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Belite Bio completes its phase 3 trial for tinlarebant, a potential first treatment for Stargardt disease, with results expected in late 2025.

Belite Bio concludes phase 3 DRAGON study for Stargardt disease

Status of the inner retinal layers in patients with multiple sclerosis

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We ask leading experts in the field what eye disease they would cure and why.

Part 4: What if? Curing any eye disease with the snap of your finger

Viridian plans to submit a Biologics License Application (BLA) for VRDN-003 by year-end of 2026.

Viridian Therapeutics completes enrollment in REVEAL-1 and REVEAL-2 clinical trials for VRDN-003

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Ophthalmology Times – Clinical Insights for Eye Specialists

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Recapping the Heidelberg Engineering International SPECTRALIS Symposium—and Beyond.

The future of imaging is out of this world

Advanced imaging and awareness of systemic risk factors are essential.


Seeing the unseen: Improving early detection for patients with MacTel

Ophthalmology celebrates 50 years of groundbreaking innovations, highlighting anti-VEGF therapies, OCT imaging, and future advancements in eye care.

From blindness to breakthrough: Milestones that changed ophthalmology forever

Retinal microvasculature on OCTA may predict coronary artery disease risk

ZinserLab will focus on accelerating the development of imaging technologies in eye care.

Heidelberg Engineering launches new innovation hub, continues industry partnerships

Andrew G Lee at ASRS 2025 on neuro-ophthalmology

At the 2025 ASRS Annual Meeting, Dr. Andy Lee from the Blanton Eye Institute at Houston Methodist Hospital presented a talk titled 

“What Every Retina Doctor Needs to Know About Neuro-Ophthalmology.”

 The core message of the presentation centered on recognizing when vision loss or other visual symptoms are 

 caused by retinal issues but instead point to neuro-ophthalmic conditions.

Lee emphasized the importance of identifying a relative afferent pupillary defect (RAPD)—a key clinical sign indicating optic nerve dysfunction. He referred to this diagnostic tool, assessed by the simple swinging flashlight test, as a “superpower” for retina specialists. The takeaway: if both the patient and physician see nothing unusual in the retina, the issue may be neuro-ophthalmic in origin and warrants further evaluation.

He also discussed the reality that neuro-ophthalmologists (neuro-ops) are scarce and often not available in every city. As a result, they frequently work in a consultative capacity with retina and general ophthalmologists. Lee recommended reaching out to neuro-ops for guidance even if they won’t directly examine the patient—especially since routine appointments may be months away. For urgent cases, he advised that patients be sent directly to the hospital, where neurology teams and imaging resources can expedite diagnosis and treatment.

A frequently asked question Lee receives is: 

 His answer: if there is suspicion of optic neuropathy, cranial neuropathy, or any possibility the issue is intracranial or intraorbital, yes, a scan is necessary. The gold standard imaging protocol he recommends is MRI of the head and orbits with gadolinium and fat suppression.

In terms of diagnostic tools, Lee noted that while the swinging flashlight test remains invaluable, optical coherence tomography (OCT) has revolutionized neuro-ophthalmic diagnosis. By providing high-resolution imaging at the micron level, OCT can distinguish between retinal and optic nerve pathology with unmatched precision—making it an essential tool in differentiating retinal disease from neuropathies.

At ASRS 2025, Andrew G Lee, MD, gave key insight into the world of a neuro-ophthalmologist and why and when a retina specialist should consult a neuro-ophthalmologist

ASRS 2025: Neuro-ophthalmology: What every retina doctor needs to know

Part 7: Looking back at 50 years of innovation in ophthalmology

Part 7 Looking back at 50 years of innovation in ophthalmology

' 50th anniversary, we asked leading experts in the field what they see as the biggest innovation in ophthalmology in the past 5 decades.

Editor's note: The below transcript has been lightly edited for clarity.

So we're now looking at almost 20 years of injection history with anti-VEGF medications, and this has completely revolutionized the field. I entered clinical practice when these were already in use, and we're actually about to hit another change in which our options can can explode quite, quite dramatically. So for treatments for diseases that were essentially, you know, blinding and irrecoverable, we're able to not only preserve vision, but improve vision, and soon we're going to be able to do it with even less treatment necessary.

You know, when we go back in time, we always look at technology and surgery, but what really changed things is people, doctors, us. So I think that's the biggest innovation people because we are better prepared, we are more aware of we [what] are facing, we are facing a bigger change, not only in terms of medicine, but also a social change. I guess that, of course, technology, devices, AI, help us a lot, so we have to include that in our practice. But we don't have to forget that the main concern is the same thing take care of our patients that didn't change at all in 50 years.

I looked back for the past 30 years, that's pretty [much] my time, my career time. I think imaging absolutely is one of the bigger propeller for the field. That's a major for example, the optical coherence tomography, the OCT, that revolutionize the current initial physician, also your physican scientist, to look at the retina previously that's really inaccessible. Also adaptive optics represent another one, [which] truly provided the imaging ability to look at the cells. Previously [cells] could only be seen either histology with a donor eye, the donor tissue. So I think that other study, for example, the AI, the artificial intelligence, that's another bigger movement. So that, I think with the past 3 or 4 decades accumulation, huge data of images that one will definitely make a different world.

To mark Ophthalmology Times' 50th anniversary, we invited top experts to reflect on the most significant innovations in ophthalmology over the past five decades.

Part 6: Looking back at 50 years of innovation in ophthalmology

Part 6 Looking back at 50 years of innovation in ophthalmology

It's a tough question. Ophthalmology is so tech and research focused, and there's been so many great innovations over the last decade or so, but personally, I think that the use of medications given intraocularly, which wasn't done until, you know, like, about, you know, 15 or 20, years ago, I think that's made the biggest difference, particularly in the treatment of macular degeneration and now in newer disorders. I think that also naturally reflexes to future therapies, specifically genetic therapies. I think that if we hadn't perfected and gotten comfortable with intraocular introduction of medications, I don't think these things would have been possible.

There are too many things that I can point out. And I think the most popular problem, the most famous is the development of the OCT. The fact that we can see the retina in vivo, right, and quantify and determine all the different layers, distinguish perfectly all the different layers of of the retina. It has been one of the most significant advances that we have done over the last 50 years. But there are multiple things that I would like to point out, but I will just stay with the OCT.

Oh, I think the intraocular lens, and the access to the intraocular lens, I guess the fact that the lenses are now available for a significantly lower price, which most of the people in the world can afford. I would count it as one of the biggest innovations, which is not just the innovation, but the fact that a lot of people have access to that innovation that's important for us.

Part 4: Looking back at 50 years of innovation in ophthalmology

So I definitely, my first thought is definitely our progress we've made in corneal transplants. I mean, it's amazing that we've been doing corneal transplants for over 100 years, but it's really only been in about the last 20 years that we've had this complete revolution in corneal transplants. I mean, for about almost 100 years, all our corneal transplants, essentially, are the vast majority were full thickness corneal transplants. And then, it's only been, it's been like this exponential change where we went from, you know, full thickness for pretty much everyone, to, you know, DALKs becoming more common, and that's still kind of slowly taking off. But really, for endothelial keratoplasty, you know, it was just like full thickness keratoplasty for 100 years, then all of a sudden, then we have DSEK, and then DMEK, and now we have cell injections. It's just this, like revolution, you know, it's kind of like an evolution that turned into a revolution. I think it's, you know, a totally new paradigm shift for our patients, which is amazing.

Well definitely in the last 20 years, I've experienced anti-VEGF. So probably every retina doctor says anti-VEGF in the last 20 years. Prior to that, we didn't have that to be able to treat macular degeneration. And now, I think in the more recent last few years, sustained delivery and multi-factorial delivery and gene therapy. So I think from an inherited retinal disease standpoint, that's for mainstream disease, from an inherited retinal disease standpoint, I think augmentation, replacement gene therapy for inherited retinal disease, monogenetic disease. [In] 2017, the approval of voretigene neparvovec for RP65, that was a landscape changer. So being able to treat and replace genes for inherited monogenetic disease was a big paradigm shift in the field of inherited retinal disease.

So in the last 50 years, it's really hard to go past anti-VEGF injections. These are medications that slow down neovascularization and retinal vessel proliferation. I think one of the reasons this has been such a major improvement or advancement is it happens to work for so many different conditions: wet macular degeneration, diabetic retinopathy, retinal vein occlusion, and one of my areas expertise is retinopathy of prematurity, and it's completely revolutionized the way we treat these patients as well. So I would say that conditions that used to be blinding conditions or require heavy laser treatments, we now have a medical treatment that can reverse and sometimes cure the condition.

Yeah, so that is a great question. I feel very lucky to be in retina because we've seen such a sea change and paradigm shift in treatment options that are available for patients, particularly with macular degeneration. So patients used to go blind from this disease, and now they can present with vision of 20/30. We do imaging. We do injections that can allow hand in hand, both the advent of OCT imaging and our anti-VEGF therapies that allow these patients with ongoing treatment to maintain excellent vision, maintain their driving vision, maintain their livelihood in a way that 50 years ago was not possible. So I think that's really, really exciting. As a retina surgeon, small incision surgery is also been an incredibly impactful part of our treatment landscape over the past 50 years, in terms of the efficiency with which we perform our surgeries, the number of surgeries we're able to perform, sutureless surgery. All of that has been hugely influential in making kind of retina surgery really modern, efficient, and, you know, effective in a way that years ago, they were doing surgery in a very different way, and I think we're now able to do so much more. I think it's a really cool field to be a part of you.

Part 5: Looking back at 50 years of innovation in ophthalmology

In the recent decade or 2 decades, we have had a huge, huge, huge breakthrough in the management of patients with diabetic macular edema in the form of anti-VEGF drugs and also slow-release devices that can release other drugs in a very controlled manner. I think the development of anti-VEGF drugs completely changed the way we manage our patients with DME. Nowadays, with the development of more advanced treatments that have either higher doses or another mode of action, patients can achieve longer duration intervals between injections, an effect that will bring another breakthrough in their management.

The introduction of the anti-VEGF agents really revolutionized the field, and it saved blindness in millions of patients around the world. And also the development of imaging, like OCT in particular, that can actually understand that this is better to see the treatment effects and diagnose them earlier. So there's no question for me; if I have to pick 2, it'sthe anti-VEGF introduction and the OCT introduction in the last 50 years. Of course, the gene therapy as a proof of concept, but I think the gene therapy was just starting to scratch the surface. We need to think of more inclusive ways that make it not practical to have a gene therapy for every single gene mutation. We need to think of more agnostic approaches, and some new, exciting things [are] coming up. So I think in the next 50 years, it will be gene therapy, but in a more agnostic way that is more widely available and applicable.

I will admit, I'm relatively new to the field. I'm just sort of exploring it. From what I can tell, I think that advancements in injection therapies for conditions like glaucoma have been, advancements in those have been extremely beneficial and are an exciting area of research. I think that also, as with many fields, the advent of AI for screening data analysis will accelerate the field as much as it has with others.

I think optical coherence tomography is one of the best inventions in the last, say, 10 to 20 years. It is letting us to image the entire backup part of the eye in very high resolution. We are able to see up to the sclera using some devices. So I think that would be the biggest invention.

Part 3: Looking back at 50 years of innovation in ophthalmology

Ophthalmology has gone through just, I don't even know the right word to describe how incredible the changes have been in the last 50 years. I don't know, phacoemulsification, cataract surgery, you know, a huge sea change in the 80s and 90s, with the development of that technology. OCT and our ability to image the retina and other parts of the eye on, you know, frankly, down to the cellular level. Anti-VEGF therapy for wet macular degeneration. Those are the 3 that would come to mind as probably the 3 biggest changes in the last 50 years.

I think my gut answer is OCT, optical coherence tomography, might be a common answer, but I think that it totally changed the landscape of the way that we look at the retina, the layers of the retina, and have an understanding of retinal pathogenesis. I think that I'm excited for what's to come. I know there's a lot of AI that's overlapping with OCT, so I'm excited to see what that means for the future of diagnosis and treatment.

As far as diagnostics go, I would have to say the OCT. The development of OCT to be able to detect glaucoma and other diseases that previously would go undetected until there was severe vision loss, and to be able to detect and intervene at a much earlier time, I think, has made a huge difference in saving vision in the last 50 years.

In terms of the last 50 years and innovations, I'm going to be very self centered and very recency biased. I think the thing that has changed in the last 10 years, and will continue to change in the next 20 years, is how we approach a myopic child. When I was studying 45 years ago, we regarded myopia as a benign refractive condition that we would correct with spectacles or contact lenses, and of course, more recently, with refractive surgery. We now understand that myopia is a leading cause of uncorrectable visual impairment, and the abnormal axial elongation that occurs in a myopic child during their youth, leads to an increased risk of diseases like myopic macula degeneration and, of course, then uncorrectable visual impairment later in life. So that is, I think, one of the big public health challenges of our time.

Part 1: Looking back at 50 years of innovation in ophthalmology

First of all, congratulations to Ophthalmology Times. Fifty years is a nice landmark. If I were to say what has shocked me the most about things being done differently, in terms of ophthalmology, I would have to pick the OCT. The development of this machine is, I think, equivalent to Helmholtz first discovering the ophthalmoscope. It has allowed us to understand disease at a remarkable level. It's allowed the clinician to quickly diagnose. It's allowed for an outcome measure against purported new treatments that has just changed everything.

I think really being able to image the retina just really changed the field, and specifically OCT. Because without OCT, we don't have that knowledge of what's going on with the retina; we can't manage how people like respond. The same with sort of the advent of intravitreal injections and treatment, but we really don't know the effect that that's having if we can't image. So amazing for us to be able to image this part of the body in a way that we hadn't before OCT.

The biggest has to be anti-VEGF agents. I mean, you know, prior to the advent of anti-VEGF, which you know, occurred around 2004, you know, we were very limited in how we treated this population. Since then, we've had numerous new agents come to market, and in fact, really has revolutionized the care of patients with neovascular AMD, DME, and CRVO, and also diabetic retinopathy. So really, that has been the biggest innovation in my mind, and has made retina really exciting.

So in the last 50 years, I'll be remiss to not mention phacoemulsification, as it has really revolutionized the way we treat and manage patients with cataracts, and with an aging population, this is a really significant achievement in ophthalmology. In the field of cornea, we've seen this rapid evolution of the treatment of the posterior cornea. We saw the evolution of PK to DSEK to DMEK, and now we are doing cell therapy to address the pathology of decreased endothelial function. So, I think we are looking at very exciting times.

ARVO 2025 Alex Choi

At ARVO 2025, in Salt Lake City, Utah, Alex Choi discussed his poster on APOE carrier genetic status and its relation to Alzheimer disease as well as changes of the retina that might reflect early signs leading to an earlier diagnosis of the disease

Hi, my name is Alex Choi. I am a second-year medical student at the Duke University School of Medicine. And yeah, to kind of briefly explain my project. I was looking at APOE carrier genetic status and how that relates to Alzheimer disease and the changes of the retina that might reflect early signs that can lead to an earlier diagnosis of the disease. And so we looked at people who were non-carriers of APOE ε4, meaning that they had no alleles. People who were also carriers having one or two alleles, and then people who were symptomatic for Alzheimer disease. In terms of the methods, we looked at OCT and OCTA imaging, and we did some statistics to ensure that they were adjusted for age and sex during the analysis as well. And so in summary, we found that the microvascular changes, namely the perfusion and vessel densities in the carriers and non-carriers tended to be higher than the ones in the Alzheimer's disease group. Meaning that as disease progression happens through the Alzheimer's disease spectrum, we kind of see a decrease in the microvascular densities in the retina.

On the other hand, we saw that the peripapillary capillary perfusion density was actually higher in the Alzheimer disease group, and we actually think that might be a response to kind of the hypoxia that might be induced as a result of the amyloid pathology happening in the Alzheimer disease group. And so that was kind of an interesting finding as well. So in summary, we found that the carriers of the APOE ε4 allel changes similar in the retina to symptomatic Alzheimer disease patients, which is interesting. And we think that some of these microvascular changes might precede the more kind of macro-level structural changes that happen in the retina in these carrier populations.

And lastly, we think that this parapapillary capillary perfusion density variable might be kind of a symptomatic biomarker to indicate progression to kind of a symptomatic Alzheimer disease state. This particular project was kind of a snapshot, so it was kind of a cross-sectional study. But the next step, actually, for me, is kind of to look at longitudinal changes, to see whether we can see these changes kind of happen over time, across kind of the same patients. And so that would be something interesting. So we actually did some surveys looking at whether people would want to know about an early diagnosis of Alzheimer, and more than half of people said that they would. And so we actually think that this is applicable kind of to everybody, or people who kind of go into these routine eye screenings get their eyes checked annually. Maybe this would be kind of an easy way to indicate early changes that might be leading to Alzheimer disease. And so anybody with, like, a family history of Alzheimer disease, anybody who would maybe want to know and kind of plan for earlier lifestyle changes, I think.

ARVO 2025: Multimodal retinal imaging in asymptomatic APOE ε4 carriers, noncarriers, and Alzheimer Disease

ARVO 2025: Sex-specific biomarkers for Parkinson's disease in retinal microvascular imaging

At the ARVO 2025 meeting in Salt Lake City, Utah, Cameron Cummings presented a poster on how retinal microvascular imaging metrics may show sex-specific biomarkers for Parkinson's disease.

Editor's note: The below transcript has been lightly edited for clarity

Hi, my name is Cameron Cummings. I'm a medical student at the Duke University School of Medicine, and my project is on retinal structure and microvasculature in patients with Parkinson's disease and how it differs by sex. Our lab and other labs have shown that retinal structure and microvasculature differ in Parkinson's disease regardless of sex, and we know that Parkinson's disease presents differently in males and females. So we wanted to look at any differences, by sex, that structural and microvasculature alterations might have. So we had a cross sectional study where we had participants with Parkinson's disease, males and females, as well as age matched controls. And we looked at OCT and OCT-A images, and essentially found that comparing female controls, with females with Parkinson's disease, the females with Parkinson's disease had reduced perfusion density and vessel density in the 3mm circle and ring. 

Those differences were not observed in males when we did the comparison between male controls and males with Parkinson's disease. This led us to believe that the previously observed differences brought upon by Parkinson's disease may be primarily driven by females, and we're hoping to do future work to figure out why that might be the case. So in terms of treatment, it may not have too much of an impact, but it's possible that retinal microvasculature could be used as an early screening tool for Parkinson's disease. 

We need to understand a lot more about it before it's used in any sort of diagnostic manner. But if that were the case, if there were to be OCT-A scans done as indicators of potential early Parkinson's disease, our data suggests that diagnostic validity may be slightly more prominent in females, such that if one were to use that criteria for males, they would have to consider that. 

We would like to investigate hypotheses as to why our data looks the way it does. Our current thinking is that it might have something to do with estrogen and its decline in menopause. Etrogen is vasoprotective, and during menopause it's obviously declines, and we were thinking that it the decline may predispose females to microvascular damage by Parkinson's.

Part 6: Biggest innovations in ophthalmology in 50 years

So the history of ophthalmology is fascinating because we are such a technology-driven field, and if you look back even 50 years, so much has changed in those 5 decades. 

So if you can imagine, 50 years ago, we didn't have all these different types of intraocular lenses, for example, for cataract surgery. So...I think about all the things that have changed, especially as an anterior segment specialist. Of course, I always think about cataract surgery as my first and foremost; it is the bread and butter of what we do. So all the changes in the diagnostic tools that we can actually now look at, I mean, the invention of OCT [optical coherence tomography], so that we can actually evaluate the parts of the eye without invasive or radiologic detriments to the patient, as well as all the specific different types of lenses, all the different medications, and glaucoma treatment. Wow, that's been a huge explosion of the different types of medications, eye drops, [and] all the MiGs [microinvasive glaucoma surgery] and the devices that can now be treated. 

And then retina, oh my goodness. I mean, we didn't even know what an injection in the vitreous was until just very recently. So the disease of macular degeneration has really evolved in terms of the treatment options that are available. So it's really great to see patients who, you know, having been diagnosed with macular degeneration,...probably thought that this really was almost like a death sentence for their vision. But now we have so many treatments that we could...give them, and they can also say, "Wow, this is not the end of my vision." It gives them hope so that they can actually have new treatments and continue their life in a very active way.

So I think when I was in fellowship training, which was not 50 years ago, of course, but when we were in fellowship training, most of our training was based on incisional surgery. So traps and tubes. And it wasn't until after I was done with fellowship that I got more involved with MiGs, and I think now most of our patients who have glaucoma will be first considered for MiGs surgery—not saying they are all candidates for it, but that is often an option that we offer to patients who are undergoing cataract surgery. And I think that really helped to prevent things like postop complications from incisional surgery but also to help with the patient's quality of life. Because the MiGs often reduces the number of glaucoma eye drops that the patient will be using after cataract surgery.

For me, it'd be anti-VEGF. I mean, wow, anti-VEGF is a game changer. It started when I was in residency. We did not have anti-VEGFs, and you'd watch people go blind, and then all of a sudden I started...fellowship and anti-VEGFs; we're just...literally...seeping into the general population. And all these patients [who] were previously going blind, we are saving and maintaining,...so easily, anti-VEGF has been the game changer for me.

I have to echo that as well, but the AI is the future, and probably we're going to be hearing much, much more about the AI involvement in ophthalmology. Disease progression, prediction,...treatment responses, clinical trials, and everything else.

Well, I'm probably biased as a retina surgeon, but I would definitely say anti-VEGF injections have revolutionized our practice, and I would be very interested to see the answer to this question in the next 50 years, as I'm guessing that it may be the gene therapy that's going to take us to the future.

In celebration of Ophthalmology Times' 50th anniversary, we asked leading experts in the field what they see as the biggest innovation in ophthalmology in the past 5 decades.

OCT

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