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Catch up on the top stories in optometry during the week of August 18-August 22.

Takeaways from this week in optometry: August 18 - August 22

Articles

The DOT lens has now been launched across Asia-Pacific, Europe, and North America, with an estimated 500,000 fitted with DOT lenses in 2025 alone.

DOT lenses for slowing myopia progression worn by a total of 1 million children

The acquisition focuses on LayerBio's OcuRing-K technology, with plans to initiate the next clinical trial.

PainReform acquires majority equity interest in LayerBio

Researchers found that patients with primary open-angle glaucoma have less agmatine and thiamine in the aqueous humor than patients without glaucoma.

Molecules in aqueous humor may lead to biomarker discovery for glaucoma, according to study

Optometry Times delivers clinical news, practice insights, and research updates by optometrists for optometrists to advance care and patient outcomes.

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Clinical Focus

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Cataract Co-management-an OD’s perspective

Ergonomics of prescribing today’s and tomorrow’s premium IOLs

Results of a study based from Johns Hopkins School of Medicine suggest that participants who undergo second-eye surgery are likely to function better than those who undergo only unilateral surgery.

Cataract surgery in both eyes may boost benefits, study shows

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.

AOA 2025: Optometry and visual impairment in Latin America

The novel intraocular lens works to restore dynamic range of vision following cataract surgery.

US FDA gives Atia Vision go-ahead to begin clinical study of the OmniVu Lens System

The 3200 square-foot unit offers diagnostics, cataract surgery, YAG laser capsulotomy, and post op care.

SpaMedica opens relocatable diagnostic and treatment center in Hereford, England

The LuxLife full range of vision IOL is available in a range of cylinders spanning from +0.75D to +6.00D.

Bausch + Lomb's LuxLife IOL receives CE mark approval in Europe

Carolyn Majcher, OD, FAAO, details a Collaborative Care Symposium 2025 presentation given with Prethy Rao, MD.

CCS 2025: Collaborative retinal disease management in the preoperative refractive surgery patient

Carolyn Majcher, OD, FAAO, detailed in a Collaborative Care Symposium (CCS) 2025 presentation discussing retinal disease management in preoperative cataract and refractive surgery. The presentation, copresented with Prethy Rao, MD, focused on comprehensive patient care and interdisciplinary approaches to eye surgery. A critical aspect of the discussion was setting realistic patient expectations. Majcher emphasized that patients with retinal conditions need to understand potential vision limitations post surgery. The goal isn't always complete vision correction, but rather reducing dependence on corrective lenses. Majcher recommended supplementary strategies like using extra lighting, magnifiers, and contrast-enhancing devices to support patients with vision challenges. 

Collaborative care emerged as a central theme, with Majcher highlighting the importance of different eye care specialists working together. By combining perspectives from optometry and retinal specialties, providers can optimize patient outcomes and develop more comprehensive treatment strategies. Key clinical recommendations included performing thorough retinal examinations, particularly under dilation, to identify potential surgical risks. 

Majcher stressed the significance of multimodal imaging techniques like macular OCT, fundus autofluorescence, and wide-field color fundus photography to detect subtle retinal pathologies. Special attention was given to patients with specific conditions. For instance, those with diabetic retinopathy require extra preoperative screening, including macular OCT to check for diabetic macular edema. Patients with macular diseases might benefit from monofocal or light-adjusted intraocular lenses instead of diffractive premium IOLs. Majcher also recommended close communication between eye care professionals, considering low vision rehabilitation referrals, and using large-print educational materials to support patients with reduced vision. The presentation underscored the complexity of managing patients with retinal diseases undergoing eye surgery. By combining thorough examinations, advanced imaging, realistic patient counseling, and interdisciplinary collaboration, eye care providers can develop more personalized and effective treatment approaches. 

Majcher concluded by emphasizing that successful patient care requires a holistic, collaborative approach that considers individual patient needs, potential surgical risks, and long-term vision management strategies.

Videos

Conference

Jamie Kuzniar, OD, FAAO, FSLS, overviews the basics on what to look out for complications-wise in corneal transplant patients that may require a referral. 

AAOpt 2024: An OD's role. incorneal transplant management

Kuzniar provided an overview of her Rapid Fire session, "An OD's Role in Corneal Transplant management," that was presented alongside her colleagues Trevor Fosso, OD, FAAO, FSLS and Brooke Messer, OD, FAAO, FSLS, at the American Academy of Optometry meeting. Fosso's portion of the presentation addressed the post-operative management of corneal transplants. In some practices, optometrists may be responsible for managing these patients from the early post-op period through the first few months. Fosso shared insights on what to look for, including potential red flags and signs of poor healing that would warrant referring the patient back to the surgeon. 

Messer's portion focused on the challenges and best practices for fitting corneal gas permeable (GP) lenses on transplant patients. Since the graft tissue is often not uniform, fitting GP lenses on these eyes can be tricky. Messer offered pearls of wisdom to achieve successful GP fittings on transplant patients. 

In the final part of the Rapid Fire session, Kuzniar discussed the benefits and considerations of fitting scleral lenses on corneal transplant patients. While scleral lenses can be a great option, providing vault over the entire cornea, Kuzniar emphasized the need for closer monitoring. These eyes are more compromised, and she looks for signs of corneal edema, rejection, or irritation at the graft-host junction. Kuzniar explained that her monitoring protocol often includes mid-year check-ups, in addition to the initial fitting, to assess the health of the graft. She may also schedule a final check-up just before the warranty period ends on the scleral lens. 

Kuzniar encourages his transplant patients to return at any time if they notice issues, rather than waiting for their scheduled appointments. The key takeaways Kuzniar hopes the optometric community will gain are increased confidence in managing post-op corneal transplants, an openness to fitting corneal GPs on these patients, and an understanding of the importance of close monitoring when using scleral lenses on transplant eyes.

AAOpt 2024: An OD's role in corneal transplant management

Jack Chapman, MD, overviews the importance of nailing refractions and fitting processes for light adjustable lenses.

Who is the best candidate for light adjustable lenses?

Jack Chapman, MD, managing partner at North Georgia Eye Associates, an EyeSouth Partners affiliate practice, gives additional overview on identifying the best candidates for the light adjustable lens, optometrists' role in lens fitting, and how lock-in periods work for the lenses in an 

This transcript has been lightly edited for clarity.

Starting out, in order for someone to be a candidate for the light adjustable lens, they have to have at least equal to or greater than .75 diopters of astigmatism. Coming in and having the optometrist nail that refraction, get it right on the first time that the patient wants, and getting it done so that when you bring the patient into the [Light Delivery Device, or] LDD machine, then you put the lens on. You dial in that prescription, and you're going to have that low level ultraviolet light that's going to shape that lens. Somewhere around 350 nanometers is the wavelength that it responds at, allows to be able to shape that lens, both for the stigmatism in the sphere that you need to be able to make that first adjustment [and] be right where you need to be on that.

As we all know from our optics days, that if you have astigmatism, you got to be able to control that or else the astigmatic patient can take you down and put you into an area of spherical equivalent, or into the circle of coronoid, which gives you that spherical equivalent and doesn't get the full astigmatism. That's where that's got to be nailed down. The first one to be able to have the others be more successful [makes it] easier to accomplish the goal that you want to.

Our optometrists come in, and we have 1 that's been trained and understands and does a fantastic job of not only communicating well with the patients but being able to nail that first refraction and get that done out of the out of the gate. Interestingly enough, the adjustment that tends to be the most critical you would think would be distance, but we're able to nail the distance pretty much with the first adjustment. It's the near that people come in with. We figure where their near is and when they go and try it out, test drive it at home, they come back and say, "Oh, well, I'd like to have a little bit more up close, or I'd like to have a little bit more pushed out." And so it tends to be the near eye most of the time that we end up doing the second and third adjustment.

On the back end, there's 2 lock-in periods that have to be done to be able to freeze that lens where you are. During all of this, the patient is wearing glasses. We give them clear ones and we also give them sunglass ones that filter out that ultraviolet light so they don't get a stray ultraviolet light, causing that material to be sharpened in a misshapen way, if you will, to give us a correction. That's not what we want. 

There is a reported case out there. I haven't seen it, but I heard about it, of a person who was in that period who went to a tanning bed and went through a tanning bed. Of course, the lens went haywire and ended up having to have the lens taken out and another 1 put in, so that's an extreme case. We warn all of our patients not to go to a tanning bed. Other items that we look for are patients that are on any medications that may make them sensitive to light. Because anything that may make them sensitive to light, then they can have a negative response in the retina from the treatment of the ultraviolet light. We always look for that as well.

Jack Chapman, MD, weighs in on the importance of nailing refraction on the first visit to the optometrist's office in the light adjustable lens fitting process after identifying the best candidate.

Jack Chapman, MD, describes the post-operative process for patients receiving light adjustable lenses

How light adjustable lenses improve visual outcomes for patients with Dr. Jack Chapman

Post-operative care for cataract surgery patients that are fitted with the light adjustable lens (LAL) has gotten easier since 2018 thanks to ActivShield, according to Jack M Chapman, MD, of North Georgia Eye Associates, an EyeSouth Partners affiliate practice. He told 

in an exclusive interview that patients don't mind the extra follow-ups because they appreciate  the flexibility LALs give them to find what is comfortable for their eyes.

Hi everyone. I'm here today with Dr. Jack Chapman, managing partner and ophthalmologist at North Georgia Eye Associates. He's here to chat about the light adjustable lens, the only post-surgery customizable cataract lens on the market. Welcome, it's great to have you today.

Hello to you, too. I’m happy to be here.

North Georgia Eye Associates just recently reopened at the beginning of this year. Could you give us an overview of what went into the decision to integrate LALs into the practice with the reopening, and what that process was like for you guys?

It’s (LALs) been approved since 2018, but recently they had the approval of the newer version, which had ActivShield in it, which made the post-operative portion a lot easier. The fact that you can adjust the lens or customize it or allow the patient to test drive it, as we say, after surgery was big for us.

One of the things that we deal with, both us and our co-managing doctors out there, is the fact that we have a good surgery, we put the lens in, patient sees well for a week, and then their vision changes and then they're not seeing as well as they were. And so what happens in that regard is the lens enters into this thing we call ELP, or effective lens position, where the cataract is that big, the implants that big, and as the bag shrinks around the implant, it can nudge the lens a little bit and change its effective lens position, and thus induce a refractive error that wasn't there previously and gives the patient not the quite as good a vision as they had at the time. This is the part that is challenging for us because neither of us has any control over it.It's the tissues that are doing the work on that regard from affecting the vision.

The other item we deal with nowadays is we have a lot of people that are in that age range that have had LASIK done, and so they had LASIK to get rid of their glasses. LASIK was approved in 1995 and came aboard on 1996, so all those people from 96 on had LASIK and so we've got hundreds of them out there. Now, they're coming to cataract age. Well, they've been many years without glasses, that's why they had the LASIK to start with, and so now they're going to have a cataract. The cataract has caused their vision to go down, and a lot of times,they'll come in and say, ‘Oh, I think my LASIK is worn offand I need LASIK again.’ And we examineand say, ‘No it’s your cataracts that have grown,’ so we have to work on the cataract process. When they go through cataract, they haven't had glasses, so they are not real thrilled about going back into glasses. In order to be able to pretty much help them get to where they can be the best afterwards and to handle this effective lens positionor this refractive error that can occur after cataract surgery, is to have a lens like light adjustable lens, where we can put the lens in, have them heal up, get over the post-op period, and then start adjusting the lens, customizing it for that patient to dial them in. A lot of times, we tell them it's like going to have a dress fitted. If you're going to have a custom fit dress, you have togo through several fittings. You have a custom fit suit, you got to go through several fittings, same way with a light adjustable lens. We use that period to be able to dial them in so we can get them to as spectacle-free as we can, similar to the way they were pre-cataract after their LASIK.

With those additional fittings that are required or possible with LALs, how have they been received by patients that have received them so far?

The patients so far have really taken to it. They like the idea of having the lens customized and they're willing to commit to going through the process, just like they were going to have clothing customized. They got to go through the process, and so we explained it to them on the front end, that it's going to take three or four visits to do the adjustments on them, to get them dialed in. Then, they'll be able to go home, try them, test it out, test their vision, and then come back. If we need to do an additional adjustment, we'll do that for them. They like the idea that they're in control of their vision, that they can go home and then come back and tell us, ‘Oh, this is what I like, this is what I don't like. This is where I'd like to be.’ And then we show them how we can get them there through customizing and doing the adjustment. As far as results go with the light adjustable lens, 96% of patients are willing to go out and tell their friends and family how much they like it, so patients are very satisfied with this process.

Besides those additional visits, how has post-operative care changed for those patients receiving LALs?

You go through the normal post-op care like we would with anyone afterwards. We treat them and manage them appropriately, and use the appropriate eye drops to prevent infection, prevent inflammation. Once they get through the period, – 17 days is required minimum, but we do three weeks because it works out well — so that's 21 days that we go through, allowing time to make sure that the eye is healed and everything's settled down. There's none of the normal things that happen after cataract surgery. No residual corneal edema, no residual swelling of the macula, which sometimes we can see. But if those things do occur with the light adjustable lens, no problem. We just keep them using the UV protection lenses and wait till that resolves. There's no limit on time when you have to do it. You don't have to do it at that three-week period. You only start it if the patient is stable, but it gives us time to manage all that. Once that's quiet, then we come in and start the process.

Given this updated technology, what should optometrists keep in mind when they're referring their patients for cataract surgery?

The optometrist – we co-manage with a lot of optometrists out there– is able to talk to the patient and to gage what their aspirations are, where they want to be after surgery. And then whether they're a type of person that it’s okay to wear glasses or the type person who’s had LASIK previously, doesn't want to wear glasses again. This is how they can get there with that process and being able to assure as best we can that their vision is going to be able to be dialed in after surgery.

Was there anything else that you wanted to add that we haven’t touched on yet?

One of the issues with having to have something that's customizable after surgery, not only as previous people had LASIK and the effective lens position, but is the fact that your intraocular lenses come from the manufacturer only in half-diopter steps. With that half-diopter step, and then a little bit of parameter on either side, if you put in a lens, this doesn't necessarily mean that lens is going to put you right on the spot because of the half-diopter steps. To be able to compensate that with a light adjustable lens is very helpful.

We work together hand in hand with our optometrist to help do the adjustments after surgery, and this is where optometry shines because optometry is very, very good at doing refractions, being able to nail down, get that refraction right where it needs to be. When you're doing the adjustments, the very first adjustment is very much key. The lens is only adjustable from -2 to +2, so that's the range that you're working with. As far as the cylinder goes, it's adjustable for -75 up to -2 diopters of cylinder, and so those are the parameters that you're dealing with. As far as doing the near part in this, many of our patients want to have near as well as distance, and so we work with them on doing a mini monovision. We start out with a mini monovision, and then sometimes we have to do more of a monovision with the light adjustable lens. They have an LAL plus lens that is out now, which is what we're using, that gives a little bit of near on top of that. It's a type of change to the lens, and so we do not have to do as much of a correction on the up close part to get what we need so that way the disparity between the distance eye and the near eye is not as much. We're able to do that mini monovision, or do a monovision, adjusting it or customized for that patient and works very well. Of course, the dominant eye is the distance eye and the non-dominant eye is the near eye, but the good thing about the light adjustable lens, we do that, patient goes home and tries it doesn't like it, we can adjust it.

Absolutely, that’s all very vital information. Well, thank you very much, Dr. Chapman. I appreciate the time today.

Not much changes in terms of postoperative care for cataract patients that opt for the LAL besides additional follow-up visits.

How light adjustable lenses improve cataract surgery outcomes for patients with Dr. Jack Chapman

Tracy Lynn Schroeder Swartz O.D., M.S., FAAO, outlines her talk on comanagement at Optometry's Meeting

AOA 2024: Supercharged comanagement

In order to streamline referral efficiency for patients who may ask for or be good candidates for refractive surgery, Tracy Lynn Schroeder Swartz, OD, MS, FAAO, gives tips for optometrists in her talk "Supercharged Comanagement." She gave her talk at this year's AOA's Optometry's Meeting in Nashville, Tennessee.

 This transcript has been lightly edited for clarity.

Tracy Lynn Schroeder Swartz, OD, MS, FAAO:

Hi, I'm Tracy Lynn Schroeder Swartz. I work in a referral center in Huntsville, Alabama, and at the Congress this year I am lecturing on "Supercharged Comanagement." We are suffering a shortage of ophthalmologists, which is resulting in considerable wait times for our patients who we refer for surgery. In my hometown, patients often have to wait 3 to 4 months between the time that I referred them to the time that they actually have cataract surgery. Optometrists need to be aware of what the patient's status is prior to that referral for surgery. Now, whether that referral is for visual elective surgery like LASIK or SMILE, or cross-linking, or Phaco, or maybe phaco with MIGS, it's important to look at the patient's overall ocular health and determine if the patient is actually ready for surgery.

So I suggest using a really easy algorithm. The first question is, "Does this patient have ocular surface disease?" The second question is, "Does this patient have a normal cornea?" And then the third question is "Does this patient have cataracts?" Your patients aren't really going to be able to have any surgery if the ocular surface disease is significant or uncontrolled. We need to fix that prior to even talking about surgery with them because, for example, if you have a patient with severe keratitis and they want LASIK because they can't wear their contact lenses, it's an understandable desire for the patient. But from our standpoint, they can't really do LASIK if we can't control their ocular surface disease. So it's important to look at their keratitis, their lids, make sure that everything is as under control as you can get it before we proceed with that referral.

The second thing to consider is, does this patient have a normal cornea? Sometimes the patients will suffer from [epithelial basement membrane dystrophy, or] EBMD or maybe a pterygium that can directly impact the refractive error. And again, we can't address the refractive error; it's the cornea is the reason the refractive error is a problem. So we need to determine if the cornea needs to be corrected. For example, maybe a [phototherapeutic keratectomy, or] PTK or visually significant basement membrane dystrophy, or maybe a pterygium removal, or cross-linking for a progressive keratoconus prior to really discussing the surgery that the patient came to you about.

The last question is if the patient has cataracts. If the patient has cataracts, or maybe early cataracts, which we now call dysfunctional lens syndrome, that is also going to determine what type of surgery the patient would benefit the most from. If the patient has cataracts or don't really want to do LASIK or SMILE and if the patient has got glaucoma with cataracts, they may want to discuss MIGS with Phaco. So if you answer those 3 questions: Do they have ocular surface disease? Is a corneal normal? Do they have cataracts? Then you're going to be ready to refer that patient. It's important to remember that if you send a patient to a surgeon, and the surgeon says, "They're not ready, they need their ocular surface disease treated," you've actually just canceled someone else's cataract surgery because now your patient is going to have to go back and will have had 2 consultations for surgery instead of just one. So someone literally didn't have cataract surgery because you didn't treat their ocular surface disease and we don't want to make that mistake.

Tracy Lynn Schroeder Swartz, OD, MS, FAAO, overview the 3 questions to ask before referring a patient for refractive surgery.

Nick Bruns, OD, FAAO, talks refractive surgery, from premium IOL options for patients with cataracts to EVO ICL for patients seeking elective surgery.

AOA 2024: Exploring options in premium IOLs and refractive surgery

At AOA 2024, Nick Bruns, OD, FAAO, discusses the evolving landscape of premium intraocular lenses (IOLs) and refractive surgery in his upcoming talk. He emphasizes the importance of listening to patients to understand their visual needs and lifestyle, ensuring the best lens match and managing expectations. Bruns highlights the success of EVO ICL, a game-changing option with minimal complications and excellent visual outcomes, particularly for patients not suited for LASIK or other procedures. He advocates for considering a range of refractive surgery options beyond LASIK to provide optimal patient care.

Yeah, I'm Nick Bruns, I practice at Summit Eye Care in Milwaukee, Wisconsin. Yeah, so tomorrow I'm gonna be giving a talk on premium IOLs, kind of the changing landscape in premium cataract and refractive surgery. And so we're gonna cover a lot of different things about kind of how there's more of a trend towards refractive outcomes. I mean, back decades ago, it was a standard monofocal lenses, and patients were understanding that they'd wear glasses. But now, today's patient in 2024 no longer is accepting, you know, wearing glasses or needing glasses full time. So we're going to talk about different lens options, the pros and cons of every one, how we try to maximize these outcomes to really meet our patient's changing lifestyle. Everybody's got different visual demands. It's kind of a weird thing to think about: How do you use your eyes? And so everybody's very different. And so every lens, trying to fit that lens to the right patient is a really important thing that optometrists really have a huge key part.

So I think the biggest tip I have for trying to make that proper match is really listening to your patient. You really have to get down to what do they want to do? What are their hobbies? What are their lifestyles? Are they a big reader? Are they very active? Are they skiers or golfers? Each lens has different, you know, different priorities and different things that it can maximize. And so trying to maximize what the lens can do to match what that patient needs is really, really important in trying to get to know your patient. So I think there's really an interpersonal relationship between doctor and patient that has to be kind of taken to the next level to match that appropriately. Number one takeaway, I think, is really listen to what your patient is telling you.

Yeah, so if patients come back, and we'd like to think that every one of our patients is just super happy and super thrilled with their their outcome and their vision, but inevitably, unfortunately, we're forced to deal with some challenging situations because not every match is perfect. We're not 100%. And so when you get that patient back, and they're just not thrilled with their outcome, we want to do a couple things. Number one, we want to advocate for our patients, we want to make sure that we're listening to what it is they're complaining about. Is it a problem with the optics of the lens? Is it a problem with maybe visual or optical discomfort? Is there any pain or dry eye sort of symptoms? Or is it more of a buyer's remorse situation? Because remember, we're taking these patients now and turning them into consumers. There is an out of pocket expense for these procedures. So they have really high expectations.

And so again, it goes back to listening. That is the number one takeaway of the entire lecture; it's going to be listen to your patient, try to hear exactly what it is. And don't run away from it. You don't want to be defensive. You know, if there's a patient complaint, it's not personal. You've got to be a teammate with your patient and try to work together to find a solution, if there is one.

And sometimes time is the best medicine. Neuroadaptation really takes weeks to months; it can take years. And so sometimes time is the best medicine. You don't have to rush to the OR or rush to the YAG laser to do a YAG capsulotomy.

So EVO ICL has been a huge game changer for us. So we've worked in Milwaukee with the Visian ICL for a long time, had fantastic outcomes. But back in 2022, when EVO was introduced, it really has opened up this whole world of refractive candidates. So the complication rates have plummeted. There's rarely any complications with EVO ICL. The visual outcomes are just impeccable. I mean, we're actually gaining lines of visual acuity from contact lenses or glasses because of where we're correcting. We're correcting vision at the nodal point of the eye, which is right at the anterior plane of the crystalline lens.

So the optics are fantastic. The complications are slim to none. And so we're really able to capture this whole portion of patients who are searching for options when maybe LASIK is not a good option, or maybe PRK is not a good option or SMILE because there are reasons that those procedures aren't 100% available for certain patients. And so we have EVO that really can open up this other subset of patients. So EVO, we kind of think of it as our more high myopic patients subset, but in reality, we have really good outcomes with mid to moderate myopes that really compete with the outcomes of LASIK. And the cool thing about EVO that patients love is that it's completely reversible. So if patients aren't really happy, never had anybody come back and ask us to take the lens out, but if they want it out, we could do it.

I think there's been a slower adaptation of it in the surgical space because of the complications that that existed with the Visian. There were complications; we saw them. There were things that did happen and they were less than, you know, fun things to go through from a clinician standpoint and a vision standpoint, obviously. And so I think there's still this sort of hesitation. Surgeons are aware of those complications and they're just a little bit gunshy. EVO has completely eliminated those complications. We don't see secondary glaucoma anymore. We don't see premature cataract formation anymore. It just the inclusion of the central [KS-]AquaPORT has eliminated all of it. A simple inclusion of a 360 micron hole has completely taken those complication risks away. So I think there's still a little bit of gunshy but if you actually look at the trends that is becoming much more and more, I think the gunshyness is going away. And so you're gonna see EVO, a lot more prevalent in the next couple of months to years. It's not going away.

My only recommendation, one of my recommendations would be to not think of refractive surgery as LASIK. Sometimes I think especially newer doctors, think of refractive surgery and LASIK as being synonyms. They are not. LASIK is a subset of refractive surgery, but there's a whole bunch of different options. EVO ICL is one of the, in my opinion, one of the best, the safest, and visually advantageous options that we have.

Nick Bruns, OD, FAAO, talks refractive surgery, from premium IOL options for patients with cataracts to EVO ICL for patients seeking elective corrective surgery.

cataract surgery in keratoconus at IKA 2024

Elizabeth Yeu, MD, Executive Board Member of IKA, and a cataract and refractive surgeon at Virginia Eye Consultants, talked about cataract surgery in keratoconus, and the diagnostic considerations clinicians can take before and in the operating room. 

Editor's note: The below transcript has been lightly edited for clarity.

My name is Elizabeth Yeu. I'm a cornea, cataract and refractive surgeon at Virginia Eye Consultants. And we have had a wonderful time here at the second annual International Keratoconus Academy annual meeting. With that we've had some excellent discussions surrounding the perioperative considerations for cataract surgery in our keratoconus patient. So as we know, the cornea naturally will crosslink over time with age, just as any part that has collagen, like our joints. But not all the corneas that we see are naturally cross-linking, especially if patients are eye rubbers. So that is something that we do take into consideration depending on if they are patients that are ours to begin with, or if it's a first-time referral. So when we do evaluate these patients, these are very important historical pieces of information that we need to gather. If their vision is correctable in spectacles versus contact lenses, and what type of contact lenses, and of course, their goals. If they're looking for uncorrected vision, etc.

Diagnostically, we know that these are some of the toughest patients in terms of reading and getting consistent values. And it is a great thing if we can get their manifest refraction to have at least meridian alignment with what we see from their different diagnostic values. For example, their advanced optical biometry and their topographic values with their tomography. So if their meridian at their manifest and in their spectacles is at 110 degrees, and we see that it is traveling, even if a little irregular, but at about 110 degrees. That also helps us know that at least there is alignment there versus totally irregular astigmatism.

And finally, it also is helpful to know if they were able to achieve some level of decent spectacle corrective vision in soft contact lenses and glasses, versus if they were completely dependent on using scleral lenses. That also tells a different story in terms of the diagnostic pathway of what we would do at the time of cataract surgery. And sometimes doing a contact lens over refraction can be also very helpful in determining what part is cornea and what part is a cataract. Particularly if this is a new patient to us. With that being said, we know that eyes that are steep have a lot of negative spherical aberration. And so it's helpful for us to either use a zero sphericity IOL. And if possible, if they were able to achieve good correctable vision at some point or decent correctable vision, we can use a zero sphericity toric IOL in order to help them achieve some level of uncorrected vision. Otherwise, using a monofocal with zero sphericity in it is probably going to be a great way to go. Or you can even use a positive aspheric IOL monofocal in order to help neutralize what is going on into the cornea. And obviously there's also the light adjustable lens as a monofocal that can be helpful. And then now in this whole new class of small aperture IOLs, if they have a normal macula, and they are good, otherwise they're not too dry. This is a great new off label indication where small aperture IOLs have helped us to actually open the possibility. I have had some of the happiest patients who start with poor uncorrected vision and are able to have this great extended depth of focus, even if they have more than one and a half diopters of astigmatism to start with because the small aperture still provides the ability to actually block out the peripheral irregular coma rays.

So with that being said, you know, it is so great that we do have more understanding that there are great IOL formulas like the Barrett True-K for keratoconus and the Kane for keratoconus and these different breadth of lenses and we are taking this into consideration for our keratoconus patients in cataract surgery.

IKA 2024: Diagnostic considerations for cataract surgery in keratoconus patients 

Anthony Wallace, Vice President and General Manager of the US Surgical Business at Bausch + Lomb, discussed the introduction of SeeLuma, a fully digital surgical visualization platform, and more at the 2023 ASCRS annual meeting in San Diego.

Hi everyone. My name is Anthony Wallace and I'm the Vice President and General Manager of the US Surgical Business at Bausch + Lomb. We're really excited to be here with you this week at ASCRS to share some of our latest updates that we're coming to the market with. The first is the introduction of SeeLuma. SeeLuma is our fully digital surgical visualization platform. SeeLuma offers optical surgeons a new level of visualization, compared to optical, hybrid and retrofitted microscopes. Some of the key features of SeeLuma include a heads-up 3D monitor, multiple digital display options, and an intuitive interface that really leads to outstanding surgical visualization, ergonomics, workflow, and a truly immersive educational experience. Built for the most complex surgical cases, SeeLuma is available in the United States as well as in Western Europe, and we soon plan to bring SeeLuma to additional markets in the near future.

In addition to SeeLuma, we recently announced the launch of StableVisc cohesive OVD as well as TotalVisc OVD System. TotalVisc is the only available dual-pack, cohesive and dispersive OVD in the United States that is formulated with sorbitol. Sorbitol is a chemical agent known to have excellent physical barrier capability as well as increased free radical scavenging capabilities. With the recent acquisition of AcuFocus, our portfolio now includes the Apthera IC-8 IOL. The Apthera IC-8 is the first, and only small aperture, nontoric extended depth-of-focus IOL for select cataract patients with as much as 1.5 diopters of corneal astigmatism, who wished to correct presbyopia at the same time. We're really excited about some of these updates and sharing additional information with you and we look forward to continuing our partnership and helping patients see better to live better. Thank you.

ASCRS 2023: The introduction of SeeLuma and more

Brian Shafer, MD, recapped his presentation and findings on the safety of office space cataract surgery with the Ophthalmology Times© team at the ASCRS annual meeting in San Diego.

Hi, I'm Dr. Brian Shafer coming to you live from ASCRS 2023. I'm a cataract refractive cornea and glaucoma surgeon with the Shafer Vision Institute and I'm excited to talk to you about corneal ulcers. 

We know that corneal ulcers are something that bogs down all of our clinics, It's usually that Friday at 5pm that walks through the door. And when a bad corneal ulcer comes through the door that's greater than one millimeter, central. And we know that we need to culture it and start fortified antibiotics. It's really difficult. 

The culturing piece is often done in our office. But when it comes time to get the fortified antibiotics, we're often sending our patients greater than an hour away, calling up this compounding pharmacy and trying to get this drug into their hands so that they can get it into their eye. 

For the first time ever we have fortified antibiotics that we can stock on our shelves. Harrow Pharmaceutical now has Fortisite, which is fortified tobramycin and vancomycin. That we can stock on our shelves and dispense to our patients via a 503B pharmacy. And if that doesn't work out for you, you can do a 503A pharmacy and get it to them the very next day. We finally have the opportunity to treat these bad corneal ulcers, right in our clinics from the moment that we see them.

Brian Shafer, MD, discussed Fortisite and the ability to treat corneal ulcers at the 2023 ASCRS annual meeting in San Diego.

ASCRS 2023: Fortisite for corneal ulcers

Lance Kugler, MD, recapped his presentation and findings on the safety of office space cataract surgery with the Ophthalmology Times© team at the ASCRS annual meeting in San Diego.

I'm Lance Kugler. I'm here at ASCRS 2023 presenting a deeper look at complication rates in office space surgery centers. This has been a really hot topic for the past couple of years because of the rapid expansion of office space cataract surgery in the United States. and one of the top questions that patients ask is, is it safe? And so we looked that. In this particular study is 18,000 eyes in the study, looking at complication rates at centers across the United States. And, what we found was the complication rates were the same better than published, accepted complication rates, cataract surgery in seasoned hospitals.

The other thing that comes up a lot about office space surgeries centers is the concept that, a lot of people think that we're making the, that the sicker patients aren't being done there. And so, we looked at, in this paper, we looked at how many of these patients have comordidity, and we actually found that 62% of patients that we looked at had comorbidity, yet they were included in that same safety view. So, the conclusions of the study were that cataract surgery in office space setting is as safe or safer at your hospital.

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