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Ophthalmology Times - Ophthalmology news, articles, and events

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Spotlight

Presbyopia: A part of Aging and Challenges

Clinical

1rem

Patient comfort, minimal foreign body sensation support routine use for cataract surgery

Liquid ocular bandage improves wound integrity, closure

Corneal inlay allows presbyopia correction either paired with or after LASIK

Simultaneous LASIK, inlay effective for ametropic presbyopia

Chemical enhancements to riboflavin solution aim to overcome need for epithelial debridement

Seeking alternatives to CXL protocol for stromal saturation

Algorithm helps ophthalmologists decide best treatment option for patients based on data

How software is simplifying keratoconus management

DSAEK + AmbioDisk technique for improved surgical results, epithelial healing

Making a diagnosis is only the first step in treating dry eye syndrome

Dry eye common, but complicated

Uncertainty outweighs risks, benefits of simultaneous crosslinking to prevent postLASIK ectasia

Evidence does not justify CXL with LASIK

Novel procedures bring glaucoma surgery into realm of cataract, corneal subspecialists

MIGS drawing interest of non-glaucoma specialists

Partial-thickness corneal graft procedure feasible in most clinical settings

How DMEK is changing corneal surgery

Julianne Matthews, MD, MPH, a resident at The Ohio State University, speaks with 

David Hutton on the key highlights from her presentation "How Long Does It Take for Bcva, Kmax, and Pachymetry to Return to Baseline after Corneal Collagen Crosslinking for Keratoconus?," during the 2020 ASCRS virtual meeting.
	
	

ASCRS

ASCRS 2020: Returning to baseline post-corneal collagen crosslinking for keratoconus

Over the years, IKA has become an invaluable resource for eye care professionals.

International Keratoconus Academy continues to provide cutting-edge education

After comparing two techniques of corneal transplant tissue preparation, research shows a newer, faster technique is safe and effective. 

New EndoGlide technique in treatment for Fuchs’ dystrophy shows promise

Stephen Pflugfelder, MD, professor and director of the Ocular Surface Center at Baylor College of Medicine in Houston, Texas, presents a challenging diagnostic dilemma. 

EyeCon 2022: Award-winning (tear) film - treating dry eye disease

CXL has been proven effective to treat patients with corneal ectasias. 

Socioeconomics impact the use of CXL technology

Receiving FDA orphan drug designation allows the company to proceed with plans to advance the development of BRM424, a novel, first-in-class, potential treatment for neurotrophic keratitis. 

BRIM Biotechnology receives FDA orphan drug designation for treatment of neurotrophic keratitis

 This transcript has been lightly edited for clarity.

. I'm joined today by Dr. Rob Sambursky, president of Verséa Holdings, and Verséa Ophthalmics, who will provide a company update. Thanks for joining us today. Tell us about some of the latest developments and Verséa Ophthalmics.

Rob Sambursky, President, Verséa Ophthalmics:

 Well, first, thanks for having me. Well, this is an exciting time for Verséa Ophthalmics. We in the process of launching several products. We have a hybrid next-generation amniotic membrane, which we call the Biovance, and we have a three-layer membrane that consists of three layers of amnion. Although it's three layers, it's still only about 45 microns thick. It is very different from other amniotic membranes, because it doesn't have a ring. It has extremely good handleability, and it allows for easy placement onto the cornea.

And with that, we've been able to show that in benchtop studies compared to other graphs, it has superb, and maybe even better viability of the cells, cell adhesion and proliferation, which are the key components to allow for growth and growth factors in healing from an amniotic membrane.

And if that isn't enough, we actually have two diagnostic tests as part of our point of care lab test platform that we've launched within eyecare. And we have one test that's focused on IgE. IT helps to differentiate allergic conjunctivitis from other forms of conjunctivitis. I like to think I'm a good cornea specialist, but despite that, it is really relatively impossible to differentiate mild, allergic conjunctivitis from dry eye, and it can be really challenging to differentiate an acute allergic conjunctivitis from viral conjunctivitis. So this test will be incredibly helpful.

And at the same time, we have a lactoferrin test, a quantitative lactoferrin test that allows us to identify patients with low lactoferrin, which would suggest that the patient has an aqueous deficient dry condition. In both cases, the diagnostic lab platform allows for 10 minute tests that provide quantitative results, and not only help to provide a diagnosis that can lead to more targeted therapy, but it offers the opportunity for monitoring of a therapeutic response.

 Ultimately, what can some of these new developments mean for ophthalmologists and their patients?

 Well, I think that from a diagnostic standpoint, it's really allowing more personalized medicine. I think the more information a clinician has, the more targeted the therapy can be. And ultimately, that should be our goal to match the therapy with the condition. And then from the amniotic membrane perspective, it's part of the continuum. When we have very advanced ocular surface disease, we want to be able to apply the best possible therapeutic intervention. And in this case, we think that we have one of the best amniotic membranes to help heal those complex non healing persistent epithelial defects that you see with advanced ocular surface disease.

Videos

The company is rolling out the Biovance 3L ocular tri-layer human amniotic membrane.

Verséa launching several products in ophthalmic space

 I'm David Hutton of Ophthalmology Times. I'm joined today by Dr. Marjan Farid, who presented at the recent American Academy of Ophthalmology annual meeting in Chicago. Thank you for joining us today. Tell us about your presentation.

 Thanks for having me, David. So, my presentation at the Academy meeting and World Cornea Congress was on updates and femtosecond laser keratoplasty. And this is an innovation that came into being in around 2005 or 2006, when femtosecond lasers were first introduced to ophthalmology, and were indicated for use in LASIK and laser vision correction.

Soon after that, you know, we had some great corneal surgeons, one of them my mentor, Dr. Roger Steiner, who really looked at applying femtosecond laser technology for keratoplasty and corneal transplantation. Several iterations of customized trepanation patterns, including a mushroom pattern, a top-hat pattern and a zigzag pattern, among others, were designed to improve the wound and the wound healing in corneal transplantation.

We've now looked at several studies and outcomes in patients who have had femtosecond laser keratoplasty. And really, we've seen improvement in wound healing time, the ability to remove sutures earlier, less irregularities, torsional and vertical misalignments. And we've applied this for not only full thickness transplantation, but also for DALK or deep anterior lamellar keratoplasty, maintaining the customized trepanation pattern and its benefits with the benefits of doing a lamellar keratoplasty and minimizing things like rejection and so on.

But the next stage and all of this is really to be able to use updated and modernized femtosecond laser platforms with lower energy and higher speed to be able to make these smooth, consistent, deep lamellar cuts in the cornea. These were not possible with the earlier femtosecond laser technologies. The energy was too high and in the deep layer of the cornea, we would see too much irregularity.

But with these modern updated femtosecond laser platforms, we may be able to move this into the next stage, which is really consistent, reproducible deep lamellar cuts in the cornea, which will make DALK really a possible and really reproduceable technique in every corneal surgeon's hand and really push the boundaries and innovation in corneal surgery. And what the next stage is in all of this is to get advocacy and get a good femtosecond laser in every corneal surgeon's hand. So that's our update on femtosecond laser keratoplasty.

Marjan Farid, MD, discussed the latest updates in femtosecond laser keratoplasty during a presentation at the American Academy of Ophthalmology’s 2022 annual meeting in Chicago. She shared the highlights of that presentation here.

Updates on femtosecond laser keratoplasty

 I'm David Hutton of Ophthalmology times. I'm joined today by Dr. Ula Jurkunas, who is here to talk about limbal stem cells to treat corneal blindness. This is such an interesting topic. I'm interested to hear what you have to say about tell us about your presentation.

 Thank you very much, David. We are very excited to be heading the first-in-the US clinical trial on replacing limbal stem cells by cultivating them from the healthy eye. The surgery that we do is called cultivated autologous limbal epithelial cell transplantation. And again, this is a first trial in the U.S. to use cell therapy to treat corneal blindness. We are currently enrolling patients and are in the process of quantifying the data of the enrolled patients. But we are very proud to have developed this technology with our collaborators from Dana Farber and Children's Hospital here in Boston, and to be able to run this one single center trial to introduce a very novel technology for our patients.

 So, our preliminary data shows very promising results. And also, our trial is showing that the procedure is safe and feasible. So our next steps would be to provide this procedure to a broader population, such as other surgeons and other sites could be cultivating limbal stem cells for transplantation for their patients.

 Ultimately, what can this mean for ophthalmologists and the patients they treat?

 I think this is very exciting technology that can serve as a stepping stone for other cell therapies for different portions of the eye and the body. This was a low hanging fruit because we are able to manufacture autologous stem cells that are easily accessible from the corneal limbus of the healthy eye. But this could mean that we could be doing other therapies in the future such as corneal endothelial cell therapy, retinal cell therapy, and many others.

Ula V. Jurkunas, MD, discusses a presentation she gave recently at the American Academy of Ophthalmology’s 2022 annual meeting in Chicago on the use of limbal stem cells to treat corneal blindness.

Harvesting limbal stem cells from healthy eyes to treat corneal blindness

This transcript has been lightly edited for clarity.

Hi, I'm Jeff Nau. I'm the the president and CEO of Oyster Point Pharmaceuticals. We're located in Princeton, New Jersey. And I'm here at the Eyecelerator 2022 meeting, and wanted to give an update as we're one year since the launch of Tyrvaya: Last October, we received our FDA approval, and in November, we launched the product into the US marketplace. We've had a great year with a lot of great uptake into the marketplace. We're really excited about the expanded patient access we've been able to offer and the adoption in the marketplace with all the dry eye practitioners.

This year, we'll have at the end of the year a readout of our phase 2 Olympia trial, which is in neurotrophic keratopathy. And so we look to expand our label into the future with dry eye disease as well as neurotrophic keratopathy. And we're excited in the future to also present data on our expanding gene therapy pipeline. So I want to thank everybody for joining us here at Eyecelerator.

So the new developments that we work on are really focused on treating diseases of the ocular surface, but we're doing it in a way that we can actually deliver it through pathways that are novel. So our product is the first and only nasal spray to treat dry eye disease. So it's not another drop that we deliver to the ocular surface. And then in our pipeline, when we think about our gene therapy program, we're using gene therapy to harness the power of the lacrimal gland. And when we transduce the lacrimal gland, we can actually use the lacrimal gland as a drug delivery device to deliver therapeutic proteins, enzymes and peptides to the ocular surface. So we're really trying to develop a new era where we move beyond the drop and we move to new delivery mechanisms.

Jeff Nau, PhD, MMS, President and CEO of Oyster Point Pharmaceuticals, provides an appraisal of the company's pipeline as well as updates on recent innovations to hit the market.

Moving beyond the drop: CEO provides updates on Oyster Point's pipeline

Kathryn A. Colby, MD, PhD, New York University Langone Health:

 Hello, everyone. I'm Dr. Kathryn Colby. I'm the Elizabeth J. Cohen Professor and chairman of the Department of Ophthalmology at NYU Grossman School of Medicine. I'm also the immediate past president of the Cornea Society, and was one of the three organizers of the World Cornea Congress, which just took place.

This meeting, which was originally scheduled for 2020 and canceled due to COVID, took place in Chicago for two days. At the end of September, we drew over 1000 registrants from all over the world.

I'd like to highlight just a single session on Fuchs dystrophy. Everyone knows that we've had tremendous advances in our surgical care of Fuchs dystrophy. And we had a spotlight thinking about what the future will be like for care of this very common corneal disease.

And I'm sure you'll be interested to know that over 50% of our people in the audience think that cultured cells are the future for the care of food dystrophy. And in 10 or 15 years, we will be doing vanishingly few endothelial keratoplasty, instead relying on medical therapy, including gene therapy, to help treat this common disease. So anyone who's interested, the programming is available online, and I encourage you to look for it. Thank you.

Kathryn A. Colby, MD, PhD, discusses highlights of the World Cornea Congress, which was held recently in Chicago. 

World Cornea Congress spotlights Fuchs dystrophy

 This transcript has been lightly edited for clarity.

 My name is Adam Szaronos. I'm the CEO at Trukera Medical. We're so excited to be here this year in Chicago at the American Academy of Ophthalmology for a number of reasons. At Trukera Medical, we've recently rebranded our organization historically founded as TearLab, a one-product company focused on in vitro diagnostics to help advance corneal health and decision making.

After nearly 25 million tests globally, today, we're now launching our second generation system. And with that opportunity, we're now also in a position to start looking across the spectrum of corneal health needs. And with an expanded vision to be the world's leading cornea health company for providers and patients, we felt it was appropriate to make sure we had a company identity that better reflected that growing portfolio in vision.

The second reason we're excited to be here is the launch of that product itself. We've learned a lot over those 25 million tests, in particular the barriers it takes to helping to get good diagnostic testing into the hands of today's busy cataract and refractive practices. We knew we needed a solution that was portable, practical and precise. And over the last two years, we've been working on that solution. It's called the ScoutPro Osmolarity System. It's the first in the US, portable, handheld objective diagnostic test to help physicians identify at-risk osmolarity levels prior to refractive surgery, and also help patients evaluate and manage those lab results to determine therapy after surgery.

Adam Szaronos, President and CEO of Trukera Medical, discusses the recent rebranding of TearLab as well as the launch of the ScoutPro Osmolarity System.

Trukera Medical rebranding allows team to expand into the broader corneal health market

At AAO 2022, Philip Dockery, MD, MPH, presents, "Effectiveness of corneal crosslinking in young patients."

Higher rates of repeat corneal crosslinking need found in younger patients

Kathryn A. Colby, MD, PhD, sits down with Ophthalmology Times to discuss her 2022 AAO presentation: "Endothelial Keratoplasty Should I Choose? DSAEK, DMEK, DSO"

Choosing among DSAEK, DMEK and DSO for endothelial keratoplasty

Hi there. My name is Christopher Starr. I'm coming to you from the World Cornea Congress in Chicago. I'm an associate professor of ophthalmology at the Weill Cornell Medical Center in New York City. And I just gave a paper presentation here at the WCC on the effect of varenicline nasal solution in the treatment of dry eye disease. And we looked at a post hoc analysis of the clinical trials, 3 clinical trials that were done for the nasal spray.

The nasal spray worked on the parasympathetic nervous system and is a cholinergic receptor agonist. And we wanted to look—do a post hoc analysis of the clinical trial data to kind of see patients who were also taking anticholinergic medications, namely antidepressants and anxiolytic medications, things like Prozac and Xanax, et cetera, et cetera, et cetera. We know that these patients tend to have dry eye disease and in a lot of cases, more difficult disease to treat because of this anticholinergic effect from these systemic medications.

So the post hoc analysis looked at Schirmer test scores and EDS eye dryness score change from baseline. It's a small sample sizes in these post hoc analyses. But in essence, what we found was that the patients who were taking antidepressant and anxiolytic medications did quite well with the varenicline OC-01 nasal spray in the clinical trial.

There was significant improvements in in Schirmer test scores at the four week visit; there was a significant increase in the proportion of patients who achieved a greater than or equal to 10-millimeter increase in Schirmer test scores amongst the anxiolytic antidepressant group and the non-AM group. And then lastly, the EDS scores improved significantly between the two groups at the 4-week visit.

So in summary, we see that the anxiolytic antidepressant, ie anticholinergic medications don't adversely affect outcomes with the OC-01 varenicline nasal spray in this post hoc analysis.

Well, you know, if you have a patient who might be taking some of these systemic medications, and as dry eye specialists, ocular surface specialist, we always look at systemic medications and try to assess the impact that these medications might be having, especially in patients who are not getting better with traditional treatments: drops, immunomodulators, so on and so forth; punctal plugs. And in those patients, sometimes we are faced with the decision of well, should we recommend stopping these medications? And, you know, no patient wants to stop an antidepressant that is helping them, you know, with their depression.

So, this, you know, the nasal spray varenicline might be a reasonable option in those patients. You know, where you're struggling, you're certainly not going to stop the systemic medication. And this, you know, would be a good medication to try in these patients with dry eye disease.

At AAO 2022 in Chicago, Illinios, Christopher Starr, MD, presented a talk entitled, "Efficacy of OC-01 (varenicline solution) (VNS) 0.03mg for Treatment of Dry Eye Disease Signs and Symptoms in Subjects With and Without Antidepressant/ Anxiolytic Use: Post-hoc Analysis of ONSET-1 and ONSET-2 Clinical Trials."

Post hoc analysis of varenicline solution OC-01 shows promise for dry eye patients undergoing anticholinergic therapy

David Hutton discusses the AAO 2022 presentation, "Corneal Edema, Opacifications, Ectasia, and Bacterial Keratitis: Diagnosis and Treatment Strategies from the Preferred Practice Pattern Guidelines," with speaker Francis S. Mah, MD.

Cornea

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