This article was reviewed by Anthony J. St. Leger, PhD



The eye is blessed with a friendly environment that has a protective effect against infection. 

Investigators have reported that tears from colonized mice provide the ocular surface with improved protection from pathogens such as 

, both of which can cause ocular infection.

This is good news because, according to Anthony J. St. Leger, PhD, an assistant professor in the departments of ophthalmology and immunology at the University of Pittsburgh School of Medicine in Pennsylvania, the eye was thought to be an “immune privileged” site, which implied that the organ was largely ignored by the immune system. 

Ocular surface inflammation: Vicious cycle of ocular surface disruption

Indeed, the eye is armed with various mechanisms that dampenexcessive inflammatory responses.

However, we do know that active immune responses occur routinely in and around the eye.

A great balancing act of inflammation must be struck to preserve visual acuity, as a nonexistent immune response would leave the eye susceptible to infectious insults and an overactive inflammatory response would result in irreversible damage. 

In the case of the cornea, excessive inflammation can lead to corneal scarring and the need for a corneal transplant.

Investigators like St. Leger and others are trying to understand the mechanisms governing the line between infection and inflammatory disease. St. Leger has focused the attention of his lab on the conjunctiva. 

In a murine study of ocular surface disease,

 St. Leger and colleagues demonstrated the power of immune responses against commensal bacteria at the ocular surface. 

ASCRS 2020: OSD improvement in eyes implanted with trabecular meshwork bypass stents

 and showed that the bacterium elicited a specific interleukin-17 response that drove the production and release of protective antimicrobials into the tears. The antimicrobials in turn protected the eye from 

St. Leger and his colleagues concluded that there was “direct evidence that a resident commensal microbiome exists on the ocular surface and identified the cellular mechanisms underlying its effects on ocular immune homeostasis and host defense.”

“Specifically, when a potential pathogen is present, the innate immune cells mobilize and start to initiate the immune response with development of inflammation,” he explained.

Cells in the conjunctiva appear, he pointed out, “have a hairpin trigger. Whenever the cornea becomes infected, the cells from the conjunctiva mobilize and infiltrate the cornea and do their best to eliminate any infections.”

New molecule for allergic conjunctivitis makes debut

The powerful antimicrobial activity in the tears is aided by the high concentration of salt, which helps prevent any microbes from successfully adhering to the eye or infecting the eye. 

There is also a relatively high concentration of antibodies in the tears that have the capability of binding bacteria, viruses, or allergens and washing them away, preventing extended exposure and the potential generation of an overactive inflammatory response.

This scenario emphasizes the importance of an adequate tear film layer to provide ultimate protection. In diseases such as dry eye, this ability is compromised.

“If the eye is not continually bathed in tears, the integrity of junctions between cells becomes weaker and bacteria have a better ability to bind and cause disease,” St. Leger said.

on the eye found that the incidence of conjunctivitis was very low, occurring in less than 0.1% of cases. In contrast, conjunctivitis develops in from 0.5% to 1% of hospital cases of influenza.

This suggested that there were few cases of conjunctivitis; however, more recent evidence suggests that the prevalence of conjunctivitis is higher than reported initially,

He noted that more cases will have to be studied to determine if the conjunctivitis is similar to another virus such as influenza or totally different.

The eyes offer conjunctival clue to COVID-19

 which indicate that human and mouse cornea and conjunctiva possess the receptors for the coronavirus.

“This suggests that the virus, when it is there, can bind and can infect the tissue,” he said.

“Preclinical and clinical studies are needed to look at the possible ocular manifestations of the virus,” St. Leger added. “In some cases, conjunctivitis is ignored because it is not a major ocular problem, but the recognition of the presence of conjunctivitis could suggest that the person is actively shedding the coronavirus, which is a serious problem in the current pandemic.”

St. Leger reported that studies are underway to examine how the virus behaves in ferrets and nonhuman primates that are receiving doses of virus in small liquid droplets aimed at the eyes to determine a phenotype. These data are forthcoming. 


St. Leger has no financial disclosures related to this content.

St Leger AJ, Desai JV, Drummond RA, et al. An ocular commensal protects against corneal infection by driving an interleukin-17 response from mucosal γδ T cells. 

. 2017;47(1):148-158. doi:10.1016/j.immuni.2017.06.014

2. Belser JA, Lash RR, Garg S, Tumpey TM, Maines TR. The eyes have it: influenza virus infection beyond the respiratory tract. 

3. Wu P, Duan F, Luo C, et al. Characteristics of ocular findings of patients with coronavirus disease 2019 (COVID-19) in Hubei Province, China. 

 2020;138(5):575-578. doi:10.1001/jamaophthalmol.2020.1291 doi:10.1001/jamaophthalmol.2020.1291

4. Zhou L, Xu Z, Castiglione, GM, et al. ACE2 and TMPRSS2 are expressed on the human ocular surface, suggesting susceptibility to SARS-CoV-2 infection. 

Articles

Researchers note that more study of conjunctivitis is needed in patients with COVID-19 

Amid pandemic, friendly bugs can help protect the eye from infection

This article was reviewed by M. Dominik Fischer, MD, PhD



Gene therapy for choroideremia, a rare, degenerative inherited disease, with adeno-associated virus 2 receptor (AAV2) improved or maintained vision in the affected patients treated.



There is currently no approved treatment for this disease, which results from mutation in the 

Blazing a new trail for gene therapy in retinal disease 

M. Dominik Fischer, MD, PhD, explained that choroideremia is a good candidate for gene therapy because the 

 gene is small, which facilitates its packaging in an AAV2 capsid and the easy access and immune-privileged state of the eye. 

In addition, the vision loss in this disease may be reversible to some extent. The mutation in the 

 gene leads to an absence of functional ras-associated binding escort protein 1 (REP1).

Investigators, led by Fischer, evaluated the safety and efficacy of AAV2-REP1 therapy in a phase 2, single-center, open-label, randomized clinical trial conducted at the University of Tübingen inGermany. The 6 male patients were treated with a single, 0.1-mL subretinal injection of 1011 genome particles after vitrectomy.

The primary outcome at 2 years was a change in the best-corrected visual acuity (BCVA) in the treated eye compared with the fellow eye. 

The secondary end points were the effects of treatment on microperimetry variables, the change in the area of fundus autofluorescence, and the findings onoptical coherence tomography.

Studies target unilateral gene therapy injection 

The results showed that by the time of the 2-year evaluation, the BCVA in the treated eye had increased by 3.7 letters compared with no change in the control eye; the difference did not reach significance (

The retinal sensitivity increased by 10.3 dB in the treated eyes and 9.7 dB in the fellow eyes at 2 years, a difference that also did not reach significance (

Fischer reported that 5 of the 6 treated eyes had improvements in all or some of the microperimetry parameters, including retinal sensitivity, peak retinal sensitivity, and/or gaze fixation area.

The treated eyes had mean declines compared with baseline of 21% in the preserved area of fundus autofluorescence, 23% in the preserved ellipsoidal zone, and 5% in the subfoveal choroidal thickness. The changes in the fellow eyes were similar.

No serious adverse effects (AEs) were associated with the treatment. About half of the reported AEs were ocular and were the same as those experienced by patients after vitrectomy.



Gene therapy offering hope for retinal, corneal patients 

The authors concluded that the results showed the potential of AAV-mediated gene therapy for CHM.

“Gene therapy with AAV2-REP1 was associated with maintenance or improvement of the visual acuity, although no significant difference was found from control eyes,” Fischer said. “Our study further adds to the evidence that gene therapy with AAVs-REP1 may be well tolerated, with no severe adverse effects occurring in the study patients.”

Fischer added that continued investigations could more precisely define the efficacy and safety of gene therapy with AAV2-REP1 in CHM. 

Dr Fischer has no financial disclosures related to this content.

--- 

1. Fischer MD, Ochakovski GA, Beier B, et al. Efficacy and safety of retinal gene therapy using adeno-associated virus vector for patients with choroideremia: a randomized clinical trial. 

 2019;137(11):1247-1254. doi:10.1001/jamaophthalmol.2019.3278

Gene therapy to treat choroideremia shows potential for maintaining or improving vision

Gene therapy offers hope for choroideremia


Dilraj Grewal, MD, associate professor of ophthalmology at Duke Eye Center/ director of grading at the Duke Reading Center, speaks with 

' David Hutton on his presentation "Evaluating the True 3-Year Recurrence Rate in Non-infectious Posterior Segment Uveitis Following an Injectable Fluocinolone Acetonide Insert," during the Inflammatory and Infectious Diseases Symposium of the virtual 2020 American Society of Retina Specialists (ASRS) meeting.

Videos

Dilraj Grewal, MD, speaks on his presentation "Evaluating the True 3-Year Recurrence Rate in Non-infectious Posterior Segment Uveitis Following an Injectable Fluocinolone Acetonide Insert," during ASRS 2020. 

Evaluating 3-year recurrence rate in non-infectious posterior segment veitis post-FAi 

 pandemic puts healthcare workers, including ophthalmologists, on the front lines of the battle against the virus.

Hasan Aytoğan, MD, of İzmir Tepecik Training and Research Hospital in Turkey, reported on research in which the coronavirus was detected on a small number of environmental samples from an exam room where asymptomatic patients underwent a routine ophthalmology exam.

The infectivity of the virus samples was not known. The investigators also note that there is little objective data that demonstrate the risks of encountering individuals carrying the virus asymptomatically in the case of maintained elective examinations.

The quality-improvement study was performed on Mar 20, 1 week after the first confirmed COVID-19 case was identified at Tepecik Training and Research Hospital in Izmir, Turkey.

According to the study, initially reported in 

, of the seven samples taken after examinations of patients who passed COVID-19 triage questions, two samples of seven—one from the slit lamp breath shield and one from the phoropter—tested positive for coronavirus, according to Aytoğan’s team.

Aytoğan noted that RT-PCR cannot determine the presence of infectious virus and that the testing method has limitations.

They examined two threads of research to conduct their study: how long the virus lasts on surfaces, as well as the role of asymptomatic transmission by looking at an examination day in an outpatient ophthalmology clinic “without interventions for patients who were asymptomatic.”

“Since we were examining patients who are asymptomatic during the pandemic, we wanted to know if we could detect COVID-19 viral material at the end of a day of examinations of patients who were asymptomatic and seen in an eye examination room,” investigators wrote.

Contamination from the preceding days was ruled out, considering that all samples that were taken before examinations had negative results for viral material. Two of the 3 samples that were taken from the slitlamp shield and phoropter in zone 1 after examinations had positive results.

The room was cleaned with a hydrogen peroxide solution and had no visitors for 18 hours after cleaning.

Importantly, the authors noted the room was not cleaned between patients, but chin and forehead rests were wiped with isopropyl alcohol, 70%.

“The same physician performed all examinations, and 1 health care worker visited the room during examinations,” the investigators wrote. “Only companions of patients of pediatric age and patients with communication and mobility problems were allowed to enter the room. The numbers of companions were recorded.”

Researchers used real-time polymerase chain reaction (RT-PCR) testing to detect viral RNA in samples from the biomicroscope stage, slit lamp breath shield, phoropter, tonometer, and door handles. In a recent study, the total positive rate of PCR was reported as 30% to 60% at the initial presentation.

1. Yang Y﻿, Yang M﻿, Shen C﻿, et al. Evaluating the accuracy of different respiratory specimens in the laboratory diagnosis and monitoring the viral shedding of 2019-nCoV infections. Published February 17, 2020. Accessed July 24, 2020. 

https://www.medrxiv.org/content/10.1101/2020.02.11.20021493v2

A team of Turkish investigators detected COVID-19 viral material on the environmental surfaces of an ophthalmology examination room despite triage systems to exclude patients with the virus. 

Study: Asymptomatic COVID-19 patients may have left viral material on surfaces of exam room

This article was reviewed by Dimitrios Damopoulos, PhD



According to results of a recent study, it may be possible to predict through machine learning which patients will have improvements in their mild nonproliferative diabetic retinopathy (NPDR).

Features based on retinal imaging were more predictive of improvements compared to features based on patient demographics and systemic measurements. The ability to predict improvements in NPDR may facilitate more personalized monitoring of patients.

App offers personal risk profile for diabetic retinopathy 

The Early Treatment Diabetic Retinopathy Study-Diabetic Retinopathy Severity Score (ETDRS-DRSS) has been an invaluable tool for clinicians treating patients with diabetic retinopathy (DR). 

The severity score guides clinicians regarding expectations of disease worsening based on each level of progression.

“A single step on the scale represents a clinically meaningful change. Progression in the ETDRS-DRSS is associated with development of vision-threatening DR,” according to Dimitrios Damopoulos, PhD, lead author of the study.

Even the early stages of DR are associated with life-changing effects, as patients’ quality of life can be affected even before there is a clinically measurable loss of central vision.

Therefore, studying the changes in DR severity early on may identify patients who have a higher risk of progression to visual loss from the disease, he explained.

Connecting the dots: Genetics and impact of diabetic retinopathy

Because time is of the essence in DR, Damopoulos and colleagues set a 3-pronged goal: to develop an initial machine learning algorithm to help predict improvements in DR in patients with mild NPDR, to test the algorithm’s capability to identify rapidly advancing disease during its early stages, and to evaluate the changes in severity over 2 years in patients with mild NPDR in the C-Tracer (95 patients at baseline, 93 at 2 years) and EUROCONDOR (NCT01726075;

340 patients at baseline, 338 at 2 years) studies who had not been treated with intravitreal therapies.

According to Damopoulos, investigators first analyzed the statistics of improvement and worsening of the DRSS from baseline to 2 years. 


Diabetic retinopathy progression in anti-VEGF versus FA implant (ASRS 2020)

He reported that at 2 years there was only a handful of patients who showed a 2-step worsening and less than 7% in each study had a 2-step improvement.

“Considering these characteristics of the study population, we focused on predicting the 1-step level of improvement,” he said. 

For this task, after excluding patients who could not improve further, they ended up with 288 patients from both studies. Of these, 123 improved, 148 remained unchanged, and 17 worsened. 

Finally, they trained the algorithms and assessed how they performed in predicting improvements based on specific families of baseline features, such as the demographics and systemic measurements, features based on retinal imaging, and the combination of those 2.

Unraveling role of genetics in the pathogenesis of diabetic retinopathy 

The patient demographics and systemic measurements included age (mean, 62.7 years), gender (65.6% male), diabetes duration (12.2 years), hemoglobin A1C (7.22), and cholesterol profile. 

The retinal and functional features included the central subfield thickness, number of microaneurysms, DRSS level, and best-corrected visual acuity.

Damopoulos explained that features from both studies were used to train random forest machine learning models to predict whether individual subjects were improvers or nonimprovers after 2 years.

The results showed that using features of retinal imaging alone, or in combination with demographic and systemic features, the respective average areas under the curve were 73% and 74%. The results with the demographic and functional features alone was 57%, he reported.


Blockchain technology aims to drive big data to 'train' AI

Conclusions reached were that combining all the features provided the higher predictive outcome for DR improvement in patients with mild NPDR, and the features of retinalimages had a higher predictive value than the demographic and systemic features. 

Importantly, using predictive machine learning models in patients with mild NPDR may facilitate personalized monitoring and follow-up, according to Damopoulos.

Moving forward, continued work in this research will attempt to predict 2-step changes and worsening of DR.

The investigators plan to use longer observational periods and employ larger datasets for modeling, possibly by complementing the dataset with similar patient groups from other clinical trials, Damopoulos concluded.


Dr. Damopoulos is an employee of F. Hoffmann-La Roche, Basel, Switzerland. Genentech Inc, a member of the Roche Group, provided funding.

Mazhar K, Varma R, Choudhury F, et al; Los Angeles Latino Eye Study Group. Severity of diabetic retinopathy and health-related quality of life: the Los Angeles Latino Eye Study. 

. 2011;118(4):649-655. doi:10.1016/j.ophtha.2010.08.003

Willis JR, Doan QV, Gleeson M, et al. Vision-related functional burden of diabetic retinopathy across severity levels in the United States. 

. 2017;135(9):926-932. doi:10.1001/jamaophthalmol.2017.2553

Machine-learning algorithms have potential to predict patients with nonproliferative diabetic retinopathy who will or will not improve over time.

Machine-learning algorithms could help predict course of NPDR


Age-related macular degeneration (AMD) is an eye disease that leads to vision loss and can cause blindness. 

The dry form affects 80% of individuals with AMD; it tends to progress more slowly than the wet type and results in a subsequent loss of visual acuity.

At present, there is no approved treatment or cure for the dry form. In dry AMD, drusen form beneath the macula, causing a progressive loss of central vision over time.

ASRS 2020: Augmented-reality headset provides vision for AMD patients

However, several studies with strong and moderate evidence in the past 5 years have shown encouraging results in treating eye diseases, such as AMD,

retinopathy of prematurity, and diabetic macular edema, with a technique known as photobiomodulation (PBM).

PBM has also been used in the last 20 years for musculoskeletal pain, injury, dysfunction, and wound healing; to improve acute muscle performance and reduce muscle damage after exercise;

 and for neuropathic pain, lymphedema, and oral mucositis

PBM, or low-level light therapy, is the application of monochromatic light to a part of the body with the aim of repairing tissues and reducing inflammation, edema, and pain.

The process is not a heat therapy, but is more akin to photosynthesis in plants. Light, in the far red and near-infrared spectral range, can stimulate the cells, which leads to a cascade of photochemical reactions. 

The low-powered light is absorbed locally by the cytochrome c oxidase; mitochondrial energy is then produced by releasing oxygen, which results in increased adenosine triphosphate concentration and reduced oxidative stress. 

This photochemical reaction then activates enzymes and second messengers, leading to a cellular and, indirectly, systemic response by tissues that have not absorbed photons.

PBM can be used in acute and chronic eye diseases such as dry AMD, as mitochondrial dysfunction and oxidative stress play a key role in many macular diseases.

The technique does not worsen the disease, has no side effects, and is completely noninvasive.

 The protocol we use provides a combination of 9 PBM therapies.

Vision-related qualities of life: Impacts of advanced AMD

PBM is performed through a medical device which applies light-emitting diodes (LEDs) to stimulate cellular function and improve energy production. 

Each cycle of therapy delivers wavelengths between 590 nm and 850 nm for 4 minutes per eye. The PBM cycles are completed in approximately 1 month.

Clinical outcomes are determined using an optical coherence tomography (OCT) test; an Amsler grid, to detect wavy, broken, or distorted lines; a Pelli-Robson chart, for assessment of contrast sensitivity; a Snellen chart, for far visual acuity (VA); and a Jaeger chart, for near VA. The outcomes are measured at the end of the PBM procedure, after 3 months and after 6 months.

The clinical results of a case after PBM are shown in 

. Nine PBM cycles were administered to a patient over 1 month. 

After 1 month and 6 months, the OCT scan showed reduced drusen. The patient obtained subjectively improved vision, less eye strain, more color contrast, higher definition, and better far and near uncorrected VA. Contrast sensitivity improved from 1.8 to 2.0. Outcomes remained stable at the 6-month follow-up.

ASRS 2020: What Aviceda's lead candidate AVD-104 may mean for dry AMD

This case demonstrates a successful noninvasive treatment with improved quality of vision in dry AMD. Irradiation could, therefore, offer a new, noninvasive, adverse effect–free means of stimulating retinal stem cells to regenerate.

PBM is a treatment whereby quality of vision is improved and not worsened in some patients suffering from dry AMD, leading to better VA and contrast sensitivity and a less damaged macular profile. 

Overall, these results are encouraging and indicate how protocols could be consolidated in the future.

Promoting cellular regeneration by using light waves represents a challenge in ophthalmology. 

To date, there are no approved theories for many retinal diseases. Intriguingly, this protocol seems to offer an extremely promising approach to prevent VA from worsening and to promote tissue repair in the dry form of AMD. Moreover, the approach has the enormous advantage of being entirely noninvasive.

Characterizing local retinal layer changes in AMD

According to this hypothesis, at certain wavelengths, irradiation could regenerate retinal cells.

Thus, modulated light can offer a novel, valid therapeutic approach for dry AMD, which may facilitate the repair of damaged tissues in the retina and promote the survival and function of epithelial cells within the retinal pigmented epithelium.

Miorica Bertelli, OD, and Elena Scaffidi, MS, contributed to this report.

Roberto Pinelli, MD, is founder of the Switzerland Eye Research Institute in Lugano.

Markowitz SN, Devenyi RG, Munk MR, et al. A double-masked, randomized, sham-controlled, single-center study with photobiomodulation for the treatment of dry age-related macular degeneration. 

. Published online August 9, 2019. doi:10.1097/IAE.0000000000002632

2. Forte R, Cennamo G, Finelli ML, Bonavolontà P, de Crecchio G, Greco GM. Combination of flavonoids with Centella asiatica and Melilotus for diabetic cystoid macular edema without macular thickening. 

 2011;27(2):109-113. doi:10.1089/jop.2010.0159

3. Khoo HE, Ng HS, Yap WS, Goh HJH, Yim HS. Nutrients for prevention of macular degeneration and eye-related diseases. 

4. Pawlowska E, Szczepanska J, Koskela A, Kaarniranta K, Blasiak J. Dietary polyphenols in age-related macular degeneration: protection against oxidative stress and beyond. 

 2019;2019:9682318. doi:10.1155/2019/9682318

5. Riva A, Togni S, Franceschi F, et al. The effect of a natural, standardized bilberry extract (Mirtoselect) in dry eye: a randomized, double blinded, placebo-controlled trial. 

6. Tao Y, Chen T, Yang GQ, Peng GH, Yan ZJ, Huang YF. Anthocyanin can arrest the cone photoreceptor degeneration and act as a novel treatment for retinitis pigmentosa. 

. 2016;9(1):153-158. doi:10.18240/ijo.2016.01.25

7. Hamblin MR. Photobiomodulation or low-level laser therapy. 

. 2016;9(11-12):1122-1124. doi:10.1002/jbio.201670113

8. Merry G, Devenyi R, Dotson R, Markowitz SN, Reyes SV. Treatment of dry age-related macular degeneration with photobiomodulation. Paper presented at: Association for Research and Vision in Ophthalmology 2012; May 7, 2012; Fort Lauderdale, FL.

9. Natoli R, Valter K, Barbosa M, et al. 670nm photobiomodulation as a novel protection against retinopathy of prematurity: evidence from oxygen induced retinopathy models. 

. 2013;8(8):e72135. doi:10.1371/journal.pone.0072135

10. Tang J, Herda AA, Kern TS. Photobiomodulation in the treatment of patients with non-center-involving diabetic macular oedema. 

. 2014;98(8):1013-1015. doi:10.1136/bjophthalmol-2013-304477

11. Ferraresi C, Kaippert B, Avci P, et al. Low-level laser (light) therapy increases mitochondrial membrane potential and ATP synthesis in C2C12 myotubes with a peak response at 3-6 H. 

 2015;91(2):411-416. doi:10.1111/php.12397

12. Koev K, Avramov L, Borissova E. Clinical results from low-level laser therapy in patients with autosomal dominant cone-rod dystrophy. 

https://iopscience.iop.org/article/10.1088/1742-6596/992/1/012060

13. Holanda VM, Chavantes MC, Wu X, Anders JJ. The mechanistic basis for photobiomodulation therapy of neuropathic pain by near infrared laser light. 

. 2017;49(5):516-524. doi:10.1002/lsm.22628

14. Baxter GD, Liu L, Petrich S, et al. Low level laser therapy (photobiomodulation therapy) for breast cancer-related lymphedema: a systematic review. 

 2017; 17(1):833. doi:10.1186/s12885-017-3852-x

15. Zadik Y, Arany PR, Fregnani ER, et al; Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO). Systematic review of photobiomodulation for the management of oral mucositis in cancer patients and clinical practice guidelines. 

 2019;27(10):3969-3983. doi:10.1007/s00520-019-04890-2

16. Natoli R, Zhu Y, Valter K, Bisti S, Eells J, Stone J. Gene and noncoding RNA regulation underlying photoreceptor protection: microarray study of dietary antioxidant saffron and photobiomodulation in rat retina. 

17. Gkotsi D, Begum R, Salt T, et al. Recharging mitochondrial batteries in old eyes. Near infra-red increases ATP. 

. 2014;122:50-53. doi:10.1016/j.exer.2014.02.023

18. Huang YY, Chen ACH, Carroll JD, Hamblin MR. Biphasic dose response in low level light therapy. 

2009;7(4):358-383. doi:10.2203/dose-response.09-027.Hamblin

19. Saini JS, Temple S, Stern JH. Human retinal pigment epithelium stem cell (RPESC). 

2016;854:557-562. doi:10.1007/978-3-319-17121-0_74

Study results demonstrate effectiveness in treating dry age-related macular degeneration

Photobiomodulation shows the power of light

Bausch Health Companies Inc. (BHC) announced in a prepared statement today its decision to spin off its eye health business into an independent publicly traded company, Bausch & Lomb-NewCo, that will be separate from the other Bausch Health entities.

By so doing, BHC anticipates a number of benefits from this action, namely, unlocking value in the Bausch + Lomb brand and integrated portfolio of eye health products, facilitating BHC focus on expanding leadership in gastroenterology, aesthetics/dermatology, neurology, and international pharma, and enhanced focus on and highlighting of two attractive but dissimilar businesses, according to the statement.

This action, according to BHC will result in 2 separate companies, specifically, a fully integrated, pure play eye-health company built on the iconic Bausch + Lomb brand and long history of innovation; and a diversified pharmaceutical company with leading positions in gastroenterology, aesthetics/dermatology, neurology and international pharmaceuticals.

Bausch & Lomb said it anticipates that this action will “improve strategic focus and enhance financial transparency to better enable stakeholders to value each business independently.”

"We are committed to taking action to unlock what we see as unrecognized value in Bausch Health shares, and we believe that separating our business into two highly focused, stand-alone companies is the way to accomplish that goal," said Joseph C. Papa, chairman and CEO of Bausch Health.

Four years ago, the organization initiated a multiphase plan, first to stabilize and then to transform Bausch Health into a company positioned to deliver long-term organic growth, Papa noted.

“We have divested approximately $4 billion of non-core assets, paid down over $8 billion of debt, resolved numerous legacy legal issues and managed a loss of exclusivity on an approximately $1.4 billion product portfolio, while also investing in R&D, new product launches­­ and core franchises with attractive growth opportunities,” he continued. “Our Board of Directors and management team have been working on alternatives over the last 12 months to determine how to best unlock value across our businesses, and we believe that the time is right to begin the separation process, so each business has greater flexibility to pursue strategic opportunities in their respective markets."

It is anticipated that after satisfying certain conditions and approvals and completion of other actions, reporting is expected to begin in the first quarter of 2021.

Bausch + Lomb - NewCo, will include Bausch Health's global vision care, surgical, consumer and ophthalmic Rx businesses. The company explained that the combination of pipeline expansion and established durable eye care brands, including BAUSCH + LOMB ULTRA, Biotrue ONEday, LUMIFY, Ocuvite and PreserVision, among others, and the launch of BAUSCH + LOMB INFUSE contact lenses, is expected to drive what is expected to be consistent revenue growth worldwide.

This action will result in 2 separate companies,

Amid pandemic, friendly bugs can help protect the eye from infection

Gene therapy offers hope for choroideremia

Evaluating 3-year recurrence rate in non-infectious posterior segment veitis post-FAi

Study: Asymptomatic COVID-19 patients may have left viral material on surfaces of exam room

Machine-learning algorithms could help predict course of NPDR

Photobiomodulation shows the power of light

Bausch Health: Spin-off of eye health business

“It took a pandemic to get me to reprioritize my life”

Research shows promising results for LHON gene therapy

Tackling the challenge of noninfectious uveitis