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

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

A total of $7000 in scholarships was awarded to 3 optometry students as part of the National Optometric Student Association (NOSA) scholarship program.

National Vision awards scholarships to optometric students during NOA Convention 2025

The primary objective of the study was to demonstrate that LUMIFY Preservative Free redness reliever eye drops is non-inferior to LUMIFY redness reliever eye drops in reducing ocular redness. 

Phase 3 study assessing LUMIFY Preservative Free and LUMIFY eye drops meets primary end point

The module can be used in combination with Ziemer’s FEMTO LDV Z8 femtosecond laser platform, an all-in-one laser for refractive, cataract, and therapeutic surgery.

Ziemer USA, CorneaGen launch GALILEI CTAK module for GALILEI diagnostic platform

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

ZinserLab will focus on accelerating the development of imaging technologies in eye care.

Heidelberg Engineering launches new innovation hub, continues industry partnerships

Incorporating peripheral OCTs into your practice provides valuable insights that may alter your clinical diagnosis.

Taking your OCT outside of the posterior pole

The investigators described the CASIA2 (Tomey Corporation) instrument, which is a new AS-OCT device with a swept-source laser wavelength of 1310 nm that can scan at a speed of 50,000 A-scan/second.

Swept-source anterior segment-OCT aids in early diagnosis of childhood glaucoma

DREAM is an acronym for deep imaging depth, rapid sweeping speed, extensive scan range, accurate results, and multimodal imaging capabilities. 

Intalight's DREAM OCT platform receives CE Mark

With the acquisition, Topcon Healthcare also assumes RetInSight’s AI algorithms that analyze retinal images to detect and monitor disease.

Topcon Healthcare acquires RetInSight to fuel AI in retinal disease diagnosis, monitoring

Susana Marcos, PhD, discusses the implications her research presents for the role optical coherence tomography (OCT) could play in presbyopia and myopia accommodation efforts.

ARVO 2025: Lens thickness as a significant biomarker for accommodation in presbyopia

Susana Marcos, PhD, discussed advanced research on optical coherence tomography (OCT) and its potential applications in understanding the crystalline lens, particularly in relation to presbyopia and myopia, during the Association for Research in Vision and Ophthalmology (ARVO) meeting in Salt Lake City held from May 3-7. Marcos explores how clinicians and researchers can leverage custom OCT technology to develop new diagnostic and treatment options. Currently, the OCT device used in the study is a custom-developed instrument, but there's significant potential for incorporating it into commercial clinical settings with some additional engineering. Key potential applications include:

Monitoring crystalline lens changes during myopia development

Improving intraocular lens positioning accuracy

Supporting the development of accommodating lenses and vision correction devices

"When we started this research, OCTs are being used widely to image the back of the eye," said Percy Lazon de la Jara, director of Research Programs for CooperVision and the paper's coauthor. "To be able to image all the anterior segment, plus the crystalline lens, it's pushing the limits of technology, and it shows how technology is progressing that fast in our world right now. By pushing these limits, Dr Marcos lab is giving us really, really nice and insightful hints on how the crystalline lens work, but not only the crystalline lens, but also what happens when we start triggering signals of accommodation in presbyopes."

The research focuses on quantifying crystalline lens parameters through advanced OCT technology. While current analysis is limited to the portion of the lens visible through the pupil, the researchers have developed techniques to extrapolate and study lens characteristics beyond this initial view. Marcos highlights several promising research directions:

Expanding parameter analysis to include equatorial diameter

Creating more comprehensive insights into presbyopia and lens changes

A critical takeaway is that lens thickness emerges as a significant biomarker for accommodation. The OCT technology provides quantitative insights into crystalline lens transformations, which could revolutionize understanding of age-related vision changes. Future technological possibilities include miniaturized OCT devices, advanced accommodating lens technologies, and more precise measurement of accommodative efforts.

Marcos underscored the research's potential to bridge current limitations in understanding presbyopia and myopia. By developing more sophisticated measurement and analysis techniques, researchers aim to provide clinicians with powerful tools for diagnosing and potentially treating vision-related conditions. The research represents an exciting intersection of advanced imaging technology, ophthalmological research, and potential clinical applications, promising more nuanced understanding of lens behavior and vision changes.

Videos

Susana Marcos, PhD, outlines a presentation she gave at ARVO 2025 on a unique utilization of optical coherence tomography.

ARVO 2025: OCT-based marker for accommodative effort in presbyopes

to discuss research that she presented at ARVO 2025 focusing on optical coherence tomography (OCT) markers for accommodative effort in presbyopes. The study utilized a custom-developed OCT technology specifically designed for high-speed, 3-dimensional imaging of the anterior segment of the eye. The research examined 3 groups of presbyopes: early, middle, and advanced, further subdivided into emmetropes and myopes. The primary goal was to identify how different parameters of the eye change during accommodative effort across these groups. Key findings revealed 3 primary parameters that change significantly during accommodation: lens thickness, anterior chamber depth, and pupil size.

"Over more than 100 years, scientists have been trying to understand the onset of presbyopia, how it progresses all the time, but also to learn more about accommodation," said Percy Lazon de la Jara, director of Research Programs for CooperVision and the paper's coauthor. "There have been hundreds of papers published around this topic. However, Dr Marcos' system gives us an additional hint because of this high technology that she's using to try to understand what previous studies couldn't find because of not having enough resolution to image the eye or to get images from OCT. So Susana's work is really interesting because she has OCT equipment that can image the front of the eye and the crystalline lens, and we can detect changes on the crystalline lens, movement, how it changed its shape, how it changed the radius, what happened to the pupil and to the anterior chamber of people suffering from presbyopia at different stages of life. So that makes it a really interesting area of research, and it can give us new hints about how the accommodative effort works and how it deteriorates over time."

Notably, the researchers discovered some unexpected results, such as a paradoxical increase in pupil diameter during accommodation. Due to this and other factors like illumination, they concluded that pupil size might not be the most reliable marker for accommodative effort. Lens thickness emerged as the most consistent and reliable marker across all presbyope groups. Even as presbyopia advanced, lens thickness demonstrated systematic changes during accommodative demands. Interestingly, myopes showed more pronounced changes compared with emmetropes, with higher slopes of lens thickness change and faster reaction times in dynamic measurements.

The researchers highlighted potential future applications of their findings, such as developing accommodating lenses or devices that could be triggered by measuring lens thickness. The custom OCT technology allows for unprecedented three-dimensional quantification of the crystalline lens, enabling measurements beyond traditional methods. Beyond this specific study, the OCT technology developed by Marcos has broader potential applications, including:

Studying lens changes in myopia development

The study represents a significant advancement in understanding accommodative effort and demonstrates the powerful diagnostic capabilities of advanced OCT imaging technologies.

Dr Luke Lindsell discusses retinal therapy and geographic atrophy at Controversies in Modern Eye Care 2025

CIME 2025: Luke Lindsell, OD, MD, on bridging innovation and practical care in retinal disease

, Luke Lindsell, OD, MD, offered a compelling perspective on how evolving therapies for 

 and improved imaging tools are reshaping 

. Now practicing at the Cincinnati Eye Institute and teaching at the University of Cincinnati, Lindsell emphasized optimism and pragmatism in how eye care professionals can collaboratively manage retinal disease.

“Having any therapy at all for GA has been exciting,” Lindsell stated, referring to the current intravitreal treatments now in clinical use. But what excites him most are the developments on the horizon: at-home therapies, gene therapy, and devices like the Valeda Light Delivery System (LumiThera), which uses photobiomodulation and shows early promise in preventing GA altogether.

Gene therapy and the quest to reduce treatment burden

With patient fatigue around frequent injections being a persistent concern, Lindsell highlighted the growing excitement around gene therapy. Although still in clinical trials, early results suggest these treatments could significantly reduce the frequency—or even eliminate the need—for repeated injections. “It’s what patients ask all the time: ‘When will I be done?’” he said.

Lindsell recommends a proactive approach to imaging for optometrists. “Most of us have an [optical coherence tomography scanner], but don’t forget about autofluorescence,” he urged. Utilizing autofluorescence alongside near-infrared imaging or red-free photography can enhance detection of subtle GA changes, particularly at the fovea, where natural hypoautofluorescence can mask early signs.

Lindsell emphasized that optometrists should feel confident in managing early to moderate stages of retinal disease, including diabetic retinopathy and macular degeneration. “Be the leaders in early retinal care,” he said. Discussions around supplements, glycemic control, and lifestyle modifications are key components of this care phase. Referral should be considered when vision is threatened or novel therapies become appropriate.

Collaboration built on respect and transparency

Above all, Lindsell championed a respectful, comanaged approach to patient care. “This patient is not mine,” he stated, reinforcing that a specialist’s role is to complement—not replace—the referring optometrist’s care. He communicates this clearly to patients and colleagues, advocating for shared decision-making and continuous communication.

Finally, he reminded ODs to set realistic expectations. Not every referral will yield a treatment option, especially in advanced disease. However, patients often benefit emotionally from a second opinion and a clearer understanding of their condition.

Lindsell discusses promising retinal therapeutics, such as at-home therapies, gene therapy, and devices like the Valeda Light Delivery System (LumiThera), which uses photobiomodulation and shows early promise in preventing geographic atrophy altogether.

Conference

Hammond and his team focused on creating a reliable conversion factor between 2 widely used optical coherence tomography (OCT) systems—the TopCon Maestro2 and the ZEISS Cirrus 5000. Their work specifically looked at ganglion cell–inner plexiform layer and retinal nerve fiber layer thickness measurements, which are critical markers in glaucoma diagnosis and monitoring.

ARVO 2025: Exploring a conversion factor between 2 OCT devices to monitor glaucoma progression

At ARVO 2025, Paul Hammond, OD, FAAO, of Twin Cities Eye Consultants shared pivotal findings in a poster aimed at solving a common clinical challenge: how to preserve the integrity of glaucoma progression data when switching OCT platforms. ARVO took place in Salt Lake City from May 4-8, 2025.

Hammond and his team presented a poster focused on creating a reliable conversion factor between 2 widely used optical coherence tomography (OCT) systems—the TopCon Maestro2 and the ZEISS Cirrus 5000. Their work specifically looked at ganglion cell–inner plexiform layer (GCIPL) and retinal nerve fiber layer (RNFL)

thickness measurements, which are critical markers in glaucoma diagnosis and monitoring.

The study analyzed data across a spectrum of glaucoma severity—mild, moderate, and severe—to ensure broad applicability. The results demonstrated that a basic, easy-to-use conversion factor could be developed for routine clinical use. In addition, the team formulated a more precise algorithm for practitioners who require higher accuracy for longitudinal assessments.

Hammond emphasized the real-world utility of their findings. “If a patient has been imaged for years on one device and the clinic transitions to another,” he noted, “our conversion factor allows clinicians to continue tracking progression without data loss.”

This is particularly beneficial in cases where:

A practice upgrades to a new OCT brand or model.

A patient transfers care to a different clinic with a different OCT system.

Seasonal patients (“snowbirds”) receive care from multiple providers using different platforms.

Without a conversion method, such transitions risk compromising clinical judgment about disease progression, potentially delaying critical treatment adjustments.

The research addresses a long-standing limitation in glaucoma management: lack of interoperability across imaging platforms. By enabling clinicians to translate data between devices, Hammond's work helps ensure continuity of care, preservation of historical data, and better decision-making over time.

As practices continue to adopt newer imaging technologies, Hammond’s work provides a practical solution for maintaining data continuity—ensuring glaucoma patients receive consistent, high-quality care regardless of where or how their imaging is performed.

John Berdahl, MD, overviews the new FYXS Ocular Pressure Adjusting Pump and HERCULES trial at the Glaucoma 360 meeting.

G360 2025: The latest in glaucoma devices and pharmaceuticals

John Berdahl, MD, practicing in Sioux Falls, South Dakota discussed the FYXS Ocular Pressure Adjusting Pump during the recent Glaucoma 360 meeting. This is the first non-surgical, non-drug treatment for glaucoma approved by the FDA in June 2024. The pump consists of 2 ocular chambers that attach to a negative pressure pump. When worn, the negative pressure draws some of the weight off the eye, causing the intraocular pressure (IOP) to decrease. Berdahl explains this using a simple analogy - if you press on the eye, the pressure increases, and when you release the pressure, it decreases. 

Berdahl describes the HERCULES trial, which looked at 186 patients with normal tension glaucoma. The study found that 100% of patients experienced IOP lowering while wearing the pump, with 97% having more than a 20% reduction and an average 39% decrease from 20.2 mmHg to 12.2 mmHg. The safety profile was good, with only 17% experiencing some eyelid puffiness. Berdahl suggests the pump will be useful for patients with IOP less than 21 mmHg who have tried other therapies like eye drops, SLT or MIGS, but need additional IOP lowering before considering more invasive glaucoma surgery. He sees this as a significant innovation, marking a new category in glaucoma treatment after previous advancements in imaging, MIGS, and drug delivery. 

Finally, Berdahl discusses the collaboration between optometry and ophthalmology in his rural state, where patients often travel long distances for care. He works closely with optometrists who manage the day-to-day clinic, while he is involved in surgical decisions and complex cases. This allows them to provide the most effective and efficient care for their patients.

Sherrol Reynolds, OD, FAAO, said that multimodel imaging has been a game changer in assessing the choroidal function and structural changes in various disease conditions.

AAOpt 2024: Current concepts in pachychoroid spectrum diseases

Sherrol Reynolds, OD, FAAO, shares an overview of her American Academy of Optometry meeting presentation "Current Concepts in Pachychoroid Spectrum Diseases."

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

My name is Dr Sherrol Reynolds, and I am a professor of optometry at Nova Southeastern University's College of Optometry in Fort Lauderdale, Florida. And thank you so much for having me to discuss my lecture at Academy 2024 on the current concepts in pachychoroid spectrum diseases. What's really important about understanding the choroid is that we have different ways now, multimodal imaging, to assess the choroidal function and structural changes in various disease condition. In patients with age-related macula degeneration, the choroid tend to be thinner than average, and in patients with certain conditions that are part of the pachychoroid spectrum of diseases, the choroid is thickened. In fact, the very term pachy means "thickened." And typically the number is greater than 320 microns. And using multimodal imaging that includes enhanced depth imaging, or EDI imaging, that penetrates a little bit deeper, this is an OCT testing can help us assess for pachychoroid. The disease spectrum has evolved and continues to evolve, and it includes central serous chorioretinopathy. It includes pachychoroid pigment epitheliopathy, or PPE. It includes pachychoroid neovasculopathy, or PNV, as well as polypoidal choroidal vasculopathy. We have peripapillary pachychoroid syndrome, as well as peripapillary pachychoroid neovasculopathy, as well as focal choroidal excavation and peripheral exudative hemorrhagic chorioretinopathy, or PEHCR, and what's new to the spectrum is adult vitelliform pachychoroid. So the disease conditions within this spectrum of diseases continues to evolve. So what's really important for clinicians to note is to incorporate enhanced depth imaging, or EDI imaging, when you see patients with any of these disease conditions to assess for a thickened choroid.

Clark Chang, OD, MSA, MSc, FAAO, discussed the complexities of diagnosing keratoconus in his Rapid Fire presentation given at the American Academy of Optometry 2024 meeting.

AAOpt 2024: Controversies in the management of keratoconus

Clark Chang, OD, MSA, MSc, FAAO, from Wills Eye Hospital and Glaukos Medical Affairs, discussed the complexities of diagnosing keratoconus in an American Academy of Optometry 2024 meeting. The presentation was given alongside Brooke Messer, OD, FAAO, FSLS; Jason Jedlicka, OD, FAAO; and John Gelles, OD, FIAO, FCLSA, FSLS, FBCLA.

Chang emphasized that central pachymetry is unreliable and referenced a 2022 study showing that pupil at apex and the thinnest point are the most heritable corneal traits in keratoconus patients. Chang also mentioned the potential of optical coherence elastography (OCE) for assessing corneal biomechanics, which could aid in diagnosing and monitoring keratoconus. He anticipates that future advancements in diagnostic tools will improve patient management and solve puzzling cases.

Hi everyone. This is Clark Chang from Cornea Service at Wills Eye Hospital in Philadelphia, as well as medical affairs in Glaukos. Just came out of a panel, avery exciting panel lecture focusing on the controversies in keratoconus management. It was too much to cover, so I would like to focus on an area that I presented, and that mainly is the diagnosis of keratoconus. So we presented cases of patients who are puzzling to us, such as those who have some mild amount of irregularity on tomography, topography, but yet are seeing 20/20 or better, as well as those who are confirmed keratoconus patients, just as an example, who the hot spot of the keratoconus areas getting bigger, but no curvature changes, for example, the Kmax stays constant. Is that a form or worsening? Should we be treating patient any differently? So I think that highlights the importance of how we approach with our diagnosis of patients, right?
And I'll skip all the current diagnostic that we're using, whether it's refractive changes or 1 diopter or more, or your topography, tomography. Let's skip ahead and say what other things may be coming to us in the future, or that potentially we could even use a little bit of the concepts now. So one thing is pachymetry. I personally also have said this before –2015 global consensus paper on management of keratoconus and ectasia – had pointed to the fact that a single point, especially central pachymetry, relying on that for diagnosis of keratoconus is the least reliable clinical factor. And I think while that's true, if you look at more recent publications, such as Wang et al in 2022, that looked at heritable corneal traits by tomography between keratoconus patients and their parents. They found that the the most heritable trait actually is pachymetry at pupil, at apex and at the thinnest point, roughly about 40 something percent chance of corresponding between keratoconus patients and their parents. So that tells us that it's unlikely to be single point pachymetry, and that is still true, but the distribution of pachymetry, probably from the thinnest point or from the apex – luckily, that corresponds pretty well in keratoconus patients anyway near the same location.
What is that relationship is like going outward? So you already have a tomography device that could give you that. But in the cases that I've told you, it still wasn't enough to let us know if this patient's keratoconus or if that patient is progressing, such as if the area of the hot spot cone is getting bigger, but no curvature changes. So maybe going more upstream to seek for the root of the problem, such as corneal biomechanics. We have one currently available in the US commercially, but, you know, better for glaucoma application rather than corneal application.
So we did an Arvo poster presentation this year, 2024 you can certainly look it up. But we looked at the application of OCE, which is optical coherence elastography, using a very small, single citation source to set off a wave and then try and then monitor the propagation of the wave across the tissue. So that we could test the different strengths. We could test the biological strength of the tissue at different axes and meridian. And that may then give us some hint of focal or diffuse weakness in a corneal tissue in the future. When do you point treatment, such as corneal cross linking, that's FDA approved, or is it glasses? Is it contact lenses and monitoring? So I think once we have more of this data in the future, we'll be able to monitor our patients better and solve some of these puzzling cases, and I look forward to seeing you next time.

Steve Ferrucci, OD, FAAO, discussed the detection and treatment of geographic atrophy during his AAOpt 2024 lecture, "Imaging Techniques and Emerging Therapies for Geographic Atrophy."

AAOpt 2024: Preserving vision by detecting and treating GA

Steve Ferrucci, OD, FAAO, discussed the detection and treatment of geographic atrophy (GA) during his AAOpt 2024 lecture, "Imaging Techniques and Emerging Therapies for Geographic Atrophy," given alongside Carolyn Majcher, OD, FAAO. Ferrucci emphasized the importance of early detection through multimodal imaging, including color, fundus photos, fundus autofluorescence, and optical coherence tomography (OCT). New FDA approved medications, such as Syfovre and Izervay, can slow GA progression by 25-35%, preserving usable vision. Ferrucci highlighted that patients with extrafoveal lesions or hyperfluorescence around lesions should be referred promptly. He stressed the urgency of recognizing GA now that treatments are available, as vision loss can occur rapidly once lesions start growing.

My name is Dr Steve Ferrucci. I'm chief of optometry at the Sepulveda VA, which is out in Los Angeles. And I did a lecture on geographic atrophy, focusing both on how to detect it through imaging, as well as some of the new treatments out there. And now that we have treatments that slow down the progression of geographic atrophy, which is great, the first step now is recognizing GA and then referring those patients that could potentially benefit from treatment out. So if you can't detect it, you really can't do anything. So that's what we focused on; talked about multi modal imaging, how you can use many different things: color fundus photos, fundus, autofluorescence, as well as OCT, and the advantages and disadvantages to each different modality. Essentially, I always tell people, whatever modality you have, or as many as you have, use whatever you have, use as many tools as you have in your toolbox to look for geographic atrophy. And then we discussed the 2 newer FDA approved medications, syfovre and izervay, and how they slow down the progression of geographic atrophy lesions, thereby allowing our patients to have longer time with usable visions. We talked about that as well, and then we closed by talking about which type of patients would be probably the best for referrals: those patients have extrafoveal lesions, and if you can see clear progression and you see those lesions getting closer to the macula. That's a patient you would think about sending out, also with fundus autofluorescence, if you see some hyper fluorescence of lesions, perhaps often circular around the lesion, that's also a lesion that we think is active and might benefit from treatment as well.

So really, as optometry, we are the ones that have these patients with geographic atrophy in our offices because there has not been any treatment. So they usually don't find themselves a retinal specialist office because there's no treatment for it. So these are patients we should have in our offices. And again through the use of these medications, they show they can slow down the lesion size growth by it–depends a little bit–25 to 35% or so. So the idea is, if we can slow down the lesion growth, prevent it from hitting the macula, prevent it from causing vision loss in these patients, then we've really helped these patients live longer lives with good, usable vision so they can drive and things like that, which obviously are important to our older patients' independence.

The OCT is probably one of the better ways to look for it. So look at the OCT, both the en face images as well as a cross section. On the cross section, we're looking for what we call hyper transmission defects, where you actually see the light penetrating more in the area of geographic atrophy. So that's what we want to look for on OCT.

My key point would be that geographic atrophy is it's more common than we probably think. And now that we have drugs to slow down the progression, it's time to start really paying attention to geographic atrophy. I would argue that when we didn't have any treatments, you know, it really wasn't that important if we missed it, because we couldn't do anything about anyway. But now that we have some treatments, it's important to be looking for it in our patients. And the other takeaway is that vision loss from geographic atrophy, these lesions grow quicker than many of us thought, I think. So it's important to refer these patients out, not immediately, but promptly. Because these lesions, once they start to grow, they do progress more rapidly, I think, than some of us previously thought.

Raman Bhakhri, OD, FAAO, outlines a handful of 2024 AAOpt presentations

AAOpt 2024: Utilizing technology to diagnose inherited retinal diseases

Raman Bhakhri, OD, FAAO, discusses his presentations at the 2024 American Academy of Optometry, one entitled "An Update on Inherited Retinal Disease," with the other being a joint session with the Academy of Ophthalmology on anterior segment herpes simplex and zoster. He highlights the complexity of diagnosing inherited retinal diseases, emphasizing the use of advanced technologies like optical coherence tomography and autofluorescence, and the importance of genetic testing. Bhakhri notes that while optometrists can manage these diseases, referrals may be necessary for specific treatments. He also stresses the significance of recognizing signs and symptoms, using bacterial anterior segment exams, and the importance of vaccinations, particularly for zoster, to reduce the risk of shingles.

Hi everyone. I'm here with Dr Raman Bhakhri to discuss this 2024 American Academy of Optometry presentations. He's presenting on inherited retinal disease, and he's also participating in a joint session between the optometry and ophthalmology academies, and should be super exciting. So thanks so much for taking the time to be here, Dr Bhakhri.

Of course. So let's start with inherited retinal diseases. What can you tell me about the update that you're giving in Indianapolis?

Sure thing. So with inherited retinal diseases, there just lots of them, and it's really hard to figure out which one a patient has. Some of them have similar presentations and the same gene mutation. Some of them have similar presentations and different gene mutations. So myself and my co-lecturer, Dr Shawn Yu from the West LA VA, we go over some of the more common inherited retinal diseases, what to look for in terms of standard stuff. Some of the more unique things are the things that we're trying to point out to the attendees as well. We also go over how to basically identify using different types of technology. There's always updates in technology, whether it be OCT, fundus autofluorescence. So we go over that with pretty much every disease that we go through in the presentation, and then we wrap it up with the importance of genetic testing. It's really opened up how we go about diagnosing inherited retinal disease.

Fantastic, and can you tell me a little bit more about the diagnostic tools and tech that you find really useful?

Sure, I think 2 of the big tools that we use, and almost every practitioner has access to it now, which is fantastic, the first one would be OCT. There we get basically, it's like a histology slide, and it's live, and we get an idea of what's going on or not going on. Whether it be at the level of the inner retina, most from our outer retinal, but we get an idea of what's going on. So that's always great. And then the next test we do is fundus autofluorescence. There, we're looking specifically at the RPE, we know that the RPE sits right below the photoreceptors, and pretty much almost every inherited retinal disease, one or both of those layers are involved. And so when you put that together with OCT, again, you have an idea of what the condition could be.

Fantastic, and in the case of inherited retinal diseases, do you often find that you refer those out to a retinal specialist, or do you tend to keep them in your chair?

I tend to keep them in my chair. I think inherited retinal disease is something that optometry can handle. If there is a need for referral, whether it be laser procedure or some type of injection, absolutely, we should make that referral. But it is something I feel like that's within our scope, is to diagnose these conditions. Unfortunately, I mean, treatment, it's just not there for inherited retinal disease. There's tons of research going on. Myself and Shawn will go over that, but it's something we can keep in our own chairs.

Yeah, and so kind of in that same vein, we're going to pivot over to that joint session between the American Academy of Optometry and the Academy of Ophthalmology. This talk is on anterior segment herpes simplex and zoster. But can you tell me a little bit about why this is an important topic to discuss jointly?

Sure, it's a diagnosis or a condition that's seen by both professions and both of us treat it. And so it just made sense for us to basically join forces on this one and go over things that we both look for, how we treat some of their stuff that might bedifferent from us. Honestly, it doesn't, though. And then when you do need to make the referral, sometimes herpes just goes out of control in the eye, whether it's simplex or zoster, and it gets to a point where we might need our friends in ophthalmology to help us out.

So across all of your talks, what are some key takeaways that you really want to drive home to optometrists?

Sure, I think the key point across at least the inherited retinal disease talk is just looking for subtle things in a retinal presentation, and you do that with the technology we had mentioned earlier: OCT and FAF. Just looking at a fundus photo usually is not enough to make a diagnosis. You need that additional testing. And then for the herpetic lecture, it's a bunch of different things: recognizing signs and symptoms, and you do that with interior anterior segment exam. But then it comes into treatment options. We have different treatment options, whether it's topical or oral. And then the big thing, one of my co-lecturer's mentions is the vaccinations, especially for zoster. Anyone over the age of 50 should really consider getting vaccinated for shingrix or for zoster with shingrix, and that drastically, I mean, drastically, reduces the chances of you picking up shingles later in life, which, again, no one wants shingles.

Oh, no, absolutely not. Well, thank you again, Dr Bhakhri for taking the time to chat with me today. I really appreciate your time and your expertise.

Raman Bhakhri, OD, FAAO, breaks down the complex process of diagnosing inherited retinal diseases.

Danica Marrelli, OD, FAAO, AAO Dip, talks OCT and glaucoma

VEW 2024: Becoming an expert on your OCT

Danica Marrelli, OD, FAAO, AAO Dip, spoke on all things optical coherence tomography (OCT) and glaucoma at this year's Vision Expo West. She outlines her 2 presentations, "Strategies for Better Diagnosing Glaucoma," and "Putting the 'Oh!' in OCT" in an interview with 

Hi, I'm Danica Marrelli, clinical professor at the University of Houston College of Optometry. So I have 2 presentations that I'm talking about glaucoma. One is called "Putting the 'Oh!' in OCT." It's a 2 hour course, so half of it is retina. Mark Dunbar is doing that and then I'm doing the hour on glaucoma. It's really something that I'm super interested in. We all have OCTs, or so many of us do, and there are some tricks and pearls to really utilize your instrument to its maximum capacity. And then the second glaucoma lecture that I'm doing is just kind of going back to the basics, and what do we need to be able to make a diagnosis of glaucoma. There's some new technology, but we can't forget about kind of the original clinical exam, the history, and a lot of other things, that it's not just about the OCT anymore.

I also am participating in a workshop. There are 4 of us. We have each one will present a little bit about a particular instrument, and then we have those instruments on the floor for participants to go and put their hands on them and and talk to the industry representatives who can tell them, is this going to be the right instrument for you? Would you do better with another one? So that's a really neat one, especially for someone who maybe is looking into getting an OCT in their practice, or maybe they have one, but they need to upgrade, and they're trying to figure out what's the best OCT to meet the needs of my practice.

I think that the instruments have gotten much better, and are in large part, we're able to upgrade them by buying new software or some new version of the actual box. Every once in a while, you're going to need to update your box. I think I have had my OCT for probably about 10 years, and we upgrade it, but we don't have to replace it, which is really nice. I think probably the biggest pitfall is just quickly looking at the reds, yellows and greens, those stop light colors that are supposed to tell us, everything is great, hey, wait a second, or oh boy, this is bad. But those stoplight colors, while they can help us alert to things that might be good or bad, there's some problems with those and that they don't represent everybody in the population. You might be not quite typical, but not necessarily have glaucoma, and so just looking at those reds, yellows and greens can sometimes trick you a little bit.

You want to look for the instrument that has the most up to date image capabilities. You know, it's kind of like buying a house. You want to stretch yourself a little bit, because something new is going to come out right after that. So I would be looking for high definition line scans, OCT-A, the ability to do wide, wide field imaging and anterior segment imaging, which I don't really do any contact lenses, but it's so important for people who are doing specialty lenses like sclerals, to really give them great information about how those lenses are working.

For a practitioner who doesn't have an OCT, maybe they don't really specialize in retina, or specialize in glaucoma, or specialized in specialty contact lenses, you sort of want a workhorse instrument. And there are some really neat instruments right now that save a lot of space by having a fundus camera and an OCT in one. That might not work for a really large practice that has lots and lots of patients that are constantly on those instruments, but for somebody who is in a smaller office and they really need to maximize the space that they have, that could be really helpful. A lot of the OCTs have wellness scans and wellness screenings that people can run on anyone. And it's not how I run my practice because I work in a more medically oriented practice, but there are all kinds of really great programs and protocols that a primary care optometrist can utilize their OCT for.

OCT is such a powerful tool. I think, that it has become so popular and so prevalent in optometric offices but it's really important to learn the very best way to utilize the instrument that you have. There are slight differences between them all. I always say, "Love the one you're with," right? So the instrument that you purchased, learn the very best way to utilize it. Learn all the tools and tricks for that particular instrument.

Danica Marrelli, OD, FAAO, AAO Dip, gives advice for those looking to upgrade their OCT or integrate the device into their practice.

OCT

Latest News