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Catch up on the top stories in optometry during the week of August 25-August 29.

Takeaways from this week in optometry: August 25 - August 29

In this podcast, experts John D. Gelles, OD, FAAO, FIAOMC, FCLSA, FSLS, FBCLA; and John Hovanesian, MD, FACS; discuss the importance of comprehensive strategies when performing corneal sensitivity testing in patients suspected of having neurotrophic keratitis (NK).

NK Insights: An Interactive Corneal Sensitivity Testing Workshop

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New report from The Vision Council finds rising eye examination rates in Canada

The Japan’s Ministry of Health, Labor, and Welfare approved the lens for manufacturing and sale in the country.

Japan rings in first soft contact lens for myopia control with MiSight 1 day approval

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Patrick D. Yoshinaga, OD, MPH, FAAO, professor and chief of low vision rehabilitation service at Southern California College of Optometry at Marshall B. Ketchum University joins host Miriam Korik, OD, on a deep dive into what low vision rehab entails. Assistive tech, diagnosis, occupational therapy referrals, and AI–all and more are discussed as these two experts discuss the the big picture and minutia of care for patients with low vision.

Follow Dr Korik on social media:

YouTube: 

https://www.youtube.com/channel/UCuIVJVZ17AJFEo8fqXK_gZg

https://www.linkedin.com/in/miriam-korik-81b492111/

Professor and chief of low vision rehabilitation service Patrick D. Yoshinaga, OD, MPH, FAAO, chats with Dr Korik about assistive tech, AI, and accessibility for patients with low vision.

You and Eye: What optometrists need to know about low vision

This podcast provides a review of some of the key highlights from the Controversies in Modern Eye Care meeting held in April 2023. The program is designed for those who did not attend the live meeting and to help reinforce learnings for those who did.



 This transcript has been lightly edited for clarity.

At the present time, we really have no idea of what causes geographic atrophy, but a lot of attentions being played to the alternative pathway in the complement cascade, as everybody knows, there's three complement pathways. There's the classical, the lectin, and the alternative pathways. There is evidence drusen and in other histopath pathologies that there are complement factors that are involved in drusen, also in the pigment epithelium. There are certain complement changes that will potentially cause these changes to progress. So a lot of attention is being played in the alternative pathway. There is one drug, Annexon, that's being used in the classical pathway. It has some rationale because it's down-regulating C3, but from a different angle. C3 unfortunately, or fortunately, I guess, is the commonality of all three of the pathways, the alternative, classical, lectin pathway. But there is some evidence that C1q, which is found in the classical pathway, will have a role. It does play a role in synapses. It's also found on drusen.

Most of the work is being done in trying to reduce the alternative pathway from even starting. So down-regulation of the alternative pathway is the goal from almost all these drugs. If you start the alternative pathway and it goes through from C3 to C5, all the way to C9, you get what they call apoptosis. So the little cells at the edge of your atrophy begin to have holes, pores put into them, and the cells die. So by treating and trying to reduce the progression, we're hopefully going to reduce the apoptosis that occurs as the final event. So there are many different factors that are being looked at. We have factor I, factor B, factor D, all which down-regulate the complement system. Factor D happens to be a oral medication very similar to lampalizumab, which failed. We have factor I, which is a gene therapy that also down-regulates the system.

Factor B down-regulates the system. Well, there's also the ability to put in complement factor H that may be not present and some patients, and if they can do that, may slow it down. There's a new company that just started. There are some good factors that stop neovascularization from occurring on a genetic basis and they're being placed into the eye and hopefully can reduce progression. But the two major areas are inhibition of factor C3 and C5. C3 is a drug known by Apellis. This drug has been approved by the FDA and showed a fairly significant improvement in the extrafoveal geographic lesions. The extrafoveal lesions basically grow faster and they grow faster, and by reducing them, you can hopefully stop the lesions from growing into the center of the fovea and losing vision.

In fact, in their study, they showed about 27% reduction in these extrafoveal lesion growths, and they recently, just a few weeks ago at ARVO presented that if patients are 250 microns or greater from the center of the fovea, that those patients at two years had five letter better vision than they did in the group that was in the sham group that wasn't treated.

They also have shown that the lesions by visual field tend to not grow as much and you save off more retina. Lesions that are sub-foveal tend to grow at a slower rate in general, and it's only about a 16-18% reduction in the growth rate in that. There's no free lunch in medicine. There's always safety, which is the biggest concern that we have. We've had very excellent drugs recently for treating AMD, but because of the side effect profile and the safety, have never really been utilized to any great degree. The safety is good, but there was about 8% of patients that did go on to developing wet macular degeneration. Inflammation was about 1.5%. There's a small incidence of infection, but that goes along with almost every drug you put into the eye. The C5 is the next drug that will probably be approved.

It is basically, I think in July or August is their PDUFA date. So we'll know in July or August if the approval comes forward. But they should be approved. They have had two phase three trials that both showed statistically significant improvement, whereas in the Apellis drug, it took the C3 inhibitor, it did take 18 months before they started to show an improvement in one of the trials. And at 24 months, both trials were clinically and statistically significant. C5 is downstream from C3 and again, blocking it will decrease the ability for C5b to go on to activating the MAC complex at C9. Another drug that's being tested right now is CD59. It's a drug that actually, CD59 is a natural occurring protein that is in the eye. It goes up when you have AMD and if you can down-regulate that... I'm sorry, it goes down when you have goes down when you have wet AMD, and if you raise that, it will be a natural inhibitor of the progression.

It's a gene therapy. So one and done. Also has been shown to reduce progression of geographic atrophy, again, by the fact that it stops the progression to the MAC complex, it doesn't allow it to form, but we have a lot of unanswered questions. What starts the complement pathway? Is it amyloid? Because amyloid is found in drusen? Is that what stimulates and causes the pathway to begin? Do we have to treat forever? Can we treat just acutely and stop the process? How long do we have to do it? Is it forever? Is this something that we have to do forever? Or once you get the patient righted and you're not having any further inflammation in that pathway, can you back off? And would combination therapy be a more benefit? You've got a C3 inhibitor and a C5 inhibitor both showing about 27% decrease in the extrafoveal lesions.

If you put them together, would that equal an improvement? If you added C3 to CD59, would that cause a bigger improvement? And those are things that'll have to be worked out in the future. Certainly, gene therapy or longer-acting delivery systems are going to be the answer to this. It's not very sustainable to give monthly or even every other month injections to these patients. And the other thing that I'm really amazed about is the number of patients who have dry AMD. When you look at autofluorescence or look at their OCTs or look at their photographs, have geographic atrophy present. It's a lot larger population than I originally thought.

So first, you can have direct damage, which is through the membrane attack complex, which directly targets the RPE cells, and you can also have the indirect damage, which is to the photoreceptor cells where you get that abnormal protein deposition, which directly leads to the mortality of photoreceptor cells.

Evidence supporting the contribution of the complement system to progression of AMD and GA has accelerated the development of therapeutics targeting complement protein C3 and C5. Drugs being investigated include avacincaptad pegol, which inhibits C5 and C5 cleavage, pegcetacoplan, which prevents C3 activation, ANX007, which inhibits C1q, and GEM 103, which controls the complement cascade. Let's listen to Dr. Boyer review these agents.

At the present time there are a number of companies that are investigating the complement pathway as a means of slowing down the progression of geographic atrophy. The thought being that the geographic atrophy occurs and progresses due to dysregulation of the complement system. We don't know what starts it. We don't know if it's started by amyloid, oxidative stress can start this, but there are a variety of different causes that activate the complement pathway. Why the complement pathway? Because a lot of complement factors that are being investigated are found within drusen, and drusen are a hallmark of dry macular degeneration. We also can see that complement factors that are involved in genetics also play a major role.

So if we go to the GATHER 1, 2 trial, which is a C5 inhibitor, basically at this time it's PDUFA date or the day that the FDA has to announce whether they'll allow us to use it or not or approve it is in late July, early August, and it probably will be approved because they've had two 12 month phase three trials that both showed an improvement. In this trial the patients had have to have extra fovea lesions, meaning that the area of geographic atrophy was not centered and was not under the center of the fovea. It could be one micron away, but that was considered non-central involvement. And in that case, in the first GATHER 1 trial, there were about a 27% reduction in progression. In the GATHER 2 trial, it was much more modest, about 16 to 18% reduction.

They were both statistically significant. And when you looked at the GATHER 1 trial data over a long period of time, 18 months, that held, and we don't have the long-term GATHER 2 data. In the second year of the GATHER 2 trial, 50% of the patients went to every other month, and some continued on a monthly basis. Now, there are other differences between the trials, but the safety of the C5 inhibitor was excellent. They had no signs of uveitis. They had a very small incidence of conversion to wet macular degeneration, about 6%.

They seem to have excellent response. They've showed a reduction in the three line loss of vision by patients being treated over the period of time. So we don't have that drug available yet, but at least for non subfoveal lesions, extrafoveal lesions, this appears to be a good alternative. The drug that has been approved recently is a C3 inhibitor by a company called Apellis. It's called SYFOVRE. And this drug acts within the complement system and is central to all the complement pathways. There are three complement pathways. There's the classical, the lectin, and the alternative, and they all meet at the C3 and then go on to C5. And the C3 blockage eliminates C3b from activating the alternative pathway and allowing it to not go to the MAC complex. They've done two trials, DERBY and OAKS. The OAKS trial was positive at 12 months showing an excellent reduction in vision.

The DERBY trial did not meet its primary specified endpoint, but at 18 months, both of them did, then at 24 months the results were excellent. For the extrafoveal lesions, which were about one third of all the lesions in their trial, they showed about a 27% reduction, very similar to the C5 inhibitor I just discussed. They also, however, had a very large percentage of patients who had the lesion under the foveal area, and those the results again, were positive compared to the sham and as well in growth. However, the growth rate was much less, in the range of about 16 17%. The growth rate was significantly decreased. In their trial again, the safety was good. There was slightly a higher incidence of inflammation, though the inflammation was mild and was treated with topical steroids. Also in addition to that, there was about an 8% risk of developing the wet MAC degeneration, having exudative form of Mac degeneration, that form.

There also had eight patients in the trial that went on to developing ischemic optic neuropathy, which seems to be a puzzle that nobody has been able to figure out. There was one patient, I think, in the GATHER trial, and there was one patient omalizumab, which was a very large trial. So this showed a definite change that's been investigated, and two neuro ophthalmologists that are world renowned could not find a correlation, and they found that all the patients had a disc at risk. They all had some other vascular episodes at a similar period of time, whether it be hypertensive crisis or some other change, and felt that this was based on that. But that is still something that needs to be discussed. There are several other complement factors that are being evaluated all again, to slow down the process of the alternative pathway. There's factor B, factor D, factor I.

There's patients who are receiving a CFH. There are also people that are now treating and trying to improve the genetics by giving proteins, or I'm sorry, giving the genes that are positive that actually can overcome the negative genes. There's one in the classical pathway called C1q that's being blocked that they feel is important. It plays a role in synapses and it's also found on drusen, so there is some reason to do it. By blocking it it does reduce C3 further down. Now, as you go down the complement pathway, you eventually end up at C9. And C9 is the MAC complex. It's composed of 5, 6, 7, 8, and 9, and it causes a pore formation, which causes cell to rupture and die. CD59 is a natural occurring protein that reduces the progression. It's found to be decreased in patients with macular degeneration.

And by gene therapy they can add CD59 as a protective mechanism. This protective mechanism may reduce the progression of the geographic atrophy and also reduce the progression of the wet MAC degeneration. So this also is being studied. There are a number of other drugs not in the complement pathway that are being studied to hopefully reduce the onset of the problem. One of them has to do with macrophages and trying to reduce the macrophages from becoming active and activating the complement pathway. Inflammasome are another substance that will cause the activation of the complement pathway and is being treated way upstream to hopefully stop the complement pathway from being activated. There are a number of other factors that are looked at. We know that our mitochondria go down as we get older, but in patients with macular degeneration, it goes down even more in the eye. So several companies are looking at treatment to try to improve the mitochondrial function over a period of time.

And as it improves the mitochondrial function, hopefully it will improve the low luminance vision, the poor vision that we get at night or just age related macular degeneration causes patients to have more difficulty with night vision. Reading needs more light. Driving at night is not very easy to do for patients with macular degeneration. So there are a number of other factors that are being evaluated to try to reduce the onset of the alternative pathway, and also to try to slow it down and hopefully in the near future, some combination of these will give us better results than we have today.

Visual loss associated with advanced GA affects many aspects of patients' lives. Daily functions like household chores become more challenging. Patients may engage in fewer social interactions and may be isolated from family and friends. Let's listen to Doctors Boyer and Macdonald discuss how GA affects patients' quality of life.

Geographic atrophy is an area of loss of the pigment as well as the photoreceptors that lie above them. So everywhere that you have an area of geographic atrophy, you actually have an area that's a blind spot or a scotoma. And obviously as a scotoma comes into the foveal area, patients lose the ability to read, drive, see people's faces clearly. Prior to that though, in both dry macular degeneration as well as wet macular degeneration, patients begin to have more difficulty with night vision. They have a lot more difficulty. They may come in to see you and they're 20/20, and the biggest complaint is, they can't read anymore. Doctor will say, well, you're 20/20. I gave you some reading spectacles, you should be able to read. The biggest problem is the loss of the ability to see. They need a lot more light and they have a hard time driving at night.

They don't feel comfortable driving at night. And even though their vision may be 20/20, their dark adaptation really suffers very early in the course of this condition and continues on. So it would be wonderful to have a drug that would improve that because that's the major complaint that I hear when I see the patients in the clinic. These patients come in and they've gotten the best spectacle correction possible, and sometimes they are 20/20, but still have bitter complaints about reading and everything.

I remember one patient specifically when I told them to buy a light that goes over their shoulder or to get a Kindle, and the patient with the light came back and said, I can read. I can read. It was like a miracle, just having more light and the Kindle has been a big boon. I think patients who want to read and try to read, the Kindle with back lighting is much better than a lot of the other machines that are out there to allow them to read. So I think that it really makes it very difficult for patients to drive and to see people's faces clearly. And again, depending on where the scotoma is, it can be devastating if it's in the center.

It affects it drastically. First, you can have direct decrease of vision. So the visual impairment can affect everything that would require detailed vision. So reading, self-care, detailed vision. And it can also affect contrast sensitivity, which is being able to see shades of gray. So looking at something that wasn't high contrast, very black on white, for instance, looking at facial features of somebody or expressions or navigating in dimmer illumination. So this can lead to a decrease in self-care and activities of daily living, which then can make somebody feel like they are more dependent on others, and that can directly lead to decreased social interaction for people. And decreased social interaction is obviously going to lead to an impact on mental health for these individuals. So it affects them very severely.

Low vision aids and vision rehabilitation services may be especially helpful for patients with GA. Among individuals with low vision, an estimated 90% have useful residual vision that could be optimized from rehabilitation services. Many patients are unaware that these low vision services are available. Doctors Boyer and Mac Donald outline these services.

I think one of the things that we as physicians and eyecare professionals in general, really don't pay enough attention to is the wonderful advances that have been made in low vision. It's very frustrating for me as a doctor for many, many, many years to not have a treatment available for these patients, many of which are very active and except for their dry macular degeneration, geographic atrophy, really want to do things that are in good health. They want to travel, they want to do whatever they can. Some of them are professors and they like to read and they want to continue reading. So I refer a fairly large number of patients to low vision specialists because there are a lot of devices out there, and there are more to come. There are a lot of devices, unfortunately are very expensive, but there'll be glasses that will magnify and will be able to help them read, be able to read to them if they can't read.

There are certain devices that can actually read to them. You can take your iPhone and blow it up also. Just if you were shopping and you couldn't read a label, didn't know how much something costs, you can take a picture on your iPhone and just blow it up and be able to see what the price is so you don't go expecting a $15 item and it's $150 item. So I think that that low vision specialists really help the patients a lot. They teach them little tricks. In the home what they can do, they teach them about navigation. You won't see very many of the patients come in with a white cane, even though they may be legally blind from macular degeneration. It just doesn't happen in my experience. So they have to be very careful when they're outside. My mother, as I indicated earlier in the conversation, had severe macular degeneration, and I took her to a wedding.

My wife was out of town. My sisters were going somewhere else, and I realized that just going down an escalator was difficult for her because she couldn't see where it started and where it ended. Going to the restroom, everybody's got fancy restrooms, little things that sometimes I have to look three times to make sure I'm going into the correct one because the little models that they have on the door are sometimes questionable when I look at them for a while. So I think that there's so many things that low vision can help, just extra lighting. When you go to read a menu, they'll be embarrassed to pull it out. But I send a lot of patients to get low vision, and I think the low vision devices in the very near future will improve greatly.

So when somebody has a vision loss, supplementing that by going to a low vision specialist, looking at what your vision is and how much magnification you need or filters or lighting to help somebody improve their quality of life and daily living tasks is important. A low vision doctor will look at various assistive technology devices or regular optical devices to assist somebody, and they may even do specific training for the patient and have adaptive strategies for them, as well as being able to coordinate with all the other eyecare professionals and other interdisciplinary professionals to help the patient navigate this condition.

This podcast provides a review of some of the key highlights from the Controversies in Modern Eye Care meeting held in April 2023. The program is designed for those who did not attend the live meeting and to help reinforce learnings for those who did.

Advances in treatment for geographic atrophy


Dr. Jay M. Haynie is an adjunct clinical professor at Pacific University College of Optometry, a Fellow of the American Academy of Optometry and a member of the Optometric Retina Society. He is a published author and has become a nationally recognized speaker on advances in technology and the management of retinal disease.



OYE Technology

Dr. Kerry Gelb speaks with Dr. Jay M. Hainie in the second part of their discussion on diabetes of the eye! 

Open your eyes: diabetes of the eye (part 2)

In the first of a two-part installment, Dr. Gelb speaks with Dr. Jay M. Haynie on diabetes of the eye.

Dr. Haynie is an adjunct clinical professor at Pacific University College of Optometry, fellow of the American Academy of Optometry, and a member of the Optometric Retina Society. He is a published author and has become a nationally recognized speaker on advances in technology and the management of retinal disease.

Open your eyes: diabetes of the eye

FDA issues a complete response letter to Outlook Therapeutics for ONS-5010, citing insufficient evidence of effectiveness for wet AMD treatment.

FDA issues complete response letter to Outlook Therapeutics for resubmitted BLA for ONS-5010

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

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

Researchers used adaptive optics scanning light ophthalmoscopy (AOSLO) to study retinas in mice with photoreceptor damage, specifically photoreceptor laser injury.

Researchers examine brain immune cell impact on the eye

A rare case of tubulointerstitial nephritis and uveitis syndrome in a teenager highlights the importance of multidisciplinary diagnosis and management.

Tubulointerstitial nephritis and uveitis: A multidisciplinary approach to diagnosing a rare disease

Ocular salvage and preservation of vision are essentially dependent on early diagnosis, and several studies have been conducted to identify the factors leading to delayed diagnosis at presentation.

Parental lag time is primary reason for delayed diagnosis and treatment of retinoblastoma 

Carolyn Majcher, OD, FAAO, detailed a talk she gave alongside Mary Beth Yackey, OD, at Optometry's Meeting 2025.

AOA 2025: A review of myopic retinal complications with Dr Carolyn Majcher

Carolyn Majcher, a professor and director of residency programs at the Oklahoma College of Optometry, presented a collaborative discussion with her colleague Mary Beth Yackey about retinal complications associated with high myopia. Their presentation focused on the critical importance of understanding and managing potential vision-threatening conditions in patients with significant myopic refractive errors. The presentation comprehensively explored several key retinal complications commonly observed in patients with high myopia. These include retinal tears, rhegmatogenous retinal detachment, foveal schisis (myopic traction maculopathy), and myopic choroidal neovascularization. Despite neither presenter personally practicing myopia management, they strongly emphasized its potential to prevent serious retinal and glaucomatous complications. 

A significant portion of the discussion centered on the critical role of multimodal imaging in monitoring and managing these conditions. Majcher highlighted the importance of using advanced diagnostic technologies like ultra-wide field imaging to detect retinal breaks or tears that might require prophylactic barrier laser treatment. Additionally, optical coherence tomography (OCT) and OCT angiography were recommended for identifying and tracking choroidal neovascularization, particularly in monitoring treatment response to anti-VEGF therapy. Patient education emerged as a crucial component of managing high myopia-related risks. 

Majcher stressed the need to educate patients about their increased vulnerability to retinal complications. She recommended providing patients with Amsler grids to help them self-monitor for early signs of macular changes and teaching them to recognize symptoms of retinal detachment and tears. 

The presentation underscored the importance of proactive management and early intervention. By educating patients, utilizing advanced imaging technologies, and maintaining vigilant monitoring, eye care professionals can potentially mitigate the risk of severe vision-threatening complications associated with high myopia. The key takeaways included the critical nature of myopia management, the value of multimodal imaging, the significance of patient education, and the need for timely referrals to retinal specialists when complex complications are detected.

Videos

Conference

Alongside Rachel Steele, OD, Rafieetary outlines what to look for in blurred disc margins and the importance of acting fast and sending patients to the ED when needed.

AOA 2025: An OD's guide to swollen nerves with Dr Mohammad Rafieetary

Mohammad Rafieetary, OD, FAAO, FORS, Dipl ABO, ABCMO, discussed his one of the many presentations he gave swollen nerves and blurred vision diagnostic approaches at the American Optometric Association's Optometry's Meeting 2025. The lecture, co-created with Rachel Steele, OD, is designed to be an engaging one-hour session that explored various conditions causing blurred vision. Rafieetary emphasized the critical nature of these conditions, which can potentially signal life-threatening medical issues. The presentation challenged audience members to participate by answering diagnostic questions and understanding different management strategies. 

Diagnostic tools are a key component of the lecture. Rafieetary highlighted several important diagnostic methods, including visual fields, optical coherence tomography (OCT), and pupil testing. He acknowledged that pupil testing can be complex, especially for patients with prior medical histories like cataract surgery or trauma. The importance of comprehensive patient history cannot be overstated, with factors like body mass index (BMI) playing a significant role in diagnosis. 

A crucial aspect of the lecture focused on identifying emergency situations requiring immediate medical intervention. Rafieetary provides specific examples of when patients should be directed to the emergency room, such as:

Pregnant patients with high blood pressure

Instances of anterior ischemic optic neuropathy

He passionately advocated for proactive patient care, comparing the urgency of medical attention to how people readily call emergency services for other situations. Rafieetary recommended that healthcare professionals not hesitate to call ambulances or emergency services when a patient's condition appears potentially life-threatening. 

Beyond this specific lecture, Rafieetary will be presenting multiple talks at the conference, including discussions on fundus autofluorescence, OCT technologies, and inherited retinal disorders. He will also conduct 2 hands-on workshops: an OCT workshop and a technology workshop. The conversation reflected Rafieetary's commitment to comprehensive patient care, diagnostic precision, and continuous medical education. His collaborative approach, working with colleagues like Steele, Roya Attar, OD, MBA, DHA, and Jessica Haynes, OD, underscores the importance of teamwork in advancing medical knowledge and patient treatment strategies.

Rachelle Lin, OD, MS, FAAO, on collaborating more effectively on neovascular retinal cases

Collaborating more effectively on neovascular retinal cases

Retinal vascular occlusions, neovascular age-related macular degeneration (AMD), and diabetic macular edema (DME) represent some of the most challenging chronic eye conditions managed in partnership between optometrists and retinal specialists. At the recent Collaborative Care Symposium, Rachelle Lin, OD, MS, FAAO, highlighted how newer retinal therapies are addressing treatment gaps by offering extended dosing intervals without compromising efficacy—ultimately easing the burden on both patients and providers.

Many patients with retinal conditions face monthly intravitreal injections, leading to treatment fatigue and, in some cases, dropout. According to Lin, newer anti-VEGF agents and sustained-delivery therapies are reducing this burden. These innovations offer optometrists an opportunity to reengage patients who may have fallen off the treatment path.

“As optometrists, we play a key role in making timely referrals, not just at diagnosis but throughout the treatment journey,” Lin emphasized. “We can help ensure patients stay engaged with their care by educating them on new options and supporting them between ophthalmology visits.”

Optometrists are often the first point of contact for patients experiencing visual changes. Lin encouraged her colleagues to take an active role in educating patients about what to expect during treatment, especially as protocols evolve.

“We need to make sure our patients are informed, motivated, and understand the importance of follow-up,” she said. “If they’re uncomfortable with their treatment plan, we should prompt them to speak with their ophthalmologist about other options.”

A team-based approach to vision preservation

Lin works closely with retinal specialists, particularly in cases where patients also require low vision rehabilitation. She noted that many of her patients see both their ophthalmologist for disease management and her clinic for tools like magnifiers, updated prescriptions, and DMV evaluations.

“Retinal specialists are doing an amazing job with cutting-edge treatments,” she said. “But once patients reach a certain point, they need support in living with reduced vision. That’s where we step in.”

Lin concluded, “By learning together and working together, we can support patients through the entire spectrum of their care journey.”

At the Collaborative Care Symposium, Rachelle Lin, OD, MS, FAAO, highlighted how newer retinal therapies are addressing treatment gaps by offering extended dosing intervals without compromising efficacy—ultimately easing the burden on both patients and providers.

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.

Dr Dilsher Dhoot speaks on retinal disease and emerging therapies at Controversies in Modern Eye Care 2025

Dilsher Dhoot, MD, FASRS, expresses excitement for emerging retinal therapies, improved comanagement

2025 Controversies in Modern Eye Care conference

, Dilsher Dhoot, MD, FASRS, of California Retina Consultants shared his forward-looking perspective on developments in 

 management, highlighting both recent breakthroughs and promising innovations on the horizon. The Controversies in Modern Eye Care meeting took place May 4, 2025, in Los Angeles, California.

“We’re in a golden era of retina,” Dhoot began, referencing a wave of recent FDA approvals and a pipeline rich with potential. He expressed particular enthusiasm about gene therapy and tyrosine kinase inhibitors, which offer new hope for patients needing longer treatment durability. These therapies, he noted, are "just around the corner" and could significantly extend treatment intervals compared with existing regimens.

The evolution in geographic atrophy management

. “We haven’t traditionally had therapy for GA, but now we do,” he noted, referring to the 2 FDA-approved treatments that have emerged in recent years. While these agents can slow atrophy progression, he emphasized that this is just the beginning.

“The pipeline will include more durable agents, and possibly more effective ones,” he said. He also stressed the growing role of artificial intelligence (AI) in identifying patients who may benefit most from current and future treatments. AI-driven imaging and biomarker identification are already showing promise in personalizing care and improving outcomes.

Optometry’s pivotal role in retinal health

Dhoot praised optometrists for their role in early detection and referral. “You do a great job identifying these patients,” he said, emphasizing that timely referral doesn’t signify imminent vision loss. “Being sent to retina is not a sentence to blindness.”

He encouraged optometrists to reassure patients about intravitreal injections, noting that they’re less daunting than they sound. “The eye is a very easy place to inject,” he said, and with current therapies, patients can retain—and sometimes even improve—vision.

Referral thresholds and collaborative care

Dhoot urged optometrists to consider a low threshold for referral, particularly when diagnostic uncertainty exists or interventions are available. “For myself, if I’m not sure, I refer,” he said. While conditions like intermediate age-related macular degeneration or mild nonproliferative diabetic retinopathy can sometimes be monitored, he stressed the importance of access to advanced imaging and clear communication between providers.

As the field of retina rapidly advances, collaboration between optometry and retina specialists will remain crucial in delivering optimal patient care.

Dilsher Dhoot, MD, FASRS, shares his forward-looking perspective on developments in retinal disease management, highlighting both recent breakthroughs and promising innovations on the horizon.

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