Allergy

Blepharitis

COVID-19

Cataract

Comanagement

Comprehensive Eye Exams

Conjunctivitis

Contact Lenses

Cornea

Diabetic Eye Disease

Dry Eye

Geographic Atrophy

Glasses

Glaucoma

LASIK

Lens Technology

Lid and Lash

Myopia

Nutrition

Ocular Surface Disease

Optic Relief

Patient Care

Pediatrics

Presbyopia

Ptosis

Refractive Surgery

Retina

Technology

Therapeutic Cataract & Refractive

News

All News

Practice Management

Media

All Videos

Expert Interviews

Podcasts

Medical World News

Viewpoints

Insights

Case Based Roundtable Series

Case Studies

Case of the Quarter

Practice Ownership

Rapid Readout

What’s Your WhEYE?

Conferences

Conference Coverage

Conference Listing

Conference Recaps

Blog

Publications

Digital Edition

Supplements And Featured Publications

iTech

Partners

Resources

Job Board

Subscribe

Articles

EyePoint Pharmaceuticals completes enrollment for the LUCIA trial, advancing DURAVYU's potential as a new treatment for wet AMD.

EyePoint completes enrollment of LUGANO and LUCIA trials

The expanded clinical suite at Stanton Optical will include keratography, optical coherence tomography, and personalized therapy options for patients with dry eye.

Stanton Optical integrates new dry eye therapy, retinal imaging technologies to care arsenal in 35 locations

Paul Levine, OD, FAAO, FIAOMC, details a pediatric case of high myopia in which the patient's prescription had increased from –5.75 DS OU to OD –7.00 DS, OS –6.75 DS within a year.

A case of orthokeratology for high myopia

The first-in-class, twice-daily topical formulation is intended for the treatment of non-proliferative diabetic retinopathy and diabetic macular edema. 

Exonate plans to initiate phase 2b CLEAR-DE trial for EXN407 topical formulation for NPDR

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

Advertise

About Us

Editorial

Contact Us

Terms & Conditions

Privacy

Do not sell my Information

Optometry Times – Clinical News & Expert Optometrist Insights

Facebook

Instagram

LinkedIn

Spotlight

Clinical

Myopia- Management

1rem

Clinical Focus

Test

In the fourth of our video series on Demodex, Dr. Mario Gutierrez offers practice management suggestions in treating patients with the mite. Plus, he gets into a mite-killing mood.

VIDEO: Practice management for Demodex

In the second of our video series on Demodex, Dr. Scott Hauswirth explains how to diagnose this tiny critter.

VIDEO: Diagnosing Demodex

Meibomian gland dysfunction never went away, but current interest by researchers has put MGD on the front burner.

MGD redux

The solution missed the primary end point of the trial, which was complete resolution of debris after 6 weeks of twice-daily dosing.

Viatris' phase 3 trial of pimecrolimus 0.3% (MR-139) for blepharitis fails to meet primary end point

Cecelia Koetting, OD, FAAO, DipABO, and Madeline Yung, MD, detailed the prevalence of the conditions, diagnostic tools, and treatment options.

CRU 2025: The ABCs of DED and OSD

The authors concluded that patients with autoimmune hyperthyroidism who used cannabis had a significantly increased risk for TED outcomes in the 1-year interval.

Cannabis users have increased risk for thyroid eye disease outcomes, study reports

A recent study assessed the effect of a modified TCLB procedure that added deframing and decompression maneuvers to the LOFC and its support structures to obtain better results for both the lower and upper lids.

Eye-opening effects caused by modified transconjunctival lower blepharoplasty

The dynamic muscle stimulation device is a noninvasive option for patients experiencing lower lid laxity and impaired blinking.

Lumenis unveils OptiLIFT for lower lid laxity and impaired blinking

Mitch Shultz, MD, discusses lotilaner 0.25% for meibomian glad dysfunction.jpg

Extended lotilaner 0.25% therapy shows meibomian gland benefits

At the 2025 ASCRS meeting, Mitch Shultz, MD, an anterior segment surgeon based in Los Angeles, presented compelling new findings from a 12-week clinical trial investigating the impact of lotilaner 0.25% ophthalmic solution on patients with 

 blepharitis. The study, sponsored by Tarsus, focused on the meibomian gland function—a key area of interest for optometrists managing ocular surface disease.

The clinical program consisted of 2 arms: the Ersa study, which administered active lotilaner (either BID or TID), and the Rhea study, a vehicle-controlled arm. Unlike prior studies (Saturn 1 and 2), which evaluated 6-week treatment courses, this research extended therapy to 12 weeks (85 days). Researchers aimed to determine whether prolonged treatment could provide additional benefits, particularly in meibomian gland function and overall ocular health.

The study found that lotilaner 0.25% ophthalmic solution was safe and effective over a 12-week treatment period, with no significant difference in outcomes or toxicity between BID and TID dosing—supporting BID as the preferred regimen. Importantly, patients experienced marked improvement in meibomian gland function. At baseline, participants had an average of 7 out of 15 glands functioning, with no clear gland secretions observed. By week 12, that number rose to approximately 13 functioning glands, with 5 to 6 glands producing clear secretions, indicating improved gland quality. These benefits are thought to result from lotilaner’s activity against both 

brevis, the latter of which resides deep within the meibomian glands and is difficult to detect. Symptomatic improvements were also notable: the percentage of patients reporting fluctuating vision dropped from 50% to 13%, while itching and redness decreased from about 50% to 14% and 12% to 14%, respectively. Additionally, extending the treatment duration led to greater success—clinical cure rates (defined as 0–2 collarettes) improved from 45% at 6 weeks to 66% at 12 weeks, and overall clinical success (1–10 collarettes) reached 100% by the end of the study.

 blepharitis and associated meibomian gland dysfunction, this study reinforces the importance of targeted mite treatment and extended therapy duration. The data support lotilaner 0.25% as a safe, effective BID treatment that not only alleviates 

 symptoms but also significantly improves gland function and visual quality.

This research underscores the evolving role of 

-targeted therapies in enhancing both ocular health and patient quality of life—valuable insight for front-line optometric care.

Videos

At the 2025 ASCRS meeting, Mitch Shultz, MD, presented compelling new findings from a 12-week clinical trial investigating the impact of lotilaner 0.25% ophthalmic solution on meibomian gland function.

Pipeline

Conference

Patricia Buehler, MD, MPH, is looking to reform blepharoplasty by reducing surgery time, recovery, and bruising by using a noninvasive approach. At ASCRS, Buehler shared a bit of background on her discovery of a new surgical technique and subsequent device development.

A noninvasive approach to blepharoplasty reduces recovery time, bruising

During a visit to an exhibit on ancient Egyptian medicine, Buehler found unexpected inspiration. The exhibit showcased a method of removing excess skin using compression—twigs tied tightly to cut off blood supply, causing the skin to fall off naturally. That concept, still used in procedures like circumcision, sparked an idea that evolved into the Ziplyft, a patented device that is now changing how upper eyelid blepharoplasty is performed.

The Ziplyft device employs compression skin contouring to remove excess eyelid skin without cautery or sutures. This technique dramatically simplifies the surgical process, making it both faster and less invasive. “Instead of a 45 to 60-minute procedure, it can now be completed in less than 10 minutes,” Buehler notes.

A major innovation in Ziplyft is the inclusion of a surgical guide, which ensures greater symmetry and consistency—something often difficult to achieve in traditional, freehand blepharoplasty.

Surgeons involved in the current pilot study report that the Ziplyft technique not only reduces operative time by up to two-thirds but also alleviates the tedious steps typically involved in the procedure. With reduced patient downtime and higher satisfaction, the appeal to both providers and patients is significant.

The development of the Ziplyft device began during the COVID-19 pandemic. With elective procedures on hold, the inventor and her husband, an orthopedic surgeon, began prototyping in their kitchen using chicken skin. This was followed by trials on 60 cadavers before moving into clinical use. As of now, 84 patients have undergone blepharoplasty using Ziplyft, and 4 surgeons are actively trained in its use.

The innovation has not gone unnoticed. At ASCRS 2023, the company won the Winning Pitch award for best early-stage company—marking the first time a female-founded company took the prize. The following year, they received the People’s Choice Award at Eyecelerator, further validating the device’s potential.

ASCRS 2025: A noninvasive approach to blepharoplasty reduces recovery time, bruising

Dr. Mile Brujic discusses his SECO 2025 presentations

Insightful discussions on light therapy, ptosis, and the view from behind the slit lamp

Enhancing paraoptometric training: A view behind the slit lamp

Mile Brujic, OD, FAAO, recently delivered a series of courses at SECO, which took place February 26 through March 2, 2025 in Atlanta, Georgia. One of these was focused on paraoptometric education. The goal was to provide support staff with a deeper understanding of what optometrists observe behind the slit lamp—something that is fundamental to patient care but often unseen by assistants.

By offering this behind-the-scenes perspective, the course aimed to improve paraoptometrics' ability to recognize both normal and abnormal ocular conditions. Through extensive video demonstrations, participants were exposed to a wide range of cases, enhancing their ability to distinguish between different pathologies. The session also provided insight into the clinical decision-making process, allowing support staff to understand why certain treatments are chosen. The feedback from attendees was overwhelmingly positive, with many expressing appreciation for the opportunity to expand their knowledge.

Advancements in light therapy for ocular conditions

Brujic also discussed the evolution of light therapy in optometric care. While UV protection has long been a key focus, modern optometry has leveraged light for therapeutic purposes, particularly in treating dry eye and meibomian gland dysfunction. Two primary treatments—low-level light therapy (LLLT) and intense pulsed light (IPL)—are making significant strides in improving patient outcomes.

 Patients undergo six 15-minute sessions, spaced one week apart, to improve meibomian gland function and ocular surface health.

 This involves four sessions, spaced two weeks apart, and is particularly effective for conditions like ocular rosacea and dry eye syndrome.

While these treatments are proving effective, they come with the challenge of being out-of-pocket expenses for patients. This presents a unique conversation for optometrists, as they must help patients navigate treatment options when insurance coverage is unavailable.

Another key topic Brujic covered was ptosis, a condition characterized by drooping of the upper eyelid. He emphasized the importance of differential diagnosis, as ptosis can sometimes be mistaken for conditions like thyroid eye disease, which can create an illusion of lid asymmetry.

Brujic categorizes ptosis into three levels:

 The eyelid is above the midpoint of the iris but below the upper limbus.

 The eyelid covers more than half of the iris but does not encroach upon the pupil.

 The eyelid droops to the point of covering part of the pupil, significantly affecting vision.

Beyond cosmetic concerns, ptosis can have functional implications. Patients often compensate by tilting their heads backward, which can lead to postural issues and an increased risk of falls due to a restricted lower visual field.

Brujic outlined three main approaches for managing ptosis:

 Patients can choose to do nothing if the condition does not interfere with daily life.

 The FDA-approved 0.1% oxymetazoline drop can be used once daily to stimulate Müller’s muscle, lifting the eyelid to a more natural position. However, this treatment is not covered by insurance, requiring patients to pay out-of-pocket.

 For those seeking a permanent solution, surgery remains a viable option, particularly for more severe cases.

Brujic’s presentation highlighted the importance of ongoing education for both optometrists and paraoptometric staff. By enhancing the knowledge base of support teams, improving access to innovative therapies, and refining patient education strategies, optometrists can continue to elevate the standard of care. The discussions on light therapy and ptosis management underscored the need for tailored treatment approaches, particularly in cases where financial constraints may impact patient decisions.

SECO 2025: Insightful discussions on light therapy, ptosis, and the view from behind the slit lamp

Ian Ben Gaddie, OD, FAAO, outlines key findings from a recent study evaluating lotilaner in patients with Demodex blepharitis and meibomian gland dysfunction.

AAOpt 2024: Lotilaner's effectiveness in the treatment of Demodex blepharitis

blepharitis is one of the largest unmet needs in eye care. In an exclusive interview with 

he overviews a presentation he gave on a clinical trial evaluating lotilaner (Xdemvy) in the treatment of patients with 

blepharitis at the American Academy of Optometry 2024 meeting in Indianapolis, Indiana.

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

Hi, Dr Ben Gaddie from Louisville, Kentucky, here, and I'm proud to present the data from our Phase 2b clinical trial on 

 blepharitis patients and MGD with the treatment of lotilaner. To start, to set this up, 

blepharitis is one of the largest unmet needs in eye care. Before basically a year ago, we had no effective or FDA indicated or approved treatment for a condition that affects nearly 60% of all individuals in an eye care practice. So what we started to notice clinically when we would treat 

 blepharitis is that patients' lids would not only look better, but their eyes felt better. And so what this study aimed to do was to see if people that had 

 blepharitis, who also had MGD, how they would respond, both from a collarette blepharitis standpoint, but also, could we improve the function of their meibomian glands? So the study was 2 separate arms, 2 separate trials, really. It was load lotilaner, and it was dosed either twice a day or 3 times a day for 6 weeks. 

And then we had a separate study just on the vehicle, looking at the same outcome measures, and what we found is about 57% of patients that have a collarette have MGD. And that's a pretty big number. If you think about it, that's a lot of patients, and the importance of MGD is really at the forefront of our profession right now, everything that you see from different treatment options and the work and the science of MGD has really exploded. So we think this is an important development. During the trial, we saw improvements in symptoms, and that's something we've never really had in a pivotal clinical trial, is symptoms with 

, and we were able to show that redness, burning, itching and fluctuating vision, most importantly, had a significant improvement in 6 weeks using Xdemvy. And we also saw what we typically see with Xdemvy and 

 blepharitis: we saw significant improvement in the reduction of collarettes, consistent with what we saw in the Phase 3 clinical trials, but we also saw an improvement in the number of glands secreting meibum, as well as the quality of that meibum that was being excreted.

 blepharitis and MGD are very commonly associated with each other. We think that 

 mites do harbor inside of the meibomian glands and contribute to meibomian gland disease. And we've been able to show with a 6 week trial of Xdemvy, of lotilaner, that patients are having improvements in their meibomian gland secretions, the quality of their secretions, as well as a significant reduction in 

 blepharitis colorettes, as well as redness, which is a primary issue that we see amongst patients with ocular surface disease. Then finally, fluctuating vision is one of the hallmark symptoms that we see with all of ocular surface disease, not just MGD, not just blepharitis, so to be able to improve that really improves the quality of the vision and the life of our patients.

Dr. Lisa Hornick goes over cosmetic habits and digital eye strain factors in OSD

AAOpt 2024: The Tear Film and Ocular Surface Lifestyle Report on cosmetic habits and digital eye strain

A Rapid Fire session given by Lisa Hornick, OD, MBA, FAAO; Tracy Doll, OD, FAAO; Leslie O'Dell Hombach, OD, FAAO; and Pam Theriot, OD; at the AAOpt meeting in Indianapolis, Indiana on the key findings from the Tear Film and Ocular Surface Lifestyle Report, with a particular emphasis on four main areas: elective procedures and medications, cosmetics, digital eye strain, and environmental conditions. One of the primary takeaways from Hornick's presentation was the importance of addressing digital eye strain, which can affect both older patients and children. She highlighted that due to the increasing use of digital devices, even pediatric populations are at risk of developing meibomian gland dysfunction and dry eye disease. Hornick stressed the need for healthcare providers to actively screen for these conditions in all their patients, regardless of age. In terms of patient education, Hornick emphasized that many patients are unaware of what dry eye disease entails and often mistake it for other eye-related issues, such as allergies or foreign objects. She emphasized the importance of educating patients on the symptoms and underlying causes of dry eye disease, including the role of digital eye strain and cosmetic use. 

Regarding cosmetics, Hornick discussed the adverse reactions that can occur due to certain ingredients, particularly prostaglandin analogs found in lash serums and other ocular cosmetics. She advised patients to be cautious of these products and to remove eye makeup thoroughly every night to prevent infections. To mitigate the effects of digital eye strain, Hornick recommended that patients take regular breaks from their digital devices, either by taking a 10-minute break every hour or following the 20-20-20 rule (looking at something 20 feet away for 20 seconds every 20 minutes). For children, she suggested a more stringent two-hour screen time limit with frequent breaks. 

Overall, Hornick's presentation highlighted the multifaceted nature of ocular surface health and the importance of addressing emerging risk factors, such as digital eye strain and cosmetic use, through comprehensive patient education and proactive screening.

Lisa Hornick, OD, MBA, FAAO, outlines key findings from the report on the impacts of healthy cosmetic habits and reducing digital eye strain.

Laura Periman details a clinical trial that made an impact on her own research

EyeCon 2024: Laura Periman, MD, shares a formative clinical experience with Demodex blepharitis

Laura M. Periman, MD, shares her passion for dry eye disease, discussing her discovery of the Alpenglow Sign in 

 blepharitis and her insights on research and education for clinicians in this interview with 

. Periman will join the EyeCon 2024 faculty as Honorary Chair. The conference will take place at the Hilton Fort Lauderdale Marina on September 27 and 28, 2024.

To learn more about or to register for EyeCon 2024,

Sheryl Stevenson, Group Editorial Director - Eye Care:

 We are joined today by Dr. Laura Periman, who is one of the cochairs for this year's EyeCon 2024, on September 27th and 28th in Fort Lauderdale, Florida, and we're so excited to have you join us. Thank you for your time today. We'd love to take a few minutes to look at the person behind the role of cochair and have the audience learn more about you.

Your passion is dry eye disease, and you've done a lot of research in this subject across your career. Do you have any favorite studies or even a pet project that you remember fondly?

 Yes, there is a particular standout study, and that was the Tarsus Phase 3 FDA studies for what we now know as Xdemvy; it's lotilaner 0.25%. First of all, it was one of the easiest studies to recruit for, which was refreshing. And another aspect of it that we really loved is we were masked to active versus placebo. But by Week 2, it was obvious. So it was really neat to see something work that quickly and provide that much improvement in such a short period of time. So that was probably my favorite, if you're going to make me pick one, it was my favorite.

It also literally opened my eyes to really appreciating the role of Demodex, and it led to some personal clinical discoveries. One is the Alpenglow Sign, so this is the Periman Alpenglow Sign. And we're taught in 

 blepharitis to have the patient look down and look for the presence of collarettes. But some patients are really good with their lid hygiene, and if you take the time to epilate lashes and look under the microscope, which we still do on all suspected cases, you can miss cases of 

 blepharitis. So the absence of collarettes does not rule it out. What I found one day while I was just like slowly spanning from right eye to left eye with the sidearm just obliquely across the nasal bridge...when I got to the left side, I saw the fine vellus hairs of the face, but then there were these coarser ones, these thick, stubby, coarse ones...like, what's that?

So I took my epilation forceps, took some lashes, like I was going to do anyway, and just grabbed a couple of those dermal collarettes and put them under the microscope. What do you think I saw? Tons of Demodex mites. Oh, my gosh! So I named it after that phenomenon at dawn in the mountains, when the sun is first coming up and it just highlights the tips of the mountaintops. That's the phenomenon that you're seeing under high mag at the slit lamp as the light crosses you see just the tips of the projections in the skin under high mag at the slit lamp. And so I call it the Alpenglow Sign. And that led to some independent work where we were able to demonstrate in an imperfect retrospective chart review, the presence of the Alpenglow Sign predicted the presence of Demodex on epilation 83% of the time. And so we now routinely take note of the presence of the Alpenglow Sign, and we can watch it get better with treatments, IPL, chemical peels, that's treating the load on the face to prevent recontamination of the lids and vice versa. When we had IPL for the longest time, I didn't have anything for treating the lids. And now I do, and I can get this total local, regional clean of the excess Demodex load and all of its accompanying inflammation.

 Much of your work has been published as well. How do you feel research has changed over the course of your career?

 How has research changed over the course of my career? Well, the good news is that it's expanding exponentially. That's what's so exciting about dry eye research. Back when I trained, we didn't even have Restasis yet (I just gave away my age) but that's all we had. And just now, we understand on such a much more intimate level, what is all involved when we talk about the immunology and inflammation on ocular surface with dry eye disease, and the story is expanding. One of our papers, I tried very, very hard to break down the complex immunopathophysiology of dry eye. I'm a molecular immunobiologist prior to medical school so I love this stuff, all those little cytokines, they have little personalities in my crazy brain. So I was trying to make it approachable for clinicians to really break down and understand that complex immunopathophysiology, and there's initiation, amplification, recruitment damage, and self-perpetuation, and it's just on this vicious circle that continues unless you intervene with your immunomodulators. So I used it as a construct, and I still use it in my lectures as a way of easily understanding that complex pathophysiology in an approachable, clinically organizable way.

Additionally, we have some things on the horizon, hopefully in 2025. We are expecting the approval of several new medications, one of which absorbs aldehyde species. It's called 'rasp' or 'rasp inhibitor' [reactive aldehyde species (RASP)] and that has the potential to be very adjunctive and synergistic with all of our other things that we're offering our dry disease patients. So we're really excited about that. Really excited about understanding the neural component, the neurosensory component of dry eye disease—it's part of the definition—in more intimate ways. We have neural stimulation, but now we're going to be able to tap into neural stimulation using a new class of molecules called TRP: transient receptor potential molecules. There's a huge, huge class of super receptors across all mammalian species. Even nematodes have it; they're nonmammalian, but it's like super well conserved. There's one called M8, which detects cold and the new medication, a cultured one doesn't have a trade name yet, stimulates that receptor directly to directly stimulate tear production using chemo receptors. So cool. So interesting. So the story about immunopathophysiology is expanding in three dimensions. As we gain more understanding about what these things are, it helps us understand our patients even better and know where to plug and play all of these different interventions,

 Is there anything that you'd like to see evolve further in research?

 Yes, I think there's some huge unmet need when it comes to neuropathic pain. Neuropathic pain can occur with severe, chronic dry eye disease after ophthalmic surgeries, excess contact lens wear, too much screen time. So I'd love to see more developments in that category, because those patients are really suffering, and I would love to be able to offer them more.

 I love education! Perhaps there's a bit of a selfish component, because I get to learn too, like none of us are masters of all of these things. It's the constant discussion with other colleagues and their clinical experience and what they're trying, what they're using. That constant learning is what keeps it fresh and fun for me. Even being in clinic on any given day, I'm constantly learning from my patients. I love being able to share that with my colleagues. I love learning from my colleagues, so it becomes a I call it circle of good, where good begets good when it comes to education. So it's a necessary thing.

And in addition to that, I think being an eye doctor, whether you're an optometrist or an ophthalmologist or a resident or a fellow, can be a bit lonely, and to know that there's other doctors that sometimes have the same questions as you, and having an opportunity to ask them, I think, is very empowering and confidence-building for our colleagues.

 Can you highlight some specific opportunities or benefits at EyeCon that it offers to residents that they might not find at any other conference?

 Oh, that's a great question! So EyeCon is going to give you a very high-quality education with references, and these are things that you're going to implement in your career as a resident/fellow, but as well as an early clinician as you get out of training. So I think that to the level of education and the practicality in which it is presented will help connect the dots in our colleagues' brains and become part of your knowledge base. It'll be something that you can absorb and learn and make it yours.

 Is there anything particularly at EyeCon for you that you're really excited about?

 Well, I always like connecting with new people. It doesn't hurt that we're in Fort Lauderdale. I can't wait to get my toes into the water and feel the sand beneath my toes, so I'm looking forward to that as well. The environment, the setting, the thoughtfulness with which this meeting has been set up, the agenda—these are all things that I'm excited about, and I can't wait to share it with everyone that's going to be there.

 When you're not busy at EyeCon, you mention Fort Lauderdale, what local spots are you interested in discovering or rediscovering or visiting while you're there?

 Anything where it's warm! One of my pet peeves is an overaggressive air conditioner, like I'm going there to be warm. We get shortchanged here in Seattle with our summers. It's so short and so fleeting; it's already gone. So I'm looking for a last blast of summer, warm my bones, because winter's coming. I'll see you there!

Laura M. Periman, MD, honorary chair of EyeCon 2024, shares her passion for dry eye disease, discussing her discovery of the Alpenglow Sign in Demodex blepharitis and her insights on research and education for clinicians. 

Canonical

James Katz, MD, details his CIME presentation on treatment options for Demodex blepharitis

CIME 2024: Holding Demodex blepharitis treatment options under a microscope

James A Katz, MD, details treatment options for Demodex blepharitis, from tea tree oil to XDEMVY.

Lid and Lash

Latest News

More News