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This phase 2b/3 trial follows new, positive 2-year data from the phase 2 ALTITUDE trial, in which sura-vec was well-tolerated in subjects with non-proliferative diabetic retinopathy

REGENXBIO launches phase 2b/3 trial of sura-vec for diabetic retinopathy

Q&A: Understanding the influences on molecular confirmation after genetic testing for IRDs

The agreement is for a planned clinical trial of AXPAXLI (also known as OTX-TKI) for the treatment of non-proliferative diabetic retinopathy (NPDR).

Ocular Therapeutix receives FDA agreement under special protocol assessment for registrational trial of AXPAXLI

Sandoz will oversee commercialization of the product across the European Union (excluding Germany), Switzerland, Norway, Australia, Hong Kong, Vietnam, and Malaysia under the terms of the agreement.

Lupin and Sandoz sign licensing deal for biosimilar ranibizumab across multiple regions

Ophthalmology Times connects eye care professionals with surgery, imaging, gene therapy, & diagnostic advances to enhance clinical and patient care.

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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

 EyePod podcasts focusing on innovation in ophthalmology. Throughout this series, we'll be hearing insights from various stakeholders including those in clinical practice, academia, and industry. The overarching message in this podcast is intended to be informational and not promotional. Today, our host Ehsan Sadri, MD, engages in a conversation with Jeffry Weinhuff, who is managing partner of Visionary Ventures. And just a quick note: the thoughts and opinions expressed are those of the speakers and do not necessarily represent the opinions of this publication.

 in Newport Beach, California, and is board-certified, fellowship-trained in treating LASIK, cataract, and glaucoma surgeries. He is a co-founder of Visionary Ventures Fund and a consultant to Tarsus.

, a series of venture capital funds which is a leading investor in drugs and devices for the eye. Visionary has current financial interests and serves on board of directors of the following companies: Aurion Biotech; Centricity Vision; CorneaGen; IanTrek; ONL Therapeutics; Orasis Pharmaceuticals; Pelage Pharmaceuticals; Re-Vana Therapeutics; Surface Ophthalmics; Sydnexis; Surface Ophthalmics; TearClear.

Explore cutting-edge ophthalmology innovations in this new series on the Ophthalmology Times EyePod podcast. Throughout this series, we'll hear insights from various stakeholders in clinical practice, academia, and industry. In this episode, host Ehsan Sadri, MD, engages in a conversation with Jeffry Weinhuff, managing partner at Visionary Ventures, exploring trends and offering advice for individuals driven by an entrepreneurial mindset.

(EyePod) From idea to impact: Navigating ophthalmic innovation

Ehsan Sadri, MD, FACS, and William Trattler, MD, highlight some of the pending FDA approvals and PDUFA dates in the anterior segment sector and what these products will mean for ophthalmologists and their patients.

The views and perspectives expressed are those of Dr. Sadri and Dr. Trattler.

Editor's note: This transcript has been edited for clarity

Hi, everyone. This is Sheryl Stevenson, group editorial director with 

®. Welcome to this episode of our EyePod podcast series. As many in our audience are aware, there is a mega list of pending FDA approvals and PDUFA dates across ophthalmology in 2023. We'll take a look today for the purposes of this podcast segment on the anterior segment. Stay tuned for our retina-related podcast soon.

In this segment, we're joined today by two special guests from the West Coast to the East Coast, we have it covered. Dr. Ehsan Sadri is CEO of Visionary Eye Institute in Newport Beach, California, and Dr. William Trattler, who is director of cornea with the Center for Excellence in Eye Care in Miami, Florida, both who will provide an overview of some of the pending pipeline approvals and what these will mean for ophthalmologists and their patients. Dr. Sadri, take it away.

Thank you, Sheryl, for putting this together for us. As you know, we get together once a quarter with Bill (Dr. Trattler), who's a good friend of mine and go over the pipeline, what's coming down the pike, and what's exciting for us. We have a nice long list that we're sorting through. There's a lot of stuff to talk about in retina. What we decided is to have a retina colleague join us to talk about those approvals. I think that'd be appropriate. To Bill's point, we don't want to talk about premium IOLs for a retina doctor, which is great, and vice versa. They probably don't want to hear me talk about GA [geographic atrophy] or treatments, but we can have them on and so be on the lookout for that podcast. I'm just really happy to get you, Bill. How have you been? The family is great?

Thank you. Everyone's great. Excited to be here with you, Ehsan, as always, and just lots to look forward to. Our practice is ever-changing and new technologies. That's why I love these conversations with you because we get to talk about what's in the pipeline, what's about to come out, and how our patients will benefit.

Absolutely. You and I see patients every day, all walks of life, all different types of payer mixes. You and I both are so excited about the unmet need, and what's coming down. We have this amazing pipeline, but then it's kind of slow to get approved and get covered so we'll talk about that another time. Obviously, for the scope of today, we're going to be talking about what's coming down [the pipeline].

Let's start with dry eye. You're an expert; you've written many papers; you're a thought leader in this space. What excites you in the next 6 to 12 months that you think are going to get PDUFA for our patients?

Well, I think that right now we have a lot of very good treatments for dry eye. Obviously, we still see patients every day and there's always patients that need more help. There's technology...we just need more technologies, more treatments. Thankfully, we have therapies, we have procedures, but they do cost or aren't covered by insurance; we have medications that may or may not be covered by insurance. Any new technologies we get to help our patients is definitely exciting.

I guess number one on the list for me is Tarsus, because that technology looks very promising. It's surprising how common blepharitis is in our patients. When you actually have patients look down...this is new for me, when I started having patients look down and look at their eyelashes, scurf is actually present in about 50% or more patients from all different age groups. So just very common. It's just a sign that these patients have excess bacteria on their eyelashes, as leading to issues with their meibomian glands. Having treatments for a healing aspect is the underlying part of scurf and blepharitis is just going to be so helpful for patients.

Absolutely. You touched upon a couple of really good points. It's probably a pivoting new medication...paradigm shift in our practices. We haven't had to honestly have patients look down like you were saying. I think that's kind of new for us, but also the novel treatment of lotilaner, or TP-03, for the treatment of Demodex blepharitis. To your point, there's a lot of unmet need. This is one of those disease states where I think it's going to lead to a lot of patients that are going to do a lot better from an anterior segment standpoint. They're on artificial tears. Maybe they've been on a cyclosporine.

They haven't gotten a relief. This is gonna be a game changer for a lot of patients. That's a great one to start with. There's going to be great opportunity, some challenges also, but they have a great team. I think the PDUFA for that is August 25. More to come obviously from FDA. I think we're going to be super excited.

Let's pivot now. What do you think about the role of Bausch and Lomb [B&L] and Novaliq. As you know, they've got the new PDUFA associated with treatment of meibomian gland, and that's going to be June 28, 2023. What are your thoughts on that?

 I am super excited. This product makes so much sense. When I first heard about a water-free solution...water-free therapy for dry eye, it's like a lubricant and it makes sense. Like in your car engine, you don't have water to keep it lubricated, you actually use oil. This is a type of lubricant that's going to make the eye feel more comfortable, and help especially when there's patients that have a lack of meibomian gland secretions, they don't have enough oil layer, their tear film is insufficient to maintain the aqueous portion of their tears. This is going to be a perfect product to help these patients. I think it's going to be used in all varieties of dry but obviously, it's key towards a patient that have lipid deficiency or not enough oil in their tear film.

Yeah, you nailed it. I think this is an unmet need, which you and I get excited about. It's gonna be evaporative, right. So it's going to hopefully get good coverage because it's different from the previous anti-inflammatory so can't be pigeonholed in those areas. That's something that really... I don't want to use the word 'frustrates' but it's frustrating for us just because we get excited about PDUFA, all this R&D, we do clinical trials together, and then it kind of goes to this buzzsaw when it comes to insurances.

I'm excited about new categories, because I think it forces the payers to look at this stuff in a different fashion and really forced to have the coverage for our patients. Okay, so with that said, cyclosporine is a molecule that's been around a long time.

Novaliq has another product. June 8 is coming up. That's the PDUFA. What are your thoughts on that segment and what they're doing?

Well, I'm excited again. I don't know as much about this product. But it seems very promising. Cyclosporine is a very effective therapy for dry eye and the fact that we might have a combination product that's going to really help our patients with dry eye get more effective cyclosporine therapy that makes a lot of sense, to me.

 Yeah. Novaliq, as you know, they sort of did a smart job working on not only evaporative, but also anti-inflammatory components. So just to kind of try to own the market, and they did a really good job. It'll be interested in seeing now that Brent Saunders is going to be at B&L to see how they do this launch. Are they going to keep acquiring stuff. I hope so because I think that'd be good. We do need another strategic in the marketplace. So more to come on Novaliq.

We've left all the AMD, even DME, that's going to be in the pipeline for back with the eye [for an upcoming podcast]. Let's talk about the other one on our list today, which is basically Aldeyra Therapeutics. Do you know much about this? I noticed later on [their] PDUFA is in November. They've been in the news lately. They've got a couple of therapeutics, one is ADX-2191 for vitreoretinal lymphoma that's going to be in the back of the eye. For the front of the eye, they've got this reproxalap product for dry eye. It's coming up November 23. What are your thoughts on that? Have you heard much? I haven't heard much.

What I understand is that this is going to be a really like a kind of a new class of anti-inflammatory that's gonna be working at a different level, kind of similar to steroids, but at a different level than steroids...working a little higher up in the pathway so that it's really going to impact your dry patients. I know that for me, my go-to therapy for dry eye is topical steroids. I use them all day, every day, whether it's MGD or aqueous deficient-dry eye combination. Topical steroids suppress inflammation, output tear production help with so much. It makes me just feel more comfortable. And apparently Aldeyra's product is going to work well for these patients with dry eye, and I'm not sure if it's necessarily aqueous deficiency versus MGD, or the combination, but having an anti-inflammatory that hopefully doesn't raise eye pressure and can be used throughout the levels of dry eye can be quite helpful for our patients.

 I agree. I mean, it's gonna be exciting. Anytime there's a new MOA [mechanism of action]. I saw their data. It's pretty impressive. I think at some point I interviewed their CEO, but I haven't heard much. So it's good to hear your perspective on it and I do think you're right. Whenever we have new player with a new MOA it probably will get, hopefully, a new ability to get coverage with our patients. Again, that's going to be a biggest sort of challenge for these companies.

The other two companies that I think you and I should talk about is interesting. Both of them get a lot of press right now. One is in presbyopia.

The other one is an in-the-office ophthalmic solution for reversal of mydriasis. So that's Ocuphire with their patented ophthalmic phentolamine solution. September 28 is the PDUFA. A lot of coverage on this product and company. I've seen them at Eyecelerator. I'm sure you've seen them in all your other meetings. What are your thoughts? How's this going to be used? What's their model? Is it going to be cash pay, or is going to be covered? What do you see in your clinic happening with this?

I think that is going to be purchased by practices and sold to patients as a way to quickly speed up their patients' pupil size so that after they're dilated, they can take the drop and get back to their normal pupil size much more rapidly. It's funny that I still have patients asking me even 15 years after the old version was available, 'hey, do you still have that product?' and hopefully, we don't. This is going to be something that's going to be well liked by patients. Again, we'll see what the economics are in practice, how do you figure this out. That still needs to be figured out but I do think that they really want it to be successful. I think they'll find the right price point to make it work for everybody.

Yeah, it's funny, you say that, because I remember when I was training, we used to have reversibles. That was really popular, and then just kind of died. That whole thing. I'm really excited. To your point is, it's still being asked. There's a lot of patients that go [to eye appointments] between work. I had one today who works with a big finance company and he's like, 'I can't go back to work' and it's morning time he came by. That's a classic example, and he would have paid for it.

I think the economics, how it's done, all that stuff. I think they're doing all the right things when it comes to talking to the KOLs and trying to price it right. It's going to be interesting, but I do think it's exciting. It's cool.

The other one is Orasis, which is 0.4% pilocarpine for presbyopia. Their PDUFA is October 22, 2023. Coming up. So probably if that goes through, they'll be the second after Vuity. You and I've talked about Vuity and the presbyopic pharmacological treatment of presbyopia. What are your thoughts there as a category, this one and the other ones you're excited about? and what should they do differently? You feel like, if they do launch, it sounds like they're going to probably launch and pull commercial, what do they need to do in order to get more traction?

 First of all, I think the whole class and the concept of presbyopia drops to me, it makes so much sense, and it works for me. Like when I use Vuity, I can see without glasses for a certain number of hours a day. I'm excited to experience Orasis' to compare the two and see how they work. For me, and for my patients, it's going to be exciting. The more options we have, and maybe for certain patients one version works best. Maybe Vuity is best for a certain group of patients; maybe Orasis is better for different group of patients. Obviously and so many others coming out from Visus and LENZ, I don't want to forget them all. Ocuphire is having theirs. We have a lot of great products coming out, and as we get more experienced we'll figure out which works best for which patients.

This category is important, especially for patients that have had previous LASIK and had great vision for 20 years without glasses. Now they're in their mid-40s and they don't want to wear glasses anymore. They see great for distance. You could try to redo one of their eyes and get better for reading, but you don't have great choices for them. I'm going to say that this is a great category and is great for our patients.

I couldn't agree with you more. I think that AbbVie/Allergan did a great job of educating the market. They did a lot of direct to consumer. They probably learned a lot of lessons along the way. I think as a sector, as a whole, sort of unmet need...130 million Americans. Big market. I do think you and I probably see less and less of these people. Mostly of the optometrists see them.

But you're spot on. You've got these LASIK patients. You're not going to do RLE [refractive lens exchange] on a plano eye, and there's nothing else so what do you do. You're sort of left with the option of drops and I do think that's a huge market. Also, patients that are still in their 40s, 50s, sometimes 60s, they come... I don't know how they do this. They're seeing 20/20 plano at 60 years old. They don't want any surgery, and they don't like readers. They may or may not be to your point of concentration and class and MOA whether or not they're going to try. I definitely think from a risk tolerance/cost analysis, it is a no-brainer. I'd love for this category to take off to be honest with you. I know it won't benefit us necessarily because we're doing surgery, but I do think it'll benefit our patients. I think there'll be a definite room for it. I'm so glad to hear you've always been supportive. I've seen your LinkedIn comments. I'm very supportive and I definitely think that some patients do better with higher concentration of pilo [pilocarpine] than others. I use this product; I use Vuity pretty much 2 or 3 times a week myself still. I do think it's a learning curve for us and ODs on how to sort of troubleshoot the patients. I'm looking forward to multiple horses in this race to clean that up and make it really just blow up.

Yes. I totally agree. I'm super excited. It's great to know that I guess company is going to have their product in 2023 and hopefully, some of the other companies will come out shortly thereafter. More choices for patients, more buzz from more doctors...trying to sit on the sidelines. Eventually, you can't because patients are going to be asking for it because this fills this zone that patients that aren't the best candidate for surgery, and drops won't solve the problem and avoid glasses and contact lenses. It's a pretty exciting area for me.

Yeah. I would go back and I would say because it's such a big market, we need to almost put together a consortium, almost like we did for cornea, like what we did for glaucoma. I think there's a missing gap there, where there's leadership of the KOLs and thought leaders that can field questions and how to market to patients. I honestly think it's so big, that what we should all do is work together with all the companies to work together. When you go to Orbitz and buy a ticket, Orbitz is owned by all the airlines. Most people don't know that it's owned by Delta, United, American, etc. They all pitched in and launched this app and everyone buys it, and they did a revenue share.

I think they almost need to do that. Because to your point earlier, there's so many companies, and you don't want to have them infight. You want to have them blow up the whole market and educate the doctors, and doctors decide. I think that will be exciting, as opposed to sort of, 'oh, this one causes this' and 'the other one doesn't work,' etc. Yeah, I think that won't do anything good for anybody and I don't know what your thoughts are on that. I firmly believe that for us to have the conversation first with our KOL colleagues and in addition to the comprehensiveness and then in addition to that our optometrists that are actually seeing these patients and give them guidelines on the dos and don'ts and our support will help maintain the growth of this sector.

I 100% agree. This is going to be...these are all great ideas. Once you get more of the companies launched, then we'll see how things play out. But being positive, because in general, these are positive medications and helpful for patients. The key is to just to figure out how to help each individual patient in the best way possible.

Thanks to Dr. Sadri and Dr. Trattler for participating in today's podcast segment. Audience members may listen to this and other podcasts at 

Podcast: Talking about the anterior segment pipeline for 2023

Jai Parekh, MD, MBA, FAAO, a clinical associate professor of Ophthalmology/The New York Eye & Infirmary of the Mount Sinai School of Medicine, and David Hutton, Managing Editor of Ophthalmology Times discuss the importance of ocular health prior to cataract and refractive surgery, specifically with osmolarity testing.

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

Welcome to EyePod, a podcast series from Ophthalmology Times in which we engage with key opinion leaders in interviews about the latest innovations in the areas of surgery, clinical diagnosis, therapeutics, imaging, device technology, gene and cell therapy, practice management, and other cutting edge topics. I'm your host, David Hutton. I'm joined today by Dr. Jai Parekh, a clinical associate professor of ophthalmology, [at] the New York Eye and Ear Infirmary of the Mount Sinai School of Medicine. He specializes in cataract, corneal, and refractive surgery at his practice in Woodland Park, New Jersey. We will discuss the importance of ocular health prior to cataract and refractive surgery, specifically with osmolarity testing. Thank you for joining us today.

I'm seeing in the literature that more than half of patients referred for cataract surgery have dry eye disease, or meibomian dysfunction and/or blepharitis. Can you talk a bit about the potential for that to affect the outcomes of surgery if left untreated?

Absolutely, David. There's no doubt that the ocular surface is incredibly important, as a vital sign when we're taking care of patients undergoing any kind of surgery, including cataract and refractive surgery. In fact, I would also include MIGs and pterygium surgery, are anyone undergoing ocular surface reconstruction. There's no doubt that up to 80% of our patients who are in our waiting rooms awaiting a cataract surgery evaluation, have some form of ocular surface disease. The literature supports that. And around 60% of our patients, when tested, actually have some abnormal tear osmolarity. 

So these vital signs are very important. When a patient comes to me, traditionally, over the last few decades, with cataract surgery, we always assumed blurry vision was why they came to see us. But often times when you tease that out, David, you'll see that patients also have fluctuating vision. So if they have fluctuating vision as well as blurry vision, I now have a couple of disease states to take care of. 

For sure the cataract, if a cataract is commensurate with that blurry vision. Of course, we do a complete examination to make sure there's no glaucoma, no macular degeneration, or no retinopathy or maculopathy, or any other reason for the blurry vision. But if they have fluctuating vision, you sure as well know, 99% of the time, there's probably an ocular surface issue. 

And David, you said it so well, it's not just dry eye — it's dry eye, it's any inflammatory state of the corneal surface, it's lid disease, it's been meibomian gland dysfunction. It could be Demodex, it could be obstructive lid disease, any and all the above can lead to some form of fluctuating vision, and therefore, ocular surface disease. 

So ocular surface disease, for sure, is a very important part of our workup of the patient. And if the patient has it, guess what, we will delay the surgery—we don't even have to call it delaying surgery—we now have the patient enter our rooms or our doors for a journey in cataract refractive surgery and or ocular surface disease rehabilitation. And when they do that, and we take care of the ocular surface, and you mitigate the fluctuating vision, you'll now have better visual outcomes after that surgery.

So you're busy. You're seeing surgical referrals, but you can't just focus on surgery, you have to deal with ocular surface disease. What does an efficient screening process look like?

It takes a village David. It takes a village of the front desk. It takes the village of our optometrists that work closely with us. And yes, that cataract surgery, that surgical evaluation now begins preoperatively, intraoperatively, and postoperatively. 

Postoperatively you want to maintain these patients' expectations and vision. And nowadays, all the companies have come out with some great multifocal IOLs and some great toric IOLs. But guess what, even though the patient doesn't pay for the upgrade, or can't afford the upgrade, they still want good vision. These patients want very, very good vision. And to do that, we have to make sure we test for the ocular surface issues.

We use tear osmolarity as our go-to testing modality in screening these patients for ocular surface issues. If they have numbers that are abnormal, we then delay the surgery, and we then start to restore their ocular surface by addressing the underlying cause. It could be inflammation, it could be obstruction, it could be infection, or it could be all the above. And sometimes we wait 4, 6 and even 8 weeks. 

So I can't do this myself. I need my optometrist, I need my front desk. I need my technicians to screen for this, to help educate our providers that refer to us that they may not have cataract surgery their patients the next week or 2 weeks, but they could have the opportunity for me to take care of their ocular surface first, and then undergo the surgical intervention. So it takes a village, very important [it] takes the right testing. We don't put patients through 20 different tests. We'll do a full examination, use the slit lamp, speak to the patient and family, use a tear osmolarity to check for that inflammatory debris, that inflammatory burden. And if abnormal, we will then start making the right medical interventions before we undergo the cataract surgery.

As you mentioned you're treating patients for 4, 6 or even 8 weeks — How do they feel about treatment and about delaying their surgery?

You know, that's a great question. Once we educate them, that we are going to provide them the best outcome in cataract surgery — not only in our surgical technique, not only what we do intraoperatively with the right IOL or the right combination of antibiotics and steroids and nonsteroidals after cataract surgery, but also their ocular surface. 

So when they hear that, and if I change my mind, they'd be like "no, Dr. J, you mentioned delaying the surgery, we trust you. We were refered to you by other doctors or other family members." And therefore it becomes much easier. If you don't spend the time to educate the patient. Now, let's say a surgeon has to do that. Sometimes it's the surgeon and the optometrist, or the surgeon and the other doctor in the practice, that's fine. That battery of specialists take care of the patient, is what the patient wants. They're paying you, not for surgery, they're paying for the best outcome possible. But also to make sure that they're the right candidates for cataract surgery. 

So a patient with an abnormal tear osmolarity or some dysfunctional ocular surface, we're going to delay it and they'll always, 100% of the time, appreciate us for that.

While you're treating dry eye, what are you looking at that says "Okay, treatment has worked, this patient is ready for surgery"?

Well, I tell the patient, if I see them on Monday, I'll see them back in 4 to 6 weeks. Oftentimes, I will start them with a good, brand name, artificial tear anti-inflammatories. We may do a warming of the lids, and wiping away, or mitigating the obstruction. We may put them on a bunch of medications and interventions to help restore the ocular surface. And as long as they're headed in the right direction, we mitigate their fluctuating vision. We'll see them back in 4 weeks, sometimes 5 weeks. 

We'll sometimes put in a plug then, to make sure that the plug is plugging up a good tear film, not a disease tear film. Once, I'm not saying you got to get to 100%, but once we get to 50, 60, 70% you then will have a better outcome in surgery. And after surgery they have to maintain that. The surgery maybe the teeth whitening, if I can use an analogy, but if they don't stop drinking coffee, or drink soda with a straw, or eat that apple or brush their teeth twice a day with flossing, it's going to come back again. 

So maintaining the patient's ocular surface health and testing them for it is incredibly important.

And lastly, do you have any tips for other surgeons who may want to make this an efficient process screening and treatment for dry disease before surgery?

Listen, I've been doing surgery now for the last 2 and a half decades. We love being in the operating room. But the best thing about our specialties our personality comes out. Our bedside manner comes out at the salt lamp in our offices. 

So always love to do surgery but you want the best outcomes for your patients. In busy surgery, you may have vitreous loss, you may have a patient that may not do well intraoperatively. Sometimes it's out of our control, right? Some patients have very tough eyes or traumatic eyes or something, you know, hyper mature cataract. Which may lead them to not do well, unfortunately. We take care of them postoperatively. 

In this scenario, we know we want to not float our risk, but manage our risk up front and make sure we take care of the ocular surface. So if you don't have enough time as a surgeon, to listen to your patient, or to screen them for ocular surface issues — have another doctor in your practice do it. It's still under the same umbrella. Have your optometrist do it, have them do the tear care to mitigate their obstruction, or put them on RESTASIS or Xiidra or CEQUA or a steroid or a plug. 

All these things are in armamentarium. So it takes a village from the technicians, the surgeons, the optometrists, all the eye care providers in your practice, to really afford the patient the best outcome. Because guess what? Your next 1000 patients undergoing cataract surgery, 80% of them will have ocular surface issues, 60% of them may have abnormal tear osmolarity, and a lot of them may have an aberration in the measurements you take around the time of cataract surgery. 

And therefore, you're not going to achieve a good premium outcome that all of our patients want, despite a multifocal lens, despite a toric lens, or just a straight plain good monofocal, say with a limbal relaxing incision. All these things will guide their management and really lead to a happy practice, happy patients and happy doctors.

Excellent. Thank you so much for your great advice today. And thank you for joining us on EyePod.

Thanks for listening to this episode of EyePod by Ophthalmology Times. If there are topics you would like to hear about, let us know. You can also stay connected with us on Twitter, LinkedIn or Instagram. We'll see you next time.

SAP Partner

Dr. Jai Parekh, a clinical associate professor of Ophthalmology/The New York Eye & Infirmary of the Mount Sinai School of Medicine and David Hutton, Managing Editor of Opthalmology Times discuss the importance of ocular health prior to cataract and refractive surgery, specifically with osmolarity testing.

The importance of ocular health prior to cataract and refractive surgery

George O. Waring IV, MD, FACS, of the Waring Vision Institute (Mount Pleasant, SC), discusses the latest results from the GEMINI 1 clinical trial (by Allergan, an Abbvie company) of AGN-190584 (pilocarpine 1.25%) ophthalmic solution for the treatment of presbyopia.

Analyzing GEMINI clinical trial results of presbyopia eye drop

George O. Waring IV, MD, FACS, discusses the latest results from the GEMINI 1 clinical trial (by Allergan, an Abbvie company) of AGN-190584 (pilocarpine 1.25%) ophthalmic solution for the treatment of presbyopia.

Highlighting results from first FDA-reported study for treatment of presbyopia 

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

KIO-104 is for the treatment of a wide range of ocular diseases, including ocular inflammation, uveitis, age-related macular degeneration (AMD), and complications as a result of refractive surgery.

Kiora Pharmaceuticals Secures US Patent for KIO-104 

Careful management of patient expectations is key to achieving optimal outcomes.

Navigate successful cataract surgery with refractive technology

From Nobel laureates to AI-driven research, the Wilmer Eye Institute honors a century of transforming vision science and care.

Wilmer Eye Institute marks 100 years: honoring the past, shaping the future

As its director, Manusis outlines the facility’s role in delivering advanced, personalized solutions to improve vision and patient experience.

Q&A: Kira Manusis, MD, on how the Center for Refractive Solutions is redefining patient care at NYEE

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

50 years of ophthalmology: What changed the game (Part 2)

 50th anniversary celebration, anterior segment surgeons at the American Society of Cataract and Refractive Surgery (ASCRS) 2025 annual meeting in Los Angeles, California, shared their perspectives on the most impactful innovations in ophthalmology over the past five decades.

Eric Donnenfeld, MD, reflected on the field’s evolution: “What has been the greatest impact on ophthalmology? My response to that is simply everything has changed.” He highlighted cataract surgery’s transformation, from large incisions to microincisions, emphasizing advances such as the intraocular lens introduced 70 years ago and phacoemulsification pioneered by Charles Kelman, MD. Donnenfeld also pointed to glaucoma management improvements, noting the promise of “interventional glaucoma and using lasers and drug delivery systems.”

Jai Parekh, MD, focused on anterior segment surgery and glaucoma innovations. “Cataract surgery has come a long way: smaller incisions, better recovery times,” he said, noting more than 5 million cataract surgeries in the US last year alone. On glaucoma, Parekh described interventional techniques including trabecular bypass stents, drug delivery, and minimally invasive glaucoma surgery (MIGS), stressing, “I’ve always said ‘all MIGS matter’ and it truly is all MIGS matter.”

Eva Kim, MD, expressed excitement about lens-based refractive surgery’s rise and the expanding “toolbox of lenses,” including multifocals and light adjustable lens technology that offer customization and reduce spectacle dependence. She also highlighted implantable collamer lens surgery, saying it allows vision correction “without even having to remove anything or change my patient’s eye.”

Joaquin de Rojas, MD, noted retinal injections for wet and dry age-related macular degeneration as a game changer, noting, “We now have a treatment for these patients.” He also cited advancements in cataract surgery such as toric lenses for astigmatism correction as pivotal.

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Ophthalmologists discuss the most impactful advancements reshaping patient care over five decades.

Refractive

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