National Institutes of Health’s National Eye Institute and National Institute on Aging.

Drug improves sight for diabetic macular edema patients. University of Virginia Health. May 27, 2025. Accessed June 10, 2025. 

https://newsroom.uvahealth.com/2025/05/27/drug-improves-sight-for-diabetic-macular-edema-patients/

Researchers hypothesize that lamivudine was effective in the clinical trial against DME because the drug blocks the activity of inflammasomes.

HIV drug lamivudine holds potential for patients with DME, researchers find

A new handheld device developed by University of Missouri – St Louis (UMSL) researchers works to detect and treat amblyopia early and utilizes the Quantitative 3 Dot (Q3D) Test to identify visual suppression.

 The device was developed by Curators’ Distinguished Teaching Professor Carl Bassi and research collaborators Michael Howe and Wayne Garver and has been licensed by Forus Health, according to a news release.

“I really do think it's going to be something that's going to help a lot of people,” Bassi said in the release. “I do think it can make a difference in the world.”

He stated in the release that he first came up with the idea for the device in the early 1990s, having just joined the UMSL faculty, while examining the vision of patients with Alzheimer disease. Bassi and his colleagues were modifying existing pediatric techniques in order to gauge binocular function, with one of the main screening tests being the Worth Four Dot Test.

“The problem is it's not quantitative,” Bassi said in the release. “It just gives you this gross kind of yes or no, and you have to have a severe problem before you're able to pick anything up with that. My idea very early on was to try to change the intensity of these lights independently. We had to wait for a long time until technology kind of caught up with doing what we wanted to do because it took the development of not only LED lights but super bright LED lights that were needed to do the test right.”

By being able to alter the intensity of these lights, the researchers have been able to detect vision suppression associated with amblyopia much soon than previous methods allowed.

The device was developed by Curators’ Distinguished Teaching Professor Carl Bassi and research collaborators Michael Howe and Wayne Garver of the University of Missouri – St Louis.

Peter Hersh, MD

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