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Fluorescence lifetime imaging ophthalmoscopy is emerging as a valuable tool to reveal previously hidden links between retinal changes and systemic disease.

Analyzing FLIO data from the AI-READI project with Aaron Y. Lee, MD, MSCI 

Sheryl brings a wealth of editorial experience to MJH Life Sciences’ Eye Care Network, having engaged with the readers and the greater ophthalmic community of 

for more than 20 years. As Group Editorial Director, Sheryl’s purview extends across the print and digital network of 

Ophthalmology Times, Ophthalmology Times Europe, Modern Retina 

 Prior to ophthalmology, Sheryl previously covered the fields of audiology and confectionery science/technology/manufacturing.

Sheryl is also passionate about the mission, vision and values of Ophthalmic World Leaders (OWL) and recently completed her term on its Board of Directors. She continues to volunteer as Editor-in-Chief of the organization’s 

Magazine. In 2013, she was honored with the group’s inaugural Rising Star Award.

In addition, she has served as a judge for 

 Health Care Heroes Awards program as well as the Jesse H. Neal National Business Journalism Awards.

The center aims to optimize patients' vision with a range of cataract and corneal refractive procedures and minimize reliance on glasses and contacts.

Mount Sinai’s NYEE unveils Center for Refractive Solutions

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The EnVision Summit, co-founded by Bonnie An Henderson, MD, is a unique family-friendly, multispecialty CME ophthalmology conference, along with a newly introduced optometry track. Henderson sits down with 

' Sheryl Stevenson, group editorial director - eye care, to talk about the 2025 conference that will take place February 14 to 17 at the Caribe Hilton San Juan, in Puerto Rico.

Henderson describes the meeting as “a place where not only are physicians and optometrists learning, but their families are part of the experience too,” emphasizing the opportunity for personal and professional growth in a supportive, community-oriented environment.

The 2025 agenda will include symposia, surgical videos, panel discussions, and leadership seminars that highlight rapid advancements across ophthalmology specialties, including cataract, refractive, retina, glaucoma, pediatrics, and oculoplastics. “It’s incredible how quickly things change in ophthalmology—if you miss a year or two, you’ll be amazed by the innovations that have emerged,” Henderson shared. Updates on new intraocular lenses, surgical tools, and diagnostic techniques will showcase the field’s forward momentum. Additionally, a leadership seminar led by Malvina Eydelman, MD, Director of the Office of Ophthalmic, Anesthesia, Respiratory, ENT, and Dental Devices at FDA, Silver Spring, Maryland, will feature discussions on career pathways and diversity, empowering attendees with insights from industry leaders.

The optometry track, introduced last year, continues to expand, emphasizing collaboration between ophthalmologists and optometrists in critical areas like preoperative and postoperative care, medications, and diagnostic tools. As Henderson explained, “It's important for both fields to come together and discuss how we can work together to improve patient care.” This cross-disciplinary dialogue reflects the summit's dedication to advancing care through shared expertise.

The youth program offers age-appropriate activities that allow children to engage in fun learning while also witnessing their parents' professional contributions. "It’s amazing to watch these kids grow up at EnVision Summit and form lasting friendships,” said Henderson. The trainee program, which offers free registration for residents, fellows, and medical students, has also seen growth. Henderson highlighted the program’s value, noting that it “gives young professionals the chance to network with leaders in the field and gain invaluable mentorship.”



To learn more about or to register for EnVision Summit 2025,

EnVision Summit

The EnVision Summit, co-founded by Bonnie An Henderson, MD, is a unique family-oriented, multispecialty ophthalmology CME conference, along with a newly introduced optometry track. Henderson sits down with Ophthalmology Times to talk about the 2025 conference that will take place February 14 to 17 at the Caribe Hilton San Juan, in Puerto Rico.

Connect, learn, and innovate in a family-friendly atmosphere:  What to expect at EnVision Summit 2025

In this EyePod® episode, Peter J. McDonnell, MD, and Neda Shamie, MD, discuss the transformative impact of minimally invasive glaucoma surgery (MIGS) on glaucoma care and its integration with cataract surgery, sharing insights and practical tips for ophthalmologists.

The views and perspectives expressed are those of Dr. McDonnell and Dr. Shamie.

This transcript has been edited for clarity.

Hi, everyone! Welcome to this episode of the 

This is Sheryl Stevenson, group editorial director with 

, and we are joined today by our co-chief medical editors.

Dr. Peter J. McDonnell is the director of the Wilmer Eye Institute at Johns Hopkins University School of Medicine in Baltimore, Maryland, and Dr. Neda Shamie is a cataract, LASIK, and corneal surgeon and partner of the Maloney-Shamie Vision Institute in Los Angeles, California, as well as an adjunct clinical professor of ophthalmology at the USC Keck School of Medicine.

In today’s episode, they discuss how embracing MIGS procedures can significantly enhance glaucoma management during cataract surgeries, offering patients the opportunity to reduce their reliance on eye drops and improve overall treatment outcomes. They share how integrating MIGS into clinical practice can be a rewarding endeavor that empowers ophthalmologists to provide more effective care for patients with glaucoma.

 Welcome, everyone! This is Neda Shamie and you are listening to EyePod, which is sponsored by 

, where we talk about topics at hand in ophthalmology and really kind of bring it to the forefront of your thoughts so that you can explore further.

It's going to be a short conversation that I will be having with Dr. Peter McDonnell, who is my mentor, a dear friend, and someone who is truly an expert in the field of ophthalmology and I turn to for advice all the time. Hi, Peter!

 Hi, Neda! It's great to be here with my co-chief medical editor of 

 and talk about a really exciting thing that, I think, taking the world of glaucoma by storm, which are these great new MIGS devices. It's really caused in evolution in glaucoma care in the United States. And you've had very positive experience yourself with these devices, right?

 Yes, most definitely. I agree with you. I think in glaucoma, there's been a real significant paradigm shift since the advent of different MIGS devices that have allowed for a minimally invasive approach to treating glaucoma. When I was in my training, it was either [eye] drops or maybe some laser treatments, but ultimately, trabeculectomies and trabeculotomies and tubes and shunts and such, which have a lot of comorbidity associated with them. 

These minimally invasive glaucoma shunts and procedures that are done often at the same time as cataract surgery can really have very little added risks to the surgery, but have significant impact on glaucoma management of patients, lessen the load of the eye drops and the toxicity that go along with them. And really a wonderful addition to the armamentarium of not just glaucoma surgeons, but also cataract surgeons. And I think that's where we should really emphasize our discussion on. 

There's no question that glaucoma surgeons, at least the ones I speak to, are huge advocates of the advanced technology in the MIGS procedures. I think the challenge is that the gatekeepers are often the general eye doctors and cataract surgeons. And a lot of the time when these patients who have glaucoma and comorbidities associated with glaucoma, when they're ready to have cataract surgery and they have the opportunity to be a candidate for the MIGS, the MIGS procedures are not necessarily offered to them. 

I think the hurdle is to get past that because there's not enough glaucoma surgeons out there to really take care of all of the glaucoma patients out there. And often the feedback I'm getting from glaucoma surgeons is they really want us cataract surgeons to consider MIGS procedures at the time of our cataract surgery to lessen the burden of glaucoma for these patients and, hopefully, prevent progressive disease for them. 

 You know, I think you hit on a lot of really key points there. When I look at the data from the Academy's IRIS Registry [Intelligent Research in Sight] and also the Medicare database, 75% or more of glaucoma surgical procedures now are MIGS. And in this recent report only 13% were trabs. In my day, that was pretty much the glaucoma operation. 

And from my perspective, it was sort of for a refractive surgeon to do this 'loosey-goosey' tighten the sutures enough but not too much, etc. It was sort of imprecise. To me, there's lots of appeal of these MIGS and to see it go from very little to such a high percentage, almost 80% now of glaucoma surgical procedures are MIGS. That's really impressive. I'm wondering, in terms of getting people who are not glaucoma specialists and don't have much experience yet, and maybe there's a little trepidation about how to get started. 

What pearls would you offer? How did you make that transition to get going?

 Often, what happens with new additions to our surgical armamentarium, it's a patient that encourages us to forge ahead. 

I had a patient who had glaucoma who came to me [and] really wanted to have her cataract surgery done by me and was on 3 [eye] drops for glaucoma management. She's the one who said — this is a while ago, this is probably nearly 8 years ago — why aren't you offering me MIGS. Truthfully, she put me to shame because there was enough evidence for the benefits that iStent at the time was offering that I should have offered it together with a cataract surgery. And so I was very honest and transparent with her. And I said, I have not done one. And she says, why don't you have my case be your first. It really just takes that motivation. 

It takes that incentive to really want to do the best for your patients to bring on new technology. There is no question that the technology has now been proven to be effective. And the truth of the matter is, what do you have to lose and that's my attitude to my colleagues who push back on MIGS. You have really nothing to lose and everything to gain for your patients. 

To bring on the MIGS procedures it's a very simple addition to your surgery. The learning curve is very, very quick. For those of us who do a lot of anterior segment surgeries, having the ability to do that gonio visualization of the angle, and being able to maneuver in the anterior chamber is not very different than what we do in our preop exams. And we all know how to use a gonio lens. And it doesn't take much to learn how to do it in intraoperatively. And we all know how to maneuver in the eye without collateral damage to structures inside the eye. 

So I would say if there's trepidation, look at the data. Like anything, I do my research. I look at the data. I ask colleagues who have experience. And now with YouTube, 

, all the different resources available to really get as much information ahead of time as possible it again shouldn't take much to forge ahead.

I would suggest starting with one device first, getting familiar with probably the simplest device, which for me, at least, it was the iStent, but for others, it may be different approaches. And then from there moving forward. I think probably the biggest challenge is how to use the gonio intraoperatively. And then kind of understanding what the postoperative management of these patients are. 

It just simply took me communicating with colleagues and friends who've done a lot of these and getting their protocols in place. I feel great about offering it to my patients. I think as a cataract surgeon you're doing your patient disservice if they come in with glaucoma and they’re on at least 1 if not 2 drops and not offer them MIGS you have taken away an opportunity for them to be able to lessen their dependency on glaucoma drops.

I think those are all great pearls. The risk:benefit, I agree, is very much in favor of the benefit. We don't see the really feared complications of hypotony with the MIGS devices, so that's really nice. Now, it is true that a few years ago, Alcon did voluntarily recall the CyPass MIGS device because of concerns regarding endothelial cell loss...progressive endothelial cell loss. As two cornea specialists, you and I both love endothelial cells and we know they're important. But beyond that, I think the track record over the years has really been pretty darn positive in terms of relatively few adverse events and I think that's really helped support the increasing use over time.

And I think all the points you made are excellent. I guess if I was still concerned about getting started, I might ask a colleague who is available that day...maybe is also operating at the ASC...to sit there next to me while I do my first one or two cases or any tricks. Someone who has experience with using the MIGS. I can't agree with you more that starting with one and then getting comfortable and then moving on makes sense.

 In my practice, I don't have necessarily a go-to but I offer the iStent infinite, the Hydrus, and Omni canaloplasty and I kind of mix and match based on the degree of the patient's glaucoma, their dependence on drops, and I would say probably the biggest challenge and the steepest or the hardest learning curve really is how to fit the different options in your practice, how to present it to the patients, where does it land in your discussion and counseling of patients, and most importantly, how do you manage the postop. 

Again, there's very different kind of varied ways of doing all of that. In our practice, we have trained our technicians to be familiar with all the different technologies available and to present the options to our patients as they come in right at the same time as they discuss cataract surgery with our patients and educate them and then flag the chart so that I know to talk about the different MIGS procedures when I go in. 

And then postop, we have the patients continue to go through glaucoma eye drops until they're off of their steroid eye drops after which then we remove, we have 1 drop removed at a time of the glaucoma drops with a 1-month time to really kind of gauge what the pressure response would be. If a patient is comanaged, which many of my patients are, our comanaging doctors are well trained on how to do that. 

I feel great about really being at the forefront of this technology and I have had great results being able to lessen the burden of glaucoma drops for my patients. And that's key I think to create just like anything else have the expectations be realistic that this is not going to cure them of glaucoma, it's only going to help with management and potentially lessen their burden of the drops, maybe 1 possibly more than 1 drops.

So with that, I think, hopefully, for those listeners out there, you're convinced to at least explore the option of MIGS and adding that to your practice. Because after all, we're here to offer our patients the best treatment options out there and this treatment has been shown to be proven effective and safe. A patient who has glaucoma together with their cataract deserve to be offered this. By the way, I should also state that their Omni can also be offered without cataract surgery. So that's one treatment option...one of the MIGS procedures that can be done standalone, which, in itself, is an excellent opportunity to lessen the burden of glaucoma on our patients.

Thank you so much, Peter, for a wonderful discussion. I look forward to our next one.

 Always a pleasure, Neda. I love these stories of innovation in ophthalmology. It's a great field. 

You'll remember, you and I in our younger days, we were colleagues with George Baerveldt. He was, of course, the author of the Baerveldt Implant and he was a great innovator and he was careful and scientific in his approach, but it's great to see what I think is this dramatic, exciting development in terms of improving our management for glaucoma patients. I'm very positive about it. Very happy to see it.

Peter J. McDonnell, MD, and Neda Shamie, MD, discuss the transformative impact of minimally invasive glaucoma surgery (MIGS) on glaucoma care and its integration with cataract surgery, sharing insights and practical tips for ophthalmologists.

EyePod: Transforming the MIGS pipeline into clinical reality

, director of Ophthalmology at Modernizing Medicine, discusses Aetna's new policy requiring prior authorization for 

, its impact on  ophthalmologists and patients, as well as potential solutions — and additional issues — that may arise in the future as a result. 


Michael Rivers, MD, discusses the impact of Aetna's new policy requiring prior authorization for cataract surgery on ophthalmologists, their workflow, and patients. 

Impact of prior authorization for cataract surgery 

Uday Devgan, MD, FACS, of Devgan Eye Surgery in Los Angeles and Beverly Hills, CA, answers a few key questions his patients have asked when considering cataract surgery.

What patients need to know about cataract surgery

The rationale for the study under discussion is that the experience level of the operating surgeon is a potential factor affecting the outcomes of all ophthalmic procedures, including ISBCS

Resident surgeons perform ISBCS with similar safety and accuracy as consultants

FDA noted that the US phase 2 trial may serve as 1 of the 2 pivotal trials required for NDA filing.

VivaVision Biotech receives positive preliminary comments from FDA on development of VVN461LD

Discover how real-world evidence shapes cataract surgery practices, highlighting user satisfaction with enhanced monofocal IOLs at the 2025 ASCRS Annual Meeting.

Ravi Patel, MD, shares ASCRS 2025 insights on enVista ASPIRE IOL user experience

Discover how dropless cataract surgery enhances patient comfort and outcomes, reducing the need for eye drops and improving recovery efficiency.

Monique Barbour, MD, highlights benefits of dropless protocol over traditional drops

ASCRS 2025: Amar Shah, MD, on why hyperosmolar tear film before and after cataract surgery matters

Amar P. Shah, MD, of Mid Ohio Eye, presented new findings on tear film hyperosmolarity and its implications for cataract surgery outcomes during the 2025 American Society of Cataract and Refractive Surgery Annual Meeting, held April 25–28 in Los Angeles, California. “One central feature of dry eye disease is hyperosmolarity of the tear film,” Shah emphasized, highlighting its role in initiating inflammatory cascades, cellular damage, and tear film instability.

For cataract patients, this is more than a dry eye concern—it has direct surgical relevance. A hyperosmolar tear film can compromise preoperative measurements, potentially skewing keratometry and biometry values and leading to inaccurate IOL power calculations. Even with precise biometry, patients may experience visual fluctuations postoperatively due to tear film–induced light scatter. “It might be going from blurry to clear and bouncing all over the place,” Shah explained.

Shah’s study identified 3 key findings:

Postoperative Emergence of Hyperosmolarity

: Remarkably, 30% of patients with normal preoperative osmolarity became hyperosmolar 1 month postoperatively. “All of a sudden 1 month after surgery, when they should be kind of healed, they're hyperosmolar,” he noted.

Limited Resolution in Hyperosmolar Patients

: Only 50% of preoperatively hyperosmolar patients normalized postoperatively, despite standard regimens of antibiotics, steroids, and NSAIDs. Shah remarked, “The fact that still half of patients in that group were hyperosmolar was telling.”

: Across all patients, nearly 40% remained hyperosmolar 1 month postoperatively, underscoring the need for greater preoperative attention to ocular surface health.

These findings suggest that osmolarity testing could play a more routine role in cataract evaluations. “It’s an additional piece of evidence that could potentially identify patients that may be at risk for ocular surface issues,” Shah said. While surgery was not delayed based on osmolarity in the study, Shah suggested elevated values could justify treatment before proceeding. Furthermore, tear osmolarity could be a valuable diagnostic tool in postoperative patients with unexplained visual dissatisfaction.

He noted that the data support a paradigm shift: integrating tear film osmolarity into pre- and postoperative workflows could significantly enhance refractive accuracy and patient satisfaction.

Videos

A significant proportion of cataract surgery patients exhibit hyperosmolar tear film both before and 1 month after surgery, underscoring preoperative screening and postoperative management to optimize visual outcomes.

 ASCRS 2025: Joaquin De Rojas, MD, leverages machine learning model to predict arcuate outcomes

Joaquin De Rojas, MD, shared highlights of his presentation on implementing machine learning to refine arcuate keratotomy (AK) nomograms, which earned him the Best Paper of Session award at the 2025 American Society of Cataract and Refractive Surgery annual meeting, held April 25 to 28, in Los Angeles, California. 

“In an effort to make the predictions of arcuate keratotomies better, we leveraged machine learning to help understand this complex interplay of multiple… ‘features’,” De Rojas explained, underscoring the model’s ability to incorporate a broader range of input variables than traditional methods.

Central to the model’s success was the concept of treated astigmatism—calculated by subtracting postoperative refractive error from preoperative astigmatism, aligned on the same axis using basic trigonometry. “This is the amount of astigmatism that was actually treated with the arcuate. And that’s how you want to train the model,” he said. Treated astigmatism emerged as the most predictive feature for incision length, followed closely by preoperative astigmatism and patient age.

Notably, the model also identified secondary but influential variables such as white-to-white distance, laterality, handedness, sex, axial length, and even device-specific differences in biometry. These nuanced factors are often overlooked in current nomograms. “A wider cornea… that same arcuate incision at 9 mm diameter is going to have a different effect,” De Rojas explained.

The machine learning framework was built on XGBoost, a gradient boosting algorithm well-suited to tabular data, offering robustness with limited datasets while avoiding overfitting. While neural networks were also explored, they proved too data-hungry and erratic without stringent controls. “You have to find the best balance… more sophistication isn’t always better,” he said.

, where two versions of the tool offer actionable guidance, including advising against AKs for high against-the-rule astigmatism. “You just have to get some good data… and within seconds, you have a customized, tailored approach," he added.

A machine learning model using treated astigmatism and other nuanced inputs can significantly improve the accuracy and personalization of arcuate keratotomy planning



Lisa Nijm, MD, says preoperative osmolarity testing can manage patient expectations and improve surgical results.

Lisa Nijm, MD, joined the Eye Care Network at the American Society of Cataract and Refractive Surgeons (ASCRS) annual meeting for an on-camera conversation. Dr. Nijm is the CEO of Warrenville EyeCare and LASIK in Warrenville, Illinois, and an assistant clinical professor of ophthalmology at the University of Illinois Eye and Ear Infirmary in Chicago, Illinois.

Dr. Nijm discussed her ASCRS presentation, focused on a study of hyperosmolarity's impact on cataract surgery outcomes. "Hyperosmolarity induces light scatter that's equivalent to a grade 2 to 3 cataract," Dr. Nijm said. "What that did show in the study is patients could [undergo] a perfect cataract surgery, pick the right lens...and still, patients would be dissatisfied with their vision afterwards, because they're experiencing this light scatter every time they're blinking. That distorts the image and decreases the quality of their vision"

Hyperosmolar patients were seven times more likely to be dissatisfied post-surgery, Dr. Nijm said, indicating that preoperative osmolarity testing is vital to a successful outcome. Preoperative testing could help clinicians manage patient expectations and improve surgical results, she said. The study results emphasized that it's crucial for surgeons to understand and, where possible, manage osmolarity to enhance refractive outcomes and patient satisfaction in cataract surgery.

Lisa Nijm, MD, says preoperative osmolarity testing can help clinicians manage patient expectations and improve surgical results.

ASCRS 2025: New research findings highlight the surprising impact of hyperosmolarity

SCRS 2025: Rotational stability and outcomes with 'monofocal plus' toric IOL with Gregory Moloney, FRANZCO, FRCSC

Gregory Moloney, FRANZCO, FRCSC, presented a straightforward but impactful study evaluating a design modification in the Eyhance toric IOL at the 2025 American Society of Cataract and Refractive Surgery annual meeting, held April 25 to 28 in Los Angeles, California. "This study is simple. The message is really, really clear and quick," Moloney explained, setting the tone for his findings on rotational stability improvements.

The key change tested was the introduction of a frosted haptic, replacing the previous polished design. "We were looking to test whether or not a design modification in the Eyhance toric lens resulted in improved or better rotational stability," he said. Patients were assessed at day 1, week 1, and 3 months post-implantation.

The results were promising. In a cohort of 98 eyes from 65 patients, the mean IOL rotation was just 1.73 degrees. "The mean average IOL rotation was 1.73 degrees, which is really very acceptable," Moloney noted. Notably, 95% of patients experienced less than 5 degrees of rotation. "I think as surgeons that's reassuring for us that we can trust this platform," he added.

Beyond objective measurements, patient-reported outcomes were also encouraging. Using a near vision questionnaire, preoperative scores (typically around 20 to 23) dropped significantly to an average of 6 postoperatively, suggesting that "near vision tasks were perceived to be easier after implantation of this lens."

Summing up the study’s practical impact, Moloney stated, "All we wanted to know personally from our perspective was...can we trust this lens to be rotationally stable?" His conclusion was confident: "Surgeons can feel reassured that a rotation rate of under 5 degrees in almost every patient...is a stable platform."

A study reports minimal rotation and improved near vision following implantation of the Eyhance toric lens.

ASCRS 2025: Rotational stability and outcomes with 'monofocal plus' toric IOL with Gregory Moloney, FRANZCO, FRCSC

Sheng Lim, MD, FRCOphth, discusses the CONCEPT study, which compared standalone cataract surgery to cataract surgery with ECP.

Sheng Lim, MD, FRCOphth, is a professor of glaucoma studies at St. Thomas’ Hospital and King’s College London, both in the United Kingdom. He attended the American Society of Cataract and Refractive Surgeons (ASCRS) annual meeting in Los Angeles, California, where he presented findings from a recent study, Comparing the Effectiveness of Phacoemulsification + Endoscopic Cyclophotocoagulation Laser and Phacoemulsification Alone for the Treatment of Primary Open Angle Glaucoma in Patients with Cataract (CONCEPT).

In conversation with the Eye Care Network, Prof. Lim explained why endoscopic cyclophotocoagulation (ECP) has major potential for patients with glaucoma. "We had over 160 patients in the study and randomizations 1 to 1, so it's interesting, the results we're getting so far, [after] 1 year," Prof. Lim said. "What the CONCEPT study has shown in 1 year is that we're seeing a median difference in IOP of 2 mm mercury, in support of use of ECP in primary open-angle glaucoma."

Prof. Lim also noted unique features of the CONCEPT study which may inspire further analysis, including the demographic makeup of the study cohort, which is unique to the study's central London population. Additional findings on specific subgroups or patient populations may be a focal point in future research, he implied. "We're still waiting on that analysis to come through," Prof. Lim said.

Sheng Lim, MD, FRCOphth, discussed the CONCEPT study, which compared standalone cataract surgery to cataract surgery with ECP.

Cataract Surgery

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