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A recent study reveals that ADHD in schoolchildren correlates with lower myopia prevalence and shorter eye length, suggesting intriguing links between vision and attention disorders.

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Is in private practice at Belcara Health in Baltimore, Maryland as well as an assistant professor of Ophthalmology at the Wilmer Eye Institute. 

Financial disclosure: speaker and consultant for RVL.

Low-lying lids affect much more than patients' visual field, with implications for visual quality and their self-esteem.

Viewing ptosis through a biopsychosocial lens

A. Initiate medical therapy with a topical glaucoma medication.

B. Have selective laser trabeculoplasty (SLT)

C. Have a minimally invasive glaucoma surgery (MIGS)

Poll: Preferred treatment plans for mild-stage POAG

Today Nanoscope Therapeutics announced its rolling submission of a biologics license application (BLA) to the FDA for MCO-010 for the treatment of vision loss caused by retinitis pigmentosa (RP).

Nanoscope’s BLA has been granted rolling review by the FDA, with the first modules already submitted. The completion of the full BLA submission is anticipated in early 2026 and is eligible for priority review under the program’s fast-track designation.

MCO-010 is Nanoscope’s lead investigational therapy designed to address the broad genetic diversity of RP. MCO-010 is a gene-agnostic gene therapy for retina disease. This BLA marks the first BLA submitted for a gene-agnostic gene therapy for retinal disease, and if approved, MCO-010 would be the first gene-agnostic therapy to restore vision in legally blind patients with RP.

Affecting more than 100,000 people, leaving more than 25,000 legally blind, RP is one of the leading causes of blindness in the working-age population in the US.

“For the first time, patients who are considered to be on a path to permanent blindness may have a chance to regain sight,” said Sulagna Bhattacharya, CEO and co-founder of Nanoscope, in a press release.

“We are deeply thankful to the FDA for their guidance as we remain steadfast in our mission to restore vision and bring light back into the lives of those living in darkness.”

The RESTORE phase 2b trial demonstrated MCO-010 met its best corrected visional acuity (BCVA) endpoints in both dose groups at 52 weeks vs sham-control. Vision gains from baseline were >0.3 LogMAR, a result equivalent to 3 or more lines on an eye chart.

Visual acuity gains have been observed in ongoing long-term follow-up through 3 years, with no serious adverse events reported in treated eyes. Nanoscope said further multiyear follow-up is scheduled to evaluate longer-term efficacy and safety.

“It’s the first time the FDA will be evaluating an application for a gene-agnostic therapy for inherited retinal disease,” Glenn Sblendorio, chairman of the board of directors for Nanoscope, said in a press release.

“We feel confident in our clinical data, which we believe will mark the dawn of a new era in retinal care. Our goal is to bring back the light of hope for RP patients – and eventually for many other retinal degenerative conditions.”

Nanoscope Therapeutics. Nanoscope Therapeutics Initiates Rolling Submission of Biologics License Application to FDA for MCO-010, the First Gene-Agnostic Therapy to Treat Retinitis Pigmentosa. Prnewswire.com. Published July 14, 2025. Accessed July 14, 2025. https://www.prnewswire.com/news-releases/nanoscope-therapeutics-initiates-rolling-submission-of-biologics-license-application-to-fda-for-mco-010-the-first-gene-agnostic-therapy-to-treat-retinitis-pigmentosa-302503892.html

The completion of the full BLA submission is anticipated in early 2026 and is eligible for priority review under the program’s fast-track designation.

Pipeline

Canonical

FDA grants Nanoscope rolling BLA submission of MCO-010

When a disheveled woman first sat before Kristin Adams, OD, the optometrist was unsure whether she would see her again. Wiping tears from her face, hands damaged from past instances of physical trauma, the patient confided in Adams that she was a survivor of domestic violence. Adams swiftly referred her to the office next door to Colleen Onstad, MSW, LICSW, for access to social services. Onstad scheduled an appointment for the patient for the following morning.

“Lo and behold, she came. She was my 9 o’clock patient,” Onstad said.

Adams said she later saw her in the hallways of Hennepin Healthcare’s Traumatic Brain Injury Outpatient Program in Minneapolis, Minnesota, smiling, wearing makeup, sporting new clothing, and feeling confident.

 “She’d always smile and wave at me about how happy she was that I took the time to listen to her, and she [told] me and my technician how we changed her life,” Adams said.

Adams and Onstad detailed the patient's story during their presentation titled “Collaborative Approaches to Recognizing and Addressing Domestic Violence: The Role of Optometrists and Social Workers” during Optometry’s Meeting 2025 in late June as a testament to the importance of recognizing the signs of domestic violence in patients. Adams said that traumatic brain injuries (TBIs) can be a common indicator of a domestic violence case, as 10% of TBI-related visits to the emergency department are from assaults, including domestic violence. Physical symptoms include headaches, dizziness and balance problems, blurred or double vision, cranial nerve palsies, sensitivity to light and noise, and cognitive issues.

Adams stated that most of the time in domestic violence cases, if there is physical abuse, there will be a related injury that involves the head, face, or eyes, leading to visual and ocular symptoms.

Women are particularly at risk of experiencing TBIs as a result of domestic violence, sustaining 11 to 12 times more TBIs than all TBIs in the military and athletes, male and female, combined. Additionally, 75% of women who have domestic violence-related TBIs also experienced childhood abuse.

“Since they were raised in a violent home, they probably also suffered head injuries early in life,” Adams said. They have these chronic head injuries throughout their life, which also highlights the point where this can be intergenerational, a cycle of violence and trauma. So we as optometrists can try and help break the cycle and help prevent more abuse happening and prevent further generations from being harmed, because as children we’re going to learn what we live and repeat those things as well.”

Additionally, only 34% of domestic violence survivors seek medical care, which may leave optometrists as one of the only medical providers survivors will visit. One survey found that only 7% of women who were injured in domestic violence cases reported that their health care provider specifically asked whether they were experiencing domestic violence.

“Traumatic brain injury is called a silent epidemic because it’s like an iceberg,” Adams said. “We can see just a tip of the problems that patients are having. There’s so much below the surface that you don’t notice.”

Physical signs to look for during examinations are injury patterns – or bruises in various healing stages – defensive fractures in the forearms, repeated injuries in the same areas, bite marks, burns, linear or circular bruises, and hoarseness in the voice and petechiae on the face or eyes due to strangulation. Other common head and ocular injuries caused by domestic violence include zygomaticomaxillary complex fractures, orbital fractures, periorbital contusions or lacerations, and subconjunctival hemorrhages.

 “We could be looking at anything from a corneal abrasion all the way to a retinal detachment,” Adams said. “No part of the eye is going to be immune from violence.”

Adams said a patient dressing inappropriately for the weather – such as a turtleneck on a hot summer day – can be an indicator that they are hiding an injury. Additionally, patients who come in often with broken glasses or need adjustments could indicate that they are receiving physical abuse to the face and head.

“We also want to talk about the inconsistent or the minimization of explanations of why they’re being hurt,” Adams said. “They might have variable stories. They might tell the technician one thing, they might tell you another.” She also noted that an electronic health record available to the entire practice or hospital system can help verify differentiation in a story between providers.

She said that speaking privately with a patient one-on-one and using empathetic language is the best way to address concerns of domestic violence. Verbal consent must be obtained before making a referral to a social worker, according to Adams. Making these referrals can be made easier by reaching out and building relationships with nearby resources such as local shelters, social service agencies, nearby hospitals and health care systems, and primary care providers.

Adams K, Onstad C. Collaborative Approaches to Recognizing and Addressing Domestic Violence: The Role of Optometrists and Social Workers. Presented at: Optometry’s Meeting 2025; June 25-28; Minneapolis, MN.

Kristin Adams, OD, and Colleen Onstad, MSW, LICSW, detailed the importance of recognizing the signs of domestic violence in patients during Optometry's Meeting 2025.

AOA 2025: Collaborative approaches to recognizing and addressing domestic violence

Many moons ago, a patient entered the office with “something in [his] eye” after grinding metal. He assured us he was wearing his safety glasses and goggles on top of them, but “somehow something still got in it.” And of course, this had happened 2 days earlier, but he was just now walking into the office at 4:55 PM on Friday because it was killing him, and he couldn’t get in any earlier because of his work schedule. We bit our tongue and pulled out our slit lamp to discover a dead-central 1-mm metallic corneal foreign body in the anterior stroma, with a rust ring, surrounding corneal edema, and an early subepithelial infiltrate. We explained to the patient what we would need to do to remove it in the office, including what antibiotic drops we would need to prescribe, along with dosage instructions. We would need to cycloplege the eye to ensure there was no intraocular foreign body, and that we would also insert a bandage contact lens to promote healing before seeing him in 24 to 48 hours (or sooner via the office’s on-call service should symptoms worsen). We deftly removed the foreign body with our instrument of choice, debrided the rust ring with an Alger brush without complication, painlessly inserted the bandage contact lens, and sent the antibiotic drops e-prescription to the patient’s pharmacy. Before we even had a chance to leave the examination room, the patient asked whether he would have to pay his co-pay today, whether he would have to pay again at the follow-up visit, and most importantly, whether he could go ahead and get his glasses that day because he was already here.

Another patient, this time a 67-year-old patient who’s still employed, presents with their vision insurance in hand for examination of blurred vision (OU) at distance for the past few months. Best-corrected visual acuity measures 20/50 in each eye, with grade 2+ to 3+ nuclear sclerotic cataracts and grade 1+ to 2+ cortical spoking in the visual axis OU. How should this examination be coded and billed? The reason for the visit is always driven by the patient’s chief concern, and our first diagnosis must coincide with that chief concern for insurance audit purposes. The reason for the visit in this case is to see better, the chief concern is blurred vision, and the chief cause is cataracts. After explaining the situation to the patient and ensuring their understanding, this examination should be billed to medical insurance if the patient is amenable to a cataract surgery consultation. But what if they aren’t?

Or how about the 40-year-old patient who presents for a vision examination, reporting near blur but also mentioning they’ve had moderately itchy eyes for the past few weeks? Upon examination, we diagnose presbyopia and allergic conjunctivitis. How should this be handled? The examination should be billed to the patient’s vision plan based on the reason for visit, but do we also prescribe allergic conjunctivitis medication as part of the vision examination and just schedule them to come back in a year? Or should we bring them back on a different day to deal with the allergic conjunctivitis under their medical insurance, without addressing their symptoms today? Alternatively, should the allergic conjunctivitis be treated under the vision plan but in conjunction with scheduling appropriate follow-up under the medical insurance? Or perhaps we should coordinate benefits between the vision plan and the medical insurance if that’s a possibility?

We’ve all experienced these scenarios (or if you’re so new to the profession that you haven’t yet, just hang in there—you will). Patients don’t understand the difference between a medical eye examination and a vision examination, and most insurance is—in my opinion—intentionally confusing to patients, making it difficult to compare plans and even harder to understand what benefits are available to them. From co-pays, deductibles, and covered services to coinsurance, noncovered services, doughnut holes, and out-of-network fees, we can barely keep it straight, even though we deal with it on a daily basis from the provider side. Nevertheless, it is important that we and our staff do our best to understand and explain insurance coverage to patients as much as we can. Even then, it never ceases to amaze me how some patients can get so upset and blame us for their large co-pay, high deductible, and/or poor coverage, despite the fact that we didn’t have anything to do with the plan that they chose or their employer chose for them. Still, the more we can help explain benefits and coverage on the front end (ie, when appointments are scheduled and/or when patients check in), the smoother it will be for everyone in the office.

It was instilled into me during my private practice externship rotation and at my first clinical position post residency that we must address medical issues first. and then vision issues, potentially during separate visits if needed. Vision care may need to be postponed until resolution of medical conditions to assure spectacle prescription accuracy and/or appropriate contact lens fit and comfort. We’ve all seen how even grade 1+ lid edema can temporarily induce –0.50 diopters or more of cylinder, so it’s incumbent to hold the patient’s refractive prescription until infection, inflammation, and/or other sequela of trauma are resolved.

Diabetic eye examinations: Vision or medical?

How about the patient with diabetes who presents their vision plan card at the front desk, saying they’re here for their diabetic eye examinations and new glasses? Early in my career, I would just perform the vision examination, dilate the patient’s eyes, thoroughly look for any retinal microaneurysms or the tiniest dot hemorrhages, and just bill the examination to the vision plan, giving away my services for free. Previously, after receiving several letters from medical insurers chastising me for not billing their beneficiaries’ diabetic eye examinations to the medical insurance, I asked my colleague Amanda Brewer-Lord, OD, what she did in her highly successful practice. As a side note, in addition to being the only entities that advocate for our patients and our profession, the beauty of participating in optometry organizations and attending their meetings (eg, the American Optometric Association, state associations, regional meetings) is the ability to network with savvy clinicians like Brewer-Lord and others who are more than willing to benchmark best practices. She shared that her practice had actively educated its patients over the years that their medical insurance covers medical eye problems, such as their diabetic eye examination, and their vision insurance covers examinations (and potentially materials) for glasses and contact lenses. Now everyone knows and expects the billing process to happen that way. The one exception to this is the limited number of vision plans that allow for coordination of benefits with the patient’s medical insurance, often resulting in the patient paying less out of pocket than they would have with just the vision plan (see more on this below).

Similarly, I also consulted with my dentist, who does a great job making insurance coverage clear up front, informing her patients exactly what is covered and what isn’t, as well as specifically what it will cost for any noncovered services or materials.

With all of this knowledge in hand, we decided to tackle the challenge of educating our patients, especially those with diabetes, up front about the difference between a medical eye examination and a vision examination, and which provider each examination type needs to be billed to. First, we put placards at the front desk and in every examination room that assured patients that we shared their frustration with understanding their insurance benefits, but were happy to try to help. Further, the placards reminded patients that their medical insurance does not cover glasses or contact lenses; that their vision insurance does not cover medical eye problems such as diabetic eye examinations, red eyes, glaucoma, cataracts, macular degeneration, eye injuries, etc; and that insurance guidelines require us to bill medical eye examinations to their medical insurance. They were then encouraged to ask us if they had any questions. Staff also received additional training to proactively educate patients about this when they scheduled an appointment, as well as when they checked in at the front desk. After successfully implementing this many years ago, just like Dr Brewer-Lord and my dentist found in their respective practices, our patients now understand the difference between a vision examination and a medical eye examination, with rarely ever any issues arising. My only regret is not initiating this from day 1 in our practice.

In eye care, when patients present with concerns of blurred vision, as mentioned in our second scenario above, there’s a little more of a gray area. If the blur is the result of cataracts, macular edema, keratoconjunctivitis sicca, or a host of other medical conditions, it’s best to explain that to patients in the examination room. For example: “Mrs Jones, I know you’d like to get glasses today, but the main reason for your blurred vision is your cataracts. My hands are tied today as far as how much we can improve your vision with just new glasses because of how large your cataracts are now. If you’d like to see clearly again, we really need to take care of these cataracts with an 8-minute outpatient procedure, in which we remove the cataract and replace it with a clear new lens implant. We can now even incorporate your glasses prescription inside this lens implant, as close as we can get it, which usually reduces your need for glasses or contacts. Your vision and glasses benefits can then be saved until after the cataracts are removed.”

What is coordination of benefits? It’s the one instance in which medical insurance and vision plans can work together for everyone’s benefit. Coordination of benefits is offered by some vision plans but not all (to know which vision plans in your area offer this, check with the plan itself). For those that do, the process usually requires the visit to be billed to the patient’s medical insurance first. When the explanation of benefits (EOB) is received back, indicating what the patient owes, a second claim is then filed with the vision plan for any remaining balance from the visit (some plans require the original medical EOB to be submitted with the vision plan claim). The vision plan then covers most, if not all, of the outstanding medical balance, and in some instances, the patient’s medical co-pay and vision plan co-pay both end up being fully covered, saving the patient money vs what they would’ve paid if just a vision plan claim was filed. Aside from the extra step of filing the second claim once the medical claim EOB is received, once your office protocols are in place, it’s relatively seamless and significantly benefits the patient and the practice.

In summary, investing the time to understand insurance benefits and terminology, proactively educating patients on the difference between vision examinations and medical eye examinations (and which plan each needs to be billed to), and using coordination of benefits whenever available can create a classic win-win situation for both patients and eye care providers.

Explaining how different examinations are billed by insurance to patients can make a difference in patient care.

An age-old optometry patient dilemma: Vision or medical?

Essilor has developed 2 versions of its Varilux progressive lens that replicates the human pupil for high vision intensity in any light for visual sharpness and contrast.

 Beginning on July 21, the Varilux Physio extensee and Varilux Physio extensee Classic Edition will be available in the US and are designed to provide correction for an individual wearer’s pupil dynamics to reduce high-order aberrations and cater to a wide range of presbyopes, according to a news release.

The Physio extensee version is offered on a new patented dual-sided blank, whereas the Classic Edition is offered as a full backside digital progressive.

“When the size of the pupil increases, the light beam entering the eye crosses a bigger portion of the lens,” said Sébastien Fricker, vision and perception modelling team manager at EssilorLuxottica, in the release. “As a result, it can contain more high-order aberrations and induce a loss in image quality. Therefore, accounting for pupil size variation in lens design is key for maximizing contrast perception and visual performance for wearers.”

According to the release, there is a market for presbyopes who need lenses that allow for the pupil to change sizes in different lighting situations. EssilorLuxottica notes that 39% of progressive lens wearers are very interested in corrective lenses designed to improve vision comfort regardless of light intensity.

Pupilizer lens technology, which helped actualize the lenses, was created by utilizing Varilux AI twinning technology that replicates thousands of wearer profiles, which allows for performing multiple tasks at all distances and in different light conditions. The technology then analyzes the data to predict a wearer’s pupil size variation. This technology is built into the Varliux Physio extensee progressive lens to reduce high-order aberrations and minimize distortion when light passes through the lens. Associating a prescription to a predicted pupil dynamism profile allows for the lens to be produced to closely match the wearer’s daily pupil variations.

“The pupil size is related to 4 parameters which have the most impact,” Fricker said in the release. “One is age and as we grow older our pupil size decreases. The others are related to the environment including the brightness, proximity, and the size of the object being viewed.

“The data from the pupil-variation modelling is fed into our digital twin allowing us to personalize the optical lens even further. When the lab receives a patient’s prescription, they will incorporate the pupil dynamic profile as part of the lens calculation to optimize and build the lens.”

Additionally, the lens utilizes Dual Booster lens surface technology to aid in optimizing near vision. The back and front sides of the dual-sided lens provide a magnification effect in the near vision zone without impacting the overall progressive power, according to Essilor. Synchroneyes lens technology also balances the left and right lenses’ designs to match power distributions and patterns of unwanted astigmatism in the management of binocular vision.

According to the release, when surveying 79 progressive lens wearers on their experience with the 2 versions of the lens, 94% experienced high vision intensity in any light, with 92% feeling confident in low light conditions. Of those wearing the Varilux Physio extensee and Dual Booster technology, 96% of participants experienced a high quality of vision at near. The lens can also include Near Vision Behavior measurement, which allows for 71% of participants to easily access the near vision zone and 78% of participants to experience extra comfortable vision during a long task in near vision.

Essilor announces latest progressive lens innovation: Varilux Physio extensee progressive lenses. News release. EssilorLuxottica. July 2, 2025. Accessed July 9, 2025.

Beginning in July 21, the Varilux Physio extensee and Varilux Physio extensee Classic Edition will be available in the US.

Essilor announces release of new progressive lens to improve vision comfort for presbyopes

Amid a vision crisis, Latin America is in a position that warrants a serious commitment to a call to action for standardizing and improving eye care across the region, according to Carlos Chacon, OD, MSc, FIACLE. In his Optometry’s Meeting 2025 presentation titled “Optometry and Visual Impairment in Latin America: A Call to Action,” Chacon cited that geographic and economic barriers for patients, along with optometric education disparities and restricted diagnostic rights, put a burden on the health care system in the form of preventable conditions going untreated.

Currently, 26.6 million people in Latin America are visually impaired, with 80% of those cases identified as preventable if the patient were treated with proper care. In the Andean region alone, nearly 21 million – or 1 in 8 people – experience vision loss. Over 75% of these cases could be prevented or treated with proper care. This number of cases of visual impairment contributes to $3.2 billion economic impact in the form of annual productivity loss in Latin America.

Additionally, those in rural and urban areas have different access to eye care. With 8.5 ophthalmologists available per 100,000 people in urban areas in comparison with 1.3 ophthalmologists available in rural areas in Latin American countries, rural areas generally lack infrastructure, specialists, and transportation options for patients.

 The cost of quality eyeglasses, specialist consultation, and cataract surgery also keeps patients from receiving the care they need. Chacon said that only those in Latin America with the highest income receive full access to preventive and specialized care. Middle-income patients receive basic care with limited specialty services, lower-income patients have only emergency services accessible to them, and poverty-level patients have virtually no access to eye care services.

Chacon stated that one of the major barriers to eye care for patients in Latin America is the lack of an optometric workforce. There are only 2.5 optometrists per 100,000 patients, compared to a 16.5 per 100,000 patient ratio in developed nations.

 He noted that a project in Ecuador 10 years ago had allocated millions of USD to aid in performing eye examinations in an effort to correct refractive errors.

“The problem at that time and today is the same problem: that they don’t have the workforce to do the examination because, as the primary eye care, they don’t have optometrists,” Chacon said. “They could [allocate] the money, but they don’t have the optometrists.”

Barriers that keep the pool of practicing optometrists from growing include educational disparities across Latin America. Puerto Rico and Colombia are the only countries in the region with universities offering doctorate programs for optometrists. Those pursuing the eye care profession can receive either a bachelor’s degree or a technician’s degree. In Ecuador, both degrees afford the same scope of practice but require different academic hours, with a bachelor’s requiring 5200 to 7400 and a technician’s requiring 2000 to 3200.

 Diagnostic limitations, difficulty with advanced technologies, and variability in quality of care are the result of training that is not standardized.

Much like the rest of the world, Latin America’s vision impairment rates are mainly caused by uncorrected refractive errors and cataracts. The World Health Organization (WHO) Vision 2030 Strategic Framework’s global goal is a 40% increase in refractive error coverage by 2030, a goal that Chacon finds lofty for the region. The WHO World Report on Vision from 2019 cites the next steps for Latin American as a 30% access to care improvement, a 40% avoidable impairment improvement for cases preventable through optometric care, and a regional collaboration potential including more than 20 countries.

“Those are the numbers that we have to work with in Latin America, and in the next years, we can do our best to improve the level of optometry and for the government to accept us as primary care and get to that number in 2030, but I’m not sure that we are going to get that,” Chacon said.

Chacon C. Optometry and Visual Impairment in Latin America: A Call to Action. Presented at: Optometry’s Meeting 2025; June 25-28, 2025; Minneapolis, MN.

World Health Organization Global Data on Visual Impairments. World Health Organization. 2020. Accessed July 8, 2025.

Hong H, Mújica OJ, Anaya J, Lansingh VC, López, Silva JC. The challenge of universal eye health in Latin America: Distributive inequality of ophthalmologists in 14 countries.

2016;6(11). doi:10.1136/bmjopen-2016-012819

Optometria. Federación de Optometristas del Ecuador. Accessed July 8, 2025. 

https://fedopte.com/#:~:text=La%20Federaci%C3%B3n%20de%20Optometristas%20del,ocular%20de%20la%20poblaci%C3%B3n%20ecuatoriana

WHO Vision 2030 Strategic Framework. World Health Organization. Accessed July 8, 2025.

Carlos Chacon, OD, MSc, FIACLE, cited economic and geographic barriers and nonstandardized education as the major barriers keeping patients from adequate eye care in Latin America.

Richard A. Adler, MD, FACS

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