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Catch up on the top stories in optometry during the week of June 9-June 13.

Takeaways from this week in optometry: June 9 - June 13

Articles

This new QLS-111 and latanoprost fixed-dose combination (QLS-111-FDC; Qlaris) is in development for the treatment of primary open angle glaucoma, ocular hypertension, and normal tension glaucoma for patients whom optimal intraocular pressure control may remain “unachievable” due to needing to lower episcleral venous pressure.

Qlaris Bio announces development of QLS-111-FDC

Anthem will also be required to conduct quarterly self-audits beginning in July of this year in order to document the correction of the issues stated in the report. 

Anthem agrees to pay $100,000 civil penalty following complaint filed in part by Maine Optometric Association

Videos

Presenters from the Collaborative Care Symposium 2025 give their key takeaways from their presentations.

What you missed in glaucoma, dry eye, myopia, and more at CCS 2025

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Myopia- Management

Given that 88 percent of annual eye exams are conducted by optometrists, it might seem strange that merely 20 percent of LASIK cases are referred to ophthalmologists by ODs. What’s the disconnect? Kyle Sandberg, OD, FAAO; Bobby Saenz, OD, MS, FAAO; and Michael Shumski, MD, sought to answer this question by providing an overview of the spectrum of modern 

Related: Managing dry eye key to patient satisfaction after cataract, refractive surgeries

Among the treatment options for refractive surgery, 

 in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), and the more recent small incision lenticule extraction (SMILE) techniques are the most common.

Modern laser technology for used in these approaches is improving, offering more accurate results and better outcomes for patients. It is easier than ever for surgeons to create corneal flaps at the proper depth, improve refractive outcomes, and reduce side effects during procedures. For example, the blackouts experienced by some patients during flap creation can be addressed with newer laser platforms.

“With VisuMax Femtosecond Laser (Zeiss), it’s down to zero,” Dr. Shumski says.

These advances apply to PRK as well with new protocols to prevent corneal haze and better bandage contact lenses that accelerate epithelial healing.

Related: How to determine an ideal LASIK candidate

For patients who don’t fit the criteria for more traditional refractive therapies, phakic implants such as Visian Implantable Collamer Lens (ICL, Staar Surgical) and Verisye (AMO) offer a new fresh approach.

New options on the market, such as toric ICLs, were approved to treat myopic reduction up to 20.00 D, and they are changing the way we deliver refractive care. Just like with LASIK, patients receiving phakic implants must undergo a pre-surgical evaluation to determine whether
	they will be successful. But ODs using these newer implants will need to make sure they’re evaluating the right criteria.

In particular, temporary intraocular pressure (IOP) spikes are a concern for ICLs. As such, the vault measurement is crucial to monitor.

“Troubleshooting early on with IOP is really important for grading the vault,” Dr. Saenz says.

Related: Measurements matter in cataract surgery, the new refractive procedure

For concerns like presbyopia, ODs may need to take a blended approach to refractive care.

“You can do blended vision with any of the laser vision correction procedures or even ICL,” Dr. Saenz says.

Blended options for presbyopia management include the following approaches:

ODs should also consider the presbyopic IOLs on the market, including monovision, accommodating, trifocal, and extended depth of focus lenses.

Related: Surgical, medical approaches making waves in presbyopia

Particularly for patients with more complex vision needs like presbyopia, it is crucial for ODs to screen 

candidates carefully and establish clear expectations for outcomes from the beginning. 

 is someone who is low risk for complications. 

The best way to make assessments and help patients understand what to expect from their treatments is to become familiar with available research and technologies. 

Getting familiar with current research and the technologies available are the best way to make these assessments and help patients understand what to expect from their treatments. 

“Patient-reported outcomes are critical,” Dr. Saenz says, especially in managing after-effects of refractive cataract surgery. 

This is a key aspect of managing outcomes for patients undergoing refractive 

. ODs should make sure to understand their patients’ activities of daily living and what type of correction they’re used to. 

Related: Cataract surgery problem solving: Is technology the answer?

 options available to ODs is a change in attitude. Optometrists should avoid falling into a referral mindset in which patient care is managed by individual providers and instead embrace the concept of collaborative care. 

Both optometrists and ophthalmologists have their own strengths and roles to play in patient care. “Ophthalmologists want your help,” Dr. Shumski says. 

From patient education to inter-office communication to follow-up evaluations, there is a lot that ODs can do to facilitate these collaborative relationships. 

“Know who is in your area, know what they offer, and discuss those offers with them,” he says.

More by Greg and Marek: Macular diseases: Emerging best practices for diagnosis, management and follow-up protocols

American Academy of Optometry

Modern refractive surgery offers additional approaches for collaborative patient care.

Unlock the potential of refractive surgery

Multifocal contact lenses are advancing fast in the contact lens market, and optometrists may be surprised at their applications. This topic was discussed at a rapid-fire session at the American Academy of Optometry 2019 annual meeting in Orlando.

Speakers included:
	• Beth Kinoshita, OD, FAAO, at Pacific University College of Optometry
	• Vinita Henry, OD, FAAO, at the University of Missouri-St. Louis College of Optometry
	• Dawn Lam, OD, FAAO, at Southern California College of Optometry at Marshall B. Ketchum University
	• Julie DeKinder, OD, FAAO, at the University of Missouri-St. Louis College of Optometry


	A crucial aspect of fitting soft multifocal contact lenses, according to Dr. Kinoshita, is good centration.

With single-vision (SV) contact lenses, there is some room for error in centration. But in multifocal lens designs, specific optics can help the lens center over the visual axis. Thus, centration is more important for a proper fit.

“Today’s off-the-shelf contact lenses provide many of these features,” she says.

Fitting considerations for multifocal contact lenses are anatomical, so ODs should take care to ensure good coverage and movement.

“I challenge ODs in practice to really start looking at the decentration, though slight, of their contact lens fits,” Dr. Kinoshita says.

Related: How to master hybrid contact lenses

She says that in her experience, many contact lens patients seen in previous evaluations appeared to be properly centered, but in actuality had temporal displacement. While challenges like centration are less of a concern for monovision fits, other aspects, such as pupil size, become more significant.

Dr. Kinoshita recommends that ODs perform topography over the contact lenses to determine centration.

“This is best achieved if ODs perform topography on the patient without a contact lens and repeat the topography while the patient is wearing the multifocal lenses,” she says.


	For both aspheric and translating gas permeable (GP) multifocal designs, a physical assessment is crucial to a proper fit.

“The lid position is going to be very important with these types of lenses,” Dr. Henry says.

She recommends that before fitting any GP lens, ODs take care to perform all necessary pre-fit evaluations, including:
	• Physical exam of tears, cornea, lid
	• Anterior and posterior health assessments
	• Current refraction and add values
	• Keratometry (K) values
	• Dominant eye identification
	• Pupil size measurements
	• Horizontal visible iris diameter (HVID) measurements
	• Lower lid position

Related: Scleral lens aids in visual rehabilitation

Aspheric GP multifocals work best on patients with smaller pupils, though lower lid sizing is less of a factor.

“Typically, these will be a little more difficult if the patient requires critical near vision,” Dr. Henry says.

She recommends that ODs follow the GP laboratory’s fitting guide or manufacturer guidelines as references when using aspheric multifocals.

For translating designs, add power and pupil size are less of a concern, but ODs should note that the ideal patient will have a lid that is at or slightly above the lower limbus. Good lid tonicity helps as well.

Dr. Henry warns that ODs should be on the lookout for potential challenges like excessive lens rotation, poor translation, and near or distant blur.


	Projections estimate that by 2050, five billion people will have myopia.1

However, new lenses for myopia control have the potential to stem this tide. Research into optical correction shows that certain contact lens designs can slow myopia by 36 to 79 percent.2-4

While applicable to all patients, lenses that slow refractive progression may offer particular value to myopic children. Typically, children as young as age 8 may wear contact lenses, though Dr. Lam notes that this range depends on the patient.

Related: Know the hidden links among glaucoma, contact lenses, and the cornea

“Look at the maturity level of the patient and cooperation among parent, guardian, and child,” she says.

She describes key considerations when fitting patients with reshaping contact lenses to control myopia progression.
	• Choose spherical-equivalent distance power from the fitting set
	• Choose the highest tolerable add power
	• Look for patients with low levels of refractive astigmatism
	• Choose among daily, two-week, and monthly wear schedules

Dr. Lam notes that while these myopia control lenses have produced results for slowing myopic progression, they are not approved by the U.S. Food & Drug Administration (FDA) for this purpose. Practitioners should make these distinctions clear to patients and establish expectations going in.


	Practitioners hoping to fit multifocal scleral lenses for patients have some obstacles.

“It’s a bit of a challenge,” Dr. DeKinder says.

Not all scleral lenses have a multifocal option, meaning that ODs need to think long-term when fitting patients in sclerals. In particular, they should consider the patient’s age and possible refractive progression.

“If you have a patient who is already presbyopic or may become presbyopic within the next few years, you need to make sure the lens you are selecting has the option for a multifocal design,” Dr. DeKinder says.

She also says that a well-fitting scleral lens will not move with blinking, so ODs must take care to ensure that the lens fits the pupil well. Scleral lenses, in general, will decenter when they are placed on the eye. 

Again, Dr. DeKinder recommends that providers reference fitting guides to help make determinations.

Designs for these lenses can be concentric or aspheric, but it is possible to find combination lenses that offer more customization options.

“If you can get a lens with a center-distance or center-near design, you have more flexibility in the way you can manipulate those optics,” she says.

Overall, Dr. DeKinder recommends practitioners have a systematic approach and gain experience fitting different types of designs, one at a time.

“When you feel very good at fitting one, add a second lens design into your toolbox,” she says.

More by Greg Hill: Offer IPL as a treatment for MGD and dry eye disease

1. Holden BA, Fricke TR, et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology. 2016;123(5):1036-42.
	2. Anstice NS, Phillips JR. Effect of dual-focus soft contact lens wear on axial myopia progression in children. Ophthalmology. 2011;118: 1152Y61.
	3. Sankaridurg P, Holden B, et al. Decrease in rate of myopia progression with a contact lens designed to reduce relative peripheral hyperopia: one-year results. Invest Ophthalmol Vis Sci. 2011;52:9362Y7.
	4. Aller TA, Wildsoet C. Results of a one-year prospective clinical trial (CONTROL) of the use of bifocal soft contact lenses to control myopia progression. Ophthal Physiol Opt. 2006 Nov;26:8Y9.

Get a rapid-fire rundown of considerations for multifocal lens success

How to succeed with multifocal contact lenses

Artificial intelligence (AI) may hold the answers to some of the biggest challenges in optometry, according to Nahida Akter, PhD; Jack Phu, OD, PhD, FAAO; and Christopher Clark, OD, PhD, at the 2019 American Academy of Optometry meeting in Orlando.


	AI shows promise in ophthalmic applications of disease screening, image interpretation, and data synthesis. Research is exploring how modified convolutional neural networks (CNNs) can analyze patterns and data to classify glaucoma based on raw optical coherence tomography (OCT) images.

This process assessed 410 raw OCT images of temporal-superior-nasal-inferior-temporal (TSNIT) retina layers across both glaucoma and non-glaucoma patients.

“I think all of the layers have some benefits,” Dr. Akter says.

Each layer contributes to the transfer-learning based CNN, creating a more detailed profile of retinal layers that could aid ODs in clinical imaging.

Related: new research highlights how data is processed to detect glaucomatous optic neuropathy


	As ODs know, angle-closure glaucoma is a significant public health problem. Gonioscopy is the gold standard for assessing angle-closure spectrum disease, but the tool has its limitations.

“It is highly skill-intensive and highly subjective among doctors,” Dr. Phu says.

And while angle-closure glaucoma is the one form of glaucoma that can be prevented, success is contingent on an early diagnosis through gonioscopy grading.

But what if ODs could rely on anterior segment (AS) OCT imaging instead of gonioscopy?

Dr. Phu detailed the research questions his team studied. He honed in on whether quantitative parameters obtained using OCT imaging could describe the spectrum of gonioscopic angle closures that ODs typically use in the clinic.

This involved reviews of gonioscopy and AS-OCT clinical data, including evaluations of nasal and temporal angles, gonioscopic grades, and the posterior trabecular meshwork.

Results showed that while AS-OCT evaluations were somewhat reliable for identifying the continuum of change in open angles to closure, there were significant errors when no prior gonioscopic information was available.

Although there is potential for further integration of artificial intelligence models for distinguishing between open and closed angles, gonioscopy is still an essential skill for ODs. It remains the gold standard for grading angle-closure disease.

“The features that we see on AS-OCT, or any imaging device, should supplement what we already see in our gonioscopic view,” Dr. Phu says.

Retinal monitoring in diabetics without retinopathy


	Computing power has advanced to the point where ODs can explore more advanced ways to diagnose and monitor diabetes through machine learning. In particular, there are applications for measuring subclinical changes to retinal architecture, based on HA1c levels, that may indicate disease.

“We can monitor changes in the retina before people have retinopathy,” Dr. Clark says.

To do so, researchers applied several training models based on 8,760 spectral domain (SD) OCT images, all taken from people with diabetes. Data sets were analyzed and applied to each model in conjunction with data on each patient's HA1c.

Results showed that the chosen model, KNN, was effective at measuring the discrepancies in data, examining topics such as capillary distance and spacing to detect retinopathy. The model was able to predict disease incidence even with relatively low HA1c levels, indicating that there may be potential for further clinical application.

“I think eyecare professionals are going to need some sort of AI, computerized detection system to diagnosis and monitoring for the average clinician,” he says.

AI may be the answer for early disease detection

Halting glaucoma progression can be challenging, but as it turns out, medication is not the only tool in an OD’s toolbox. Many factors influence glaucoma progression in patients, some of which may be unrelated to the disease itself.

ODs must be aware of the hidden links among glaucoma symptoms, medication, and contact lenses with respect to how ocular surface disease (OSD) affects patient outcomes.

Karen Lee, OD, FSLS, FAAO, and Jane Kuo, OD, FAAO, rose awareness to these links at the American Academy of Optometry 2019 meeting in Orlando.


	It is known that there is a higher prevalence of OSD in glaucoma patients, primarily related to decreased tear production and break up time. These symptoms may not be related to glaucoma proper, but instead, the medical drops patients use to manage symptoms.

In particular, the benzalkonium chloride (BAK) preservative is a common culprit, present in 70 percent of ophthalmic glaucoma drops. These drops may sometimes produce side effects in patients that may reduce treatment compliance.

“When you have patients with dry eye, it really decreases the quality of life. Anti-glaucoma eye drops containing BAK compromises patient compliance,” Dr. Kuo says.

This molecule disrupts the corneal epithelium by damaging DNA and increasing inflammation. Such a disruption can create particularly challenging concerns when the patient is a contact lens wearer.

Certain contact lenses, particularly hydrogel lenses with high water content, absorb BAK molecules and release them slowly into the corneal epithelium over time. Prolonged exposure to BAK is known to increase symptoms.

Fortunately, ODs can mitigate these corneal/drug interactions through patient education.

“The big idea here is that corneal exposure time to BAK tends to be relatively short-lived,” Dr. Lee says.

The U.S. Food & Drug Administration (FDA) recommends that patients using both glaucoma drops and contact lenses wait at least 15 minutes after instilling drops before applying their lenses. ODs should share this information with their patients to ensure they understand the possible interaction between their contact lenses and their medication.

Additionally, ODs who fit glaucoma patients in contact lenses can work these considerations into their lens selection.

“I might be reaching for a low water content hydrogel soft lens if I know the patient will abuse his drops with contact lens wear,” Dr. Lee says.

Related: Keep an eye on link between glaucoma and blood pressure


	It is common for ODs to encounter patients interested in wearing contact lenses during or after surgical treatments. While there are no contraindications to contact lens wear after procedures like minimally invasive glaucoma surgery (MIGS), ODs need to assess the corneal health of each patient to determine the best approach.

“If the cornea or the sclera is not affected, then patients can potentially keep wearing what they are currently wearing,” Dr. Lee says.

However, if the cornea is affected, ODs will need to consider using gas permeable (GP)s contact lenses that produce a new refractive surface. In these cases, soft contact lenses may not be enough.

“Think about other options. Maybe using scleral topography or some customized lens designs,” Dr. Lee says.

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