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In this podcast, experts Quan Dong Nguyen, MD, MSc; and Cecelia Koetting, OD, FAAO, DipABO; discuss the diagnosis, staging, and treatment of NK, focusing on early-stage disease.

Neurotrophic Keratitis: Multidisciplinary Approaches to Enhance Patient Outcomes

In this podcast, experts Deborah Ristvedt, DO; and Melissa Tawa, OD, FAAO, discuss individualizing glaucoma therapy with selective laser trabeculoplasty and sustained-release drug implants, providing key take-home insights for optimizing glaucoma management across diverse patient profiles.

Navigating the Glaucoma Therapeutic and Surgical Landscape from Conventional to Cutting Edge

Articles

In addition to Prevent Blindness’s usual free resources, the organization is providing a dedicated webpage, fact sheets, and graphics in both English and Spanish.

Prevent Blindness declares July to be Dry Eye Month, provides patient resources

In this podcast, experts Marc R. Bloomenstein, OD, FAAO; Cory J. Lappin, OD, MS, FAAO; and Selina R. McGee, OD, FAAO, discuss the roles of ophthalmologists and optometrists in managing DED in an evolving treatment landscape, from screening and diagnosis to disease management.

Practical Approaches to Modern Dry Eye Treatment and Management

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Dr. Tullo is the vice president of clinical services for TLC Vision and adjunct assistant clinical professor at SUNY College of Optometry.

The femtosecond laser has brought many significant advances to eye surgery. For more than a decade, it has been used to create lamellar corneal flaps for laser in situ keratomileusis (LASIK), and more recently this laser is used to precisely perform several steps in cataract surgery.

Will the SMILE procedure replace LASIK?

One of the most common questions I hear every day from patients is, “What is new in refractive surgery?” I have asked Jim Owen, OD, an expert in refractive surgery technology, to discuss the latest version of LASIK-topography-guided LASIK-with David Geffen, OD, FAAO, who participated in Alcon’s Contoura Vision clinical trials.

Topography-guided LASIK provides personalized vision

Ashley Mills, CEO of The Vision Council, gives insight into the decision to move to a single annual meeting and shares the vision for the meeting going forward.

Vision Expo: Q&A with The Vision Council CEO Ashley Mills on big changes coming to the meeting

announced a strategic shift to a single, annual Vision Expo beginning in 2026

. Ashley Mills, CEO of The Vision Council, shared that this isn’t merely a consolidation; it's a strategic evolution aimed at strengthening the industry’s premier event and delivering even greater value to exhibitors, attendees, and stakeholders.

“We’ve spent years listening to our community and reviewing data. What emerged was a clear desire for 1 powerful, unified event—a true industry touchstone,” said Mills.

Vision Expo has long served as a centralized platform where professionals across the optical spectrum gather to see product launches, connect with peers, and access education. In today’s demanding economic and regulatory environment, the Vision Council’s goal is to maximize the value of every minute spent at the event.

Beginning in 2026, Vision Expo will take place annually in Q1, which is a deliberate decision to establish it as the North American launchpad for the entire optical industry. Exhibitors have already committed to holding major product releases for this event, ensuring it becomes the primary showcase for the latest technologies, designs, and initiatives.

The decision aligns with broader changes at The Vision Council itself. Mills highlighted the organization’s efforts to become more inclusive and reflective of where the industry is headed:

The addition of an Optical Retail Division to better represent patient-facing sectors.

The inclusion of health care and technology members, acknowledging the industry's convergence with medical and digital innovation.

This more comprehensive representation will be mirrored in the future Vision Expo, ensuring a platform that unites all segments, from manufacturing and retail to tech and clinical care.

Recognizing regional attendance patterns from the former East and West events, the new annual Vision Expo will rotate locations across the US to maintain accessibility:

2026: Orange County Convention Center in Orlando, Florida

2028: The Javits Center in New York, New York

This rotational model ensures all regions of the country have access to this critical industry event.

One of the unique elements of Vision Expo is that it directly fuels the mission of The Vision Council. Revenue from the show supports:

Advocacy efforts in Washington, DC (eg, recent tariff discussions with the White House)

World-class data and research programs to guide optical businesses

Consumer awareness campaigns, such as National Sunglasses Day and other public health initiatives

“Vision Expo isn’t just a trade show. It’s the economic engine driving industry-wide growth,” Mills emphasized.

As the optical industry faces increased complexity and opportunity, Vision Expo’s next chapter offers a centralized, future-focused event that fosters innovation, collaboration, and growth.

“This is the time to unify, fortify, and amplify the vision industry," Mills concluded. "We’re proud of what Vision Expo stands for, and we’re ready for what comes next.”

Ashley Mills, CEO of The Vision Council, gives insight into the decision to move to a flagship annual meeting and shares the vision for the meeting going forward.

Conference

Vision Expo: Q&A with Vision Council CEO Ashley Mills on big changes coming to the meeting

The recent 2024 Impact Report released by VSP Vision highlights an increase in the percentage of frames made from sustainable, recycled, and biobased materials by the company. VSP has a goal of producing 50% of its eyewear frames from sustainable materials by 2025, and has documented a current percentage of 53%, according to a news release. This marks a 61% increase from 2023.

“I’m incredibly proud of the thousands of VSP employees whose dedication and sense of care are what drive these programs,” said VSP Vision President and CEO Michael Guyette in the release. “I’m also grateful for the members, clients, and doctors whose engagement with VSP makes all of this possible. This year, we will continue to build on the work of the past as we mark our 70th anniversary, a milestone that serves to remind us all about the potential we can achieve together.”

As part of its sustainability efforts, VSP switched to producing sustainable demo lenses made from 100% recycled postconsumer content and is GRS-certified. The company has also discontinued using polyvinyl chloride nose pads, commonly used in the eyewear industry. Greener packaging solutions were also implemented in the use of polybags that are made from 100% recycled postconsumer content and GRS-certified, which diverted 31 tons of plastic from landfills in 2024. VSP has diverted 66 tons since 2023.

Additionally, VSP has invested more than $11.3 million in direct and in-kind funding with the goal of increasing equitable access to vision care in 2024. Last year, the company provided 252,000 people in need with access to free vision care through its VSP Vision Eyes of Hope initiative. In total, the program has now helped more than 4.3 million patients. In 2024, 201,000 pairs of eyewear were donated, making the program’s total 2.9 million.

The company also invested $695,000 in relief to communities affected by Hurricanes Helene and Milton, among other natural disasters. The total donated for disaster relief is now $21.4 million. Scholarships and grants were also supported in the investment of $335,000 in 2024 for optometry students, with more than $4 million invested to date.

Other academic initiatives taken on by VSP last year include the launching of the Future Leaders Academy, a professional development program for recent graduates and early-career optometrists, which works to develop leadership skills.

On the inclusion front, VSP cited an improved onboarding process for new employees, which has led to retention rates 17% above industry standards. As a result, VSP won the Training Magazine APEX Award and Great Place to Work Certification. In partnership with VSP Business Resource Groups, VSP also launched the “Special Fit” page on its online eyewear store Eyeconic. The page supports patients with Down syndrome and other patients who may need large or small fits, low bridge, or high prescription.

VSP employees also showed out to volunteerism opportunities in 2024, rising by 41% to over 16,200 volunteer hours that helped raise $506,000 for almost 1500 nonprofits.

VSP Vision releases 2024 Social Responsibility Impact Report; exceeds sustainable eyewear frame goal. News release. VSP Vision. June 23, 2025. Accessed June 24, 2025.

The company is producing 53% of its eyewear frames from sustainable materials, according to VSP's 2024 Impact Report.

VSP Vision surpasses sustainable eyewear frame goal

The Contact Lens Institute (CLI) has published a new comprehensive report investigating how and why individuals seek information about contact lenses through online resources.

 The Digital Discovery: Consumer Searches Reveal Contact Lens Realities report is the latest of CLI’s 

“Patients are posing questions about contact lenses to search engines, artificial intelligence [AI] platforms, and social channels that they may never raise in the exam chair. By understanding what’s being asked, eye care practitioners and staff can reconsider how they’re presenting contact lens wear, care, and purchase options,” said Stan Rogaski, CLI’s executive director, in the release. “Based on preliminary findings that we shared earlier this year, some practices are already adjusting how they’re communicating with and educating wearers, plus evolving their practice management techniques. This report goes much further, with perspectives that are broadly applicable.”

The report examined the most common contact lens searches via Google auto-complete results, 65% of which were reported as purchase driven. Not only were search behaviors examined in the US and Canada, but common questions asked by patients were also researched to reveal patient challenges. These may suggest that the contact lens community could benefit from increased focus on health and safety, cost, wear and care, and how brands differ, the release stated. The report also relayed the importance of optimizing a practice’s website for location-based search, in addition to liberally include the term 

into digital content, which is reported as the preferred shorthand used by patients when searching for clinical sources online regarding contact lenses.

Large language models including ChatGPT, Copilot, and Gemini were also assessed in the adoption of AI platforms in how they handle contact lens queries. CLI’s report found that AI platforms’ ability to provide the best sources of information is often inconsistent. Therefore, the organization recommended that eye care providers have preemptive conversations concerning AI-generated results with patients who frequently use AI platforms. According to the National Bureau of Economic Research, 40% of US adults aged 18 to 64 years use generative AI, with Leger reporting that 47% of Canadian adults have used AI tools.

The report also examined searches made for different contact lens modalities, insertion and removal guidance, part-time contact lens and glasses wear, regional and global differences on X (formerly Twitter), and the use of non-English languages. The report also included “how to” columns from 16 CLI Visionaries in order to offer practical advice on using the data and insights from the report in practice.

“Our latest report delivers a snapshot of what may be on the minds of the person considering contact lenses for the first time as well as new and longtime wearers, helping the thousands of professionals in eye care remain 1 or more steps ahead as the ultimate experts,” Rogaski said in the release.

New report investigates why consumers search online for contact lens information. News release. Contact Lens Institute. June 23, 2025. Accessed June 23, 2025.

The report examined the most common contact lens searches via Google auto-complete results, 65% of which were reported as purchase driven. 

New CLI report investigates the "how" and "why" of online searches for contact lens information by patients

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

Aldeyra resubmits NDA for reproxalap, aiming to address FDA concerns and demonstrate efficacy in treating dry eye disease symptoms.

Canonical

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

At this year’s Association for Research in Vision and Ophthalmology (ARVO) meeting in Salt Lake City, Kayla Karpuk, OD, presented compelling new research on the impact of perfluorohexyloctane (PFHO) ophthalmic solution (Miebo; Bausch + Lomb) on preoperative biometry and intraocular lens (IOL) power calculations. Her poster, titled “The Impact of a Single Drop of Perfluorohexyloctane Ophthalmic Solution on Biometry Measurements and Intraocular Lens Calculations,” addressed a timely and clinically relevant question: Can a drop of PFHO, known to persist in the tear film, influence the precision of keratometry and ultimately affect surgical planning?

Karpuk’s prospective observational study investigated this by analyzing biometry measurements in subjects with dry eye before and after a single instillation of PFHO. With both OCT-enhanced and Scheimpflug imaging used to track changes at 15 and 60 minutes post-instillation, the findings offer reassurance for surgeons—demonstrating that PFHO has no significant impact on preoperative measurements critical for successful cataract outcomes.

In this Q&A, Karpuk shares insights into the study design, clinical implications for cataract and refractive surgeons, and how this research contributes to the growing body of dry eye science showcased at ARVO.

For those who weren’t able to attend ARVO this year, can you detail the parameters and methods of the research featured in this poster?

This prospective study looked at pre-operative biometry measurements of approximately 60 eyes of 30 subjects with healthy dry eye parameters at baseline. Biometry measurements were obtained prior to instillation of PFHO and compared to measurements obtained 15- and 60-minutes post instillation. Keratometry measurements were obtained using both an automated OCT-enhanced method as well as Scheimpflug corneal images.

How did the actual performance of preoperative PFHO compare to your expectations?

It was an important concept to better understand; we know from the rabbit PK data the PFHO molecule was detectable in the tears for up to 6 hours post-instillation. We wanted to better understand how a drop that is made from 100% of a single molecule, such as MIEBO, and detectable in the tears for a prolonged period of time, would impact measurements. The results of this study were consistent with what we expected—use of PFHO and presence of the PFHO molecule in the tears does not have an impact of biometry as a majority of patients in the study did not demonstrate a significant change in keratometry measurements 60 minutes post-instillation.

This is a prospective, observational study. What are the next steps in this research? 

The value of treating the ocular surface prior to any cataract or refractive cataract procedure is well established and future research could involve evaluating perioperative use of PFHO in these patients to better understand the value of this treatment option.

What immediately-applicable clinical advice does this research yield, especially for cataract/refractive surgeons who hope to limit the prevalence of dry eye disease among their patients?

I think this particular study provides strong evidence that use of MIEBO preoperatively does not negatively impact biometry measurements and ultimately does not lead to less predictable IOL power calculations for patients.

It helps to rule out that changes seen in pre-operative corneal measurements would be due to the treatment, or molecule itself per se, but rather stabilizing the underlying disease state is what helps ensure we are getting the most reliable results ultimately leading to successful cataract patient outcomes.

What was the response to these findings at the meeting? How do you think this research fits into the broader landscape of clinical dry eye research presented at ARVO, especially this session?

Dry eye disease is a hot topic and the interest in dry eye was palpable at ARVO. We are very fortunate to have had multiple new topical therapies come to the market in recent years with more on the horizon. As new treatment options are introduced, it is critical to better understand what patients would benefit from each treatment option to tailor and further individualize approaches to treatment of dry eye.

Can a drop of perfluorohexyloctane, known to persist in the tear film, influence the precision of keratometry and ultimately affect surgical planning?

Evaluating the effects of perfluorohexyloctane on biometry: A Q&A with Kayla Karpuk, OD, from ARVO 2025

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.

William Tullo, OD

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