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The lesion area growth was reduced by more than 50% in its first human clinical trial of K8.

Inflammasome inhibitor found to reduce GA lesion area growth in clinical study

The beauty of this conference is its collaborative and comprehensive nature. 

EyeCon 2025: A comprehensive tour of the eye for the comprehensive ophthalmologist/optometrist

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Catch up on the top stories in optometry during the week of September 8-September 12.

Takeaways from this week in optometry: September 8- September 12

Long-term atropine use to treat myopia associated with increased risk of ocular complication in schoolchildren in Taiwan

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Today, the surgical correction of refractive error is most commonly performed on the cornea. LASIK surgery is the most popular form of refractive surgery in the U.S. with more than 16.5 million procedures performed to date.1 For many of our patients, LASIK may be the best surgical option, but sometimes removing tissue from the cornea may not be the best surgical option.

Identifying candidates for non-corneal refractive surgery

Chandra Mickles, OD, MS, FAAO, FSLS, the North America professional education lead on myopia with Johnson & Johnson Vision, sat down with 

® to debunk some of the common orthokeratology (ortho-k) myths.

Before diving into the debunking, Mickles described ortho-k as “a fitting process of specially designed gas permeable lenses” that “reshape the cornea” of a patient’s eye—all while they sleep—promoting correction-free, clear vision.

I think most [individuals] think of the freedom, the flexibility, that having correction-free, clear vision provides. But ortho-k does so much more than that. Many studies have shown that it slows the progression of myopia …. Patients who wear [ortho-k lenses] have better vision-related quality of life than patients who wear soft contact lenses and spectacles. [Ortho-k] has also been shown to improve self-esteem. I even hear from parents of children who wear these lenses that one of the great benefits is that they don’t have to worry about their children losing their glasses or breaking them or losing their contact lenses.

The biggest [expectation] is having that clear vision. But to be honest, it’s not that they’re going to have it 30 minutes after the exam is over. What we typically expect is, by the next day—depending on how their prescription is—or after a couple of days, their vision will be clear during the day. It does take some time. It’s not like soft lenses: You put them on during the exam, and now you have clear vision. It does take a little time for that shaping to happen.

[Ortho-k] is kind of like a retainer; I use that analogy a lot…. It does take a little time to really shape it and make it semipermanent. But unlike surgery, this isn’t permanent. After you say, “Well, I don’t want to have this anymore,” a patient can stop wearing the lenses and then their eyes go back to their original shape.

What are some common misconceptions of ortho-k that might be keeping doctors from fitting these lenses?

It amazes me that despite these benefits, there are very few doctors who are fitting ortho-k lenses—less than 8% of doctors in the [US] …. The literature shows that the key myths holding them back from fitting are that they believe that parents aren’t interested, they think that ortho-k may not be safe, and they think it is complicated and time consuming.

Ortho-k is safe. If you think about anything foreign that you’re putting on the eye—like a contact lens—of course it’s going to increase the risk for infection, but that risk is very low.

If we look at the risk of microbial keratitis [MK], which is what most doctors are concerned about, it is 1 in 5000 patient-wearing years for daily disposable soft contact lenses, and then approximately 1 in 1000 [patient-wearing years] for reusable soft
contact lenses and ortho-k.

Essentially, what that means if I turn that around, is that if a patient wears an ortho-k lens every day for 1000 years, they have 1 chance of probably having [MK] or having an infection. If you think of it that way, that’s a really low risk.

If we just look at children, there are studies—[including] 1 study that I was a part of—looking at children [aged 8 to 12 years]; they have a lower risk of developing infections compared with adults and teens. That’s probably due to better [adherence to] care and wear with a parent’s supervision.

Overall, yes, ortho-k is a very safe contact lens option that doctors should recommend for their patients.

And I think another piece [is] that a lot of times doctors think soft lenses are safer than ortho-k lenses. But when we compare a daily wear of soft reusable lenses and ortho-k [lenses], based on the latest studies, they essentially have the same risk.

And it may be now that even ortho-k has a lower risk of MK than daily wear of soft, reusable contact lenses.

Is ortho-k complicated and time consuming?

There are doctors my age or older—when we think back to being in school—we went through this long process of trial and error of fitting these lenses.

But now, ortho-k fitting has come a long way, where there have been advancements that make it not so complicated [or] time consuming, such as the designs.

There has also been an improvement in the technology that we use to fit the lenses, such as topography. Also, now there is computer-based software available to help with designing the lens. All of this has helped [ortho-k] become not as complicated [or] time consuming as we originally thought when they came out on the market.

Yes. And the crazy thing is that when I looked at literature on this—and all of this
is just published this year and in 2021—[uninterested parents are] a top reason holding doctors back.

A few years ago, I was [a] lead investigator on a multicenter study looking at parents’ knowledge and perception of myopia and myopia management. What we found was that 70% of the parents in that study were interested in myopia management; they just need to be educated about it.

And then when we dive in a little further, the top choice of the treatment options for myopia management was ortho-k, which I’m sure [was] surprising for a lot of practitioners. So [parents are] interested, and when I ask my peers, they’re like, “Yeah, Chandra, most of my patients, once I ask them about it, they jump on board, for sure.”

The education is a huge piece. I did an event [recently], where I brought in a parent of a patient, and she’s just surprised that more doctors aren’t sharing with patients and parents about these lenses [and] all the great benefits.

It’s been so helpful for her twin boys who are wearing ortho-k lenses during the evening, and she’s like, “I tell all my friends about it.” I think we just need to do a better job at educating our patients.

Yes, it is cost-effective. Considering that parent again, she opened my eyes to something I didn’t always think about. But when you think about it, especially children—and they’re constantly breaking their glasses—then it makes ortho-k a lot more cost-effective. And then if you even compare it to surgery, ortho-k is more cost-effective …. All the benefits outweigh any of the costs. When I think about all the specialty lenses out there, [ortho-k] is right in line with the cost of those lenses, and I think it’s well worth it for sure.

What do you hope our audience takes away from this discussion?

Now [that] we know that ortho-k lenses have all these benefits, I think all doctors—or as many as possible—should jump on the opportunity to utilize these lenses to help their patients. Because their misconceptions aren’t true. Yes, parents are interested, ortho-k is safe, and it isn’t as time consuming or complicated as we originally thought.

Financial disclosure: Chandra Mickles, OD, MS, FAAO, FSLS, is an employee of Johnson & Johnson Vision"

Black Eyecare Perspective

Eyecare practitioners' top misconceptions just may surprise you.

Debunking common ortho-k myths

The trial will evaluate the solution in treating significant, chronic night driving impairment in keratorefractive patients with reduced mesopic vision.

Opus Genetics doses first patient in phase 3 LYNX-3 trial evaluating phentolamine ophthalmic solution 0.75%

The lens portfolio includes spherical, aspheric, toric, multifocal, multifocal toric, reverse geometry, and keratoconic contact lenses.

Bausch + Lomb launches ASANA gas permeable lenses in the US

Calista Ming, OD, FAAO, FSLS, provides 3 cases of how to fit specialty lenses at the right time for patients.

First, next, last: Timing of specialty lenses  for patients with keratoconus

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

PainReform acquires majority equity interest in LayerBio

With this expansion, BostonSight reinforces its commitment to advancing care for patients with severe ocular surface disease and irregular corneas.

BostonSight expands clinical trials capabilities for optometric and ophthalmic research

Clark Chang, OD, MSA, MSc, FAAO, gave a presentation alongside Susan Gromacki, OD, MS, FAAO, FSLS, at this year's Optometry's Meeting.

AOA 2025: Keratoconus contact lens fitting before and after surgery

Clark Chang, OD, MSA, MSc, FAAO, delivered a lecture on keratoconus contact lens fitting, focusing on management before and after surgical interventions. The presentation, copresented with Susan Gromacki, OD, MS, FAAO, FSLS, highlighted the significant advancements in treating this complex corneal condition. Chang emphasized that recent developments in corneal collagen cross-linking and contact lens technologies have dramatically improved keratoconus management. However, he stressed that early detection and treatment remain critical. When early intervention fails, multiple treatment options exist to enhance patient outcomes. These options include:

The lecture featured a compelling case study of a patient who underwent penetrating corneal keratoplasty within the past 12 months. The patient mistakenly believed the surgery would eliminate the need for corrective lenses. In reality, optimizing vision post surgery requires specialized contact lens management. Initially fitted with a profilometry-guided scleral lens, the patient reported persistent visual disturbances, including halos and glare. A detailed examination revealed significant higher-order aberrations, specifically vertical coma and secondary astigmatism. The innovative solution involved applying a high-order aberration (HOA) guided optical patch to the lens surface. This intervention yielded remarkable results:

Eliminated patient's halo and glare complaints

Combination management is crucial in complex cases

Early intervention with corneal cross-linking can prevent more invasive surgeries

Advanced lens fitting techniques can dramatically improve patient outcomes

The presentation concluded by highlighting the importance of comprehensive, personalized approaches to keratoconus management, emphasizing that surgical intervention is not the end of the treatment journey, but often just one step in ongoing vision care.

Videos

Conference

Janna Pham, OD, shares key takeaways from a corneal tomography session she presented alongside Travis Pfeifer, OD, and Matthew McGee, OD.

AOA 2025: Is it keratoconus or a bonus diagnosis?

At the 2025 AOA Optometry’s Meeting, Janna Pham, OD, delivered an insightful and engaging lecture titled, "To be or not to be: keratoconus or a bonus diagnosis," presented alongside Travis Pfeifer, OD; and Matthew McGee, OD. The session addressed a topic that continues to challenge and intrigue optometrists: how to confidently diagnose keratoconus and differentiate it from similar corneal irregularities.

Pham began by reviewing the fundamentals of keratoconus—a progressive, degenerative corneal disease characterized by thinning and conical protrusion of the cornea. Patients often present with distorted vision, frequent prescription changes, and, in advanced cases, significant visual impairment.

During the lecture, Pham emphasized the importance of recognizing early signs and subtle presentations. She noted that a thorough understanding of the condition’s clinical features—such as irregular astigmatism, inferior corneal steepening, and characteristic topographic changes—is essential for early detection and timely intervention.

The role of tomography and advanced diagnostics

A significant portion of the presentation focused on corneal tomography, which can reveal subtle signs of ectasia even before significant visual changes occur. Pham and her colleagues shared real-world case studies where initial tomography scans suggested keratoconus due to borderline inferior steepening. However, after additional assessments—including refraction, slit lamp examination, OCT, and the Belin/Ambrosio Enhanced Ectasia Display—these cases were ultimately determined not to be keratoconus.

Pham highlighted the importance of combining multiple diagnostic tools rather than relying on a single scan. She encouraged optometrists to consider the entire clinical picture and avoid premature conclusions based solely on tomography.

The importance of monitoring and referrals

A major takeaway from Pham’s presentation was the critical need for repeat scanning and monitoring for progression. Even if keratoconus is ruled out at the initial visit, optometrists should continue to monitor for subtle changes over time. Progression might manifest later, making periodic tomography essential to protect long-term visual outcomes.

She also stressed the value of timely referrals for corneal cross-linking—a treatment that can halt progression and preserve vision if performed early enough. Recognizing progression and referring patients to the appropriate specialist can make a profound difference in their quality of life.

: Use a combination of tomography, refraction, slit lamp, and OCT to make an accurate diagnosis.

: Disease progression can be slow and subtle; ongoing monitoring is vital.

: Timely treatment can help preserve vision and prevent severe keratoconus complications.

Pham’s lecture served as both a practical guide and a reminder of the importance of vigilance in corneal disease management. By thoughtfully combining advanced diagnostics and careful monitoring, optometrists can make a significant impact on patient outcomes—ensuring they not only "see" keratoconus but see it at the right time.

Janna Pham, OD, shares key takeaways from a corneal tomography session she presented alongside Travis Pfeifer, OD; and Matthew McGee, OD.

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

CCS 2025: Identifying keratoconus in patients through successful comanagement

Presentations that Peter Hersh, MD, gave at the Collaborative Care Symposium (CCS) 2025 on May 31 focused on keratoconus, a progressive corneal disease that requires early detection and specialized management. He spoke on keratoconus and complex refractive surgery and corneal cross-linking with John Gelles, OD, FAAO, and Steven Greenstein, MD.

Hersh emphasizes the critical importance of identifying keratoconus in younger patients, particularly those diagnosed in their early teens, who are most likely to experience rapid disease progression. Primary eye care providers should be vigilant in screening for keratoconus, recognizing that it is more prevalent in younger populations compared to conditions like glaucoma or retinal disorders. Key diagnostic indicators include patients whose vision cannot be corrected to 20/20 through standard refraction, unusual astigmatism patterns, and irregular keratometric measurements. Advanced diagnostic tools are crucial in identifying keratoconus. Corneal topography and tomography are considered the gold standard for diagnosis, allowing practitioners to detect subtle corneal changes that might indicate the disease's onset. Hersh strongly recommended thorough screening when standard vision correction methods prove ineffective. Interdisciplinary collaboration is paramount in managing keratoconus. 

Optometrists, ophthalmologists, and surgeons must work together to ensure comprehensive patient care. This collaborative approach is especially critical for early intervention strategies like corneal cross-linking, which can significantly improve patient prognosis when implemented early. Long-term patient management is another crucial aspect discussed. Keratoconus patients require ongoing monitoring, typically with yearly examinations. Contact lens fitting remains a primary treatment modality, and patients will need specialized care throughout their lives. As patients age, additional challenges emerge, such as difficulty managing contact lenses and preparing for potential procedures like cataract surgery. Hersh highlighted emerging innovative treatments that can enhance patient outcomes, including CTAK and topography-guided PRK. These techniques can improve corneal curvature and optical focus, offering new hope for patients as they navigate the complexities of keratoconus across different life stages. 

Ultimately, Hersh underscored the need for heightened awareness, early detection, continuous education, and collaborative medical approaches to effectively manage keratoconus and improve patients' quality of life.

An emerging treatment approach for a commonly underdiagnosed ocular surface disease

ChatGPT said: Recognizing and Managing Neurotrophic Keratitis with Cryopreserved Amniotic Membrane

Neurotrophic keratitis (NK) remains a vastly underdiagnosed condition, especially in post-operative cataract patients. Despite being less visible than other ocular surface disorders, its consequences—including persistent epithelial defects, phantom ocular pain, and poor visual outcomes—can be significant. At ASCRS 2025, Brett Bielory, MD, presented a poster that explored the role of cryopreserved amniotic membrane (CAM) in the management of NK, with early data pointing toward improved outcomes and symptom relief.

Cryopreserved amniotic membrane as a cross-specialty tool

Cryopreserved amniotic membrane has long been used in orthopedic, podiatric, and urologic fields, but its application in ophthalmology—particularly for NK—is gaining traction. CAM’s regenerative properties help promote wound healing, reduce scarring, and modulate inflammation, making it ideal for the ocular surface. In this presentation, the focus was specifically on gamma-irradiated, high-preservation CAM and its benefits in early-stage NK.

Understanding the link between cataract surgery and NK

Cataract surgery, while routine, can act as an inciting event for patients with underlying dry eye or subclinical NK. The speaker noted a pattern of patients with “pain without stain” or “stain without pain” in the post-operative period—symptoms often missed or attributed to dry eye alone. In reality, many of these patients may be experiencing early-stage NK, particularly Stage 1, characterized by diffuse epithelial keratopathy.

The speaker emphasized the importance of incorporating corneal sensitivity testing into pre-operative workups. This aligns with the 2025 ASCRS Ocular Surface Disease Protocol, which now includes such testing as a standard of care. By detecting reduced corneal nerve function early, clinicians can better identify candidates for CAM therapy or recombinant nerve growth factor treatment.

In a small case series of three patients, CAM treatment led to significant improvements in corneal sensitivity, epithelial staining, and subjective visual outcomes. This suggests that CAM may help bridge the gap between diagnosis and recovery in patients with early-stage NK.

This poster presentation serves as a critical wake-up call to the optometric community. NK, particularly in its early stages, mimics other forms of ocular surface disease and is easy to overlook. However, by raising awareness and applying targeted therapies like CAM, optometrists can significantly improve surgical outcomes and long-term ocular health for their patients.

An emerging treatment approach for a commonly underdiagnosed ocular surface disease.

ASCRS 2025: Recognizing and managing neurotrophic keratitis with cryopreserved amniotic membrane

Melissa Barnett, OD, FAAO, FSLS, FBCLA, gave 2 presentations alongside other ODs and MDs at CRU 2025. 

CRU 2025: Exploring neurotrophic keratitis cases with Dr Melissa Barnett

In their presentation "Neurotrophic Keratitis: Multidisciplinary Approaches to Enhance Patient Outcomes," Melissa Barnett, OD, FAAO, FSLS, FBCLA; Cecelia Koetting, OD, FAAO, DipABO; Jennifer Li, MD; and Quan Đông Nguyễn, MD, MSc, emphasized the importance of corneal sensitivity testing before any anesthetics, considering various conditions like preservatives, artificial tears, and eye surgeries that can lead to neurotrophic keratitis (NK). Treatment options include bandage lenses, sclera lenses, topical nerve growth factor, medications, occlusion, and corneal neurotization. 

Barnett and Li also gave the presentation "Restoring Connections in Neurotrophic Keratitis," which covered patient cases, stressing the need for early diagnosis and treatment to preserve vision. Patients were advised to monitor for symptoms like redness, pain, and loss of vision and to seek immediate medical attention. The sessions were interactive and appreciated by both in-person and virtual audiences.

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

We had 2 lectures on neurotropic keratitis. So the first lecture really went into the diagnosis of NK. So the importance of checking corneal sensitivity, checking corneal sensitivity in all quadrants of the cornea, checking the eye that is not affected, the unaffected eye first, and then the affected eye, and checking corneal sensitivity prior to any topical anesthetics, for example, that would numb the cornea. We spoke about all the different conditions that are associated with NK, those like preservatives and artificial tears, any topical anesthetic drugs used chronically, any sort of history of eye surgery. So it could be cataract surgery done many years ago, retinal surgery, glaucoma surgery, refractive surgery, all sorts of autoimmune conditions, multiple sclerosis, diabetes and, of course, herpetic disease. So there are many, many conditions associated with NK. So when you have a patient, and if you're unsure, maybe it's dry eye, maybe it's NK, checking coronal sensitivity is key. We also covered all sorts of treatment options for NK, so those including bandage lenses, scleral lenses, topical nerve growth factor medications for NK, punctal occlusion, and even corneal neurotization. So many different options to treat NK, important to diagnose early, treat patients, and really save their vision.

In the second lecture, we covered all sorts of different patient cases ranging from mild to quite severe, and the complications that can occur with NK. So since patients cannot feel their corneas, informing them to look in the mirror or see if their eyes are red, have someone look at them to see if they have any redness, any pain, loss of vision, and then to come back and giving appropriate information on how to contact you anytime, day or night. So these sessions have been great, very interactive. We appreciate the in-person and the virtual audiences and all the questions that are being asked in the interaction from the sessions.

Jennifer Li, MD, details a talk she gave alongside Melissa Barnett, OD, FAAO, FSLS, FBCLA, at CRU 2025 in Napa, California.

Neurotrophic keratitis: Multidisciplinary approaches to enhance patient outcomes

Jennifer Li, MD, a professor of ophthalmology at UC Davis Eye Center, provides an in-depth overview of neurotrophic keratitis (NK), emphasizing its critical yet often overlooked nature in eye care. NK is a condition characterized by reduced corneal sensation that frequently goes undiagnosed. Li stresses the importance of healthcare providers keeping this condition in mind, especially when patients present with dry eye symptoms. The key to early detection is a simple corneal sensation test, which can be performed using a cotton wisp, comparing sensation between both eyes. The diagnostic approach involves checking corneal sensation in all quadrants, starting with the unaffected eye. Li advises against applying eye drops before testing, as this can interfere with accurate sensation assessment. She recommends testing with a small cotton wisp, not the entire cotton swab, to get precise results. Management of NK is multifaceted and patient-specific. Initial steps include:

Surgical interventions like neuronization

Li emphasizes a collaborative approach, working closely with optometrists and oculoplastic surgeons to provide comprehensive care. Each patient requires a tailored strategy, considering their unique underlying causes and symptoms. The overarching message is early detection and proactive management. By maintaining a high index of suspicion for NK, checking corneal sensation systematically, and adopting a stepwise treatment approach, healthcare providers can significantly improve patient outcomes. Key takeaways include the simplicity of diagnosis, the importance of thorough examination, and the need for personalized, collaborative treatment strategies in managing NK.

CRU 2025: Neurotrophic keratitis and multidisciplinary approaches to enhance patient outcomes

Melissa Barnett, OD, FAAO, FSLS, FBCLA, discusses keratoconus management, diagnosis, and other key insights at CRU 2025.

Prioritizing early diagnosis of keratoconus

Melissa Barnett, OD, FAAO, FSLS, FBCLA, director of optometry at University of California Davis, discusses keratoconus diagnosis, management, and key insights in a presentation given alongside John D. Gelles, OD, FIAO, FCLSA, FSLS, FBCLA, at CRU 2025. In an interview with 

she emphasizes early detection as critical for effective treatment.

Can diagnose keratoconus without advanced equipment

Use indicators like: - Retinoscopy - Vision changes - Increased astigmatism - Differences between auto refraction and refractive astigmatism

Advanced techniques include corneal topography and tomography

Crucial for halting keratoconus progression

Prevents vision loss and potential corneal transplant

Especially important before pregnancy, as cornea changes during this period

Progresses more rapidly in younger populations

More aggressive progression compared to older patients

Provide educational materials for patients and parents

Barnett stresses the importance of understanding keratoconus, detecting it early, and utilizing available treatments to preserve vision and prevent progression. The focus is on comprehensive care, patient education, and leveraging both diagnostic techniques and treatment options to manage this corneal condition effectively.

Cornea

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