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Opioids like fentanyl effectively prevent sneezing during propofol sedation for periocular injections, enhancing patient safety in ophthalmic procedures.

Using opioids to prevent sneezing and potential ocular tissue damage during sedation and periocular injections

assistant professor of ophthalmology at the Atrium Health Wake Forest Baptist School of Medicine

ASRS 2025: Neighborhood-level characteristics associated with delay in surgery and loss to follow-up

Discover how dropless vitrectomy with suprachoroidal injection effectively controls inflammation, offering a promising alternative to traditional eye drop therapy.

ASRS 2025: Dropless vitrectomy with suprachoroidal triamcinolone-moxifloxacin

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

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Ophthalmology Times – Clinical Insights for Eye Specialists

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Managing ophthalmic surgery patients on antithrombotic drugs

Prevention of CME, infection in lens-based surgery: Evidence-based approaches

New loteprednol gel reduces drop burden for treatment of postoperative inflammation, pain

Submicron formula ‘step forward’ in steroid therapy

Rates drop in both phacoemulsification, manual small-incision cataract surgery patients

Study: Intracameral moxifloxacin reduces endophthalmitis cases

Cataract patients may benefit from new drug-delivery methods

The 14th annual Glaucoma 360 conference will take place February 6 to 8, 2025, at the Westin St. Francis on Union Square in San Francisco, California. Co-founded by Adrienne Graves, PhD, and Andrew Iwach, MD, and hosted by Glaucoma Research Foundation, the three-day event highlights progress in glaucoma care while fostering innovation and collaboration.

The conference opens on Thursday, February 6, with a gala to celebrate advancements in the field, followed by the New Horizons Forum on Friday, February 7, which serves as an incubator for innovation. Topics include artificial intelligence in glaucoma management, neuroprotection and vision restoration, and cross-species insights from veterinary ophthalmology. Carla J. Siegfried, MD, president of the American Glaucoma Society, will deliver the keynote address.

The program on Saturday, February 8, begins with a continuing medical education program featuring M. Roy Wilson, MD, MS, who will present the Shaffer-Hetherington-Hoskins Lecture, and concludes with an optometric symposium. Visit 

SAP Partner

The 14th annual Glaucoma 360 conference, co-founded by Adrienne Graves, PhD, and Andrew Iwach, MD, and hosted by Glaucoma Research Foundation, will be held from February 6-8, 2025, at the Westin St. Francis in San Francisco, California. The event will focus on the latest advancements in glaucoma care and encourage innovation and collaboration.

California dreaming: 2025 Glaucoma 360 brings celebration, innovation, and education to San Francisco

Ehsan Sadri, MD, FACS, of Visionary Eye Institute in Newport Beach, California, sat down with Professor Emeritus Colin R. Green, PhD, DSc, Department of Ophthalmology, Faculty of Medical and Health Sciences, University of Auckland, in Auckland, New Zealand, to learn more about a novel therapy in development for the treatment of keratoconus and other corneal ectasias. 

Green outlines the status of the research, involving a unique combination of transforming growth factor beta-3 and dexamethasone, and the setup for a proof-of-concept study (via TheiaNova, a spin-out early-stage company of the University of Auckland). 

Green also offers career advice for vision scientists and entrepreneurs, advising that making the transition from basic research to research translation is challenging and that having an application in mind is crucial. He emphasizes the importance of persevering through the highs and lows of research and development, highlighting the long-term benefits and sense of achievement.

Ehsan Sadri, MD, FACS, of Visionary Eye Institute in Newport Beach, California, sat down with Professor Emeritus Colin R. Green, PhD, DSc, University of Auckland, in Auckland, New Zealand, to learn more about a novel therapy in development for the treatment of keratoconus and other corneal ectasias. 

Innovation Series: What a noninvasive eye drop approach may mean for the future of keratoconus

 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

' co-chief medical editors Peter J. McDonnell, MD, and Neda Shamie, MD, delve into the clinical nuances of 

blepharitis. Through personal anecdotes, they stress its underrecognized gravity and discuss diagnostic cues like collarettes. The experts share their enthusiasm for improved treatments, echoing the transformative impact seen in dry eye care.

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

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.

’ very own co-chief medical editors from the West Coast to the East Coast.

Dr. Peter 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.

blepharitis and its impact on millions of patients, and what a newly FDA-approved treatment will mean for clinicians and their patients.

 Hi! Welcome to EyePod. I'm Peter McDonnell. And it's my pleasure to be here today with the famous Dr. Neda Shamie and to talk about really an important common and undertreated condition that we see so often in our practices. 

Neda, we're recording this just shortly after the tropical storm-hurricane got out there to Los Angeles. So everything's okay out there with you and your family?

 Yes, everything is perfect. And first of all, thank you so much for having me on this EyePod. I'm really excited to do this with you, Peter, especially since you are the reason I entered into ophthalmology many years ago. You've always been a mentor, a friend, a huge advocate. 

And as far as the tropical storm or the California hurricane that we had, I had one or two leaves fall off a tree in our backyard. I think that was very traumatic for us. Jokes aside, there were unfortunately many who were quite affected by it. In our area, thankfully, there wasn't much, and I was a little embarrassed to say even call it a hurricane or a tropical storm with my friends who live in the East Coast who experience much worse such experiences but thank you for asking.

 blepharitis. It's something that has been funny enough as a cornea specialist near and dear to my heart. I've been in search of a wonderful treatment option that hopefully would become available to us. 

I first noticed...I don't know when was the first time you started really thinking about 

blepharitis...for me, it was about 15 years ago. I saw a poster that Scheffer Tseng [MD] presented at ARVO about 

 blepharitis and how it can really affect the ocular surface. I had a patient [whom] I had done a corneal transplant on and who just could not hold on to his corneal transplants...kept melting his cornea, really severe ocular inflammation. After that ARVO meeting, I came back I plucked a few of his eyelashes. I went and looked under the microscope and saw these live mites living around the follicles of his eyelashes, and at the time started him on a regimen that Scheffer would recommend and was able to help him hold on to his corneal transplants thereafter. 

So, for me, it was a rude awakening that it's a real problem that we miss often because we are not looking for it. But thankfully, I think more and more we are being educated and made aware of 

 blepharitis being such an important problem. And you know, more than 25 million Americans are affected by it. What do you think about this new FDA approval of Xdemby [lotilaner ophthalmic solution 0.25%; Tarsus Pharmaceuticals]?

 Well, I think it's exciting for all the reasons you mention. This is a disease that—and it's the most disgusting organism I'm pretty sure that I've ever seen—but it's a disease that's really only become to be appreciated during our careers. We know that these organisms live amongst most, if not, almost all adults to some degree, and they live there and they eat sebum and keratinaceous debris and they're these gross little creatures. In a certain percentage of patients, presumably where there's an excessive population on the lid margins, they can cause very significant pathology as you pointed out. 

When I was a resident, the teaching that I got was when you saw these collarettes and these funny little secretions at the lid margins that it was Staph. It made sense because you'd do a culture and grow some Staph as you would any place you culture the skin. But it's thanks to Scheffer Tseng and others, as you pointed out, we've learned that these mites are present and that they can cause significant pathology in people.

To me, it's a lot like when I started out doing dry eye. Not a lot of interest in it. Not much therapy. Once Allergan got the approval with topical cyclosporine and we had an FDA-approved treatment, all of a sudden it really focused the interest of ophthalmologists in diagnosing and treating patients with substantial dry eye. And it essentially created recognition of the disease that affects so many people [with] dry eye disease. 

And, as you pointed out, with those staggering numbers of people where the 

 blepharitis is a factor, it's an important unmet need. So I applaud the people at the company, Tarsus, and I have no relationship with that company, whatsoever, but I applaud them for the persistence that it takes to take a new treatment through the FDA for something for which there's no available treatment. In the old days, we were doing stuff pretty off-label when we had to treat patients with this. To have something that's on label, FDA approved, will I think really be nice, and I'm really looking forward to it been readily available.

 I absolutely agree that it's going to elevate awareness. What's nice about this is that it's not very difficult to diagnose. Whereas with dry eye, there was a lot of...one of the biggest hurdles was trying to encourage our colleagues to diagnose inflammatory dry eye, and there were so many challenges in really documenting that. 

 blepharitis, all it takes is really for the doctor to have the patient look down and look at the base of the eyelashes and look for the collarettes and the collarettes are pretty pathognomonic for the 

. If you see that...often patients describe itching at the eyelid margin; they have ocular surface inflammation; they have meibomian gland disease; they have other inflammatory ocular surface-related symptoms, and if they have 

, now with the new FDA-approved eye drop that's a 6-week treatment. It's a really nice kind of treat as you see it and see the response and then kind of go after other layers of inflammation there as there may be. 

I am really excited about this. I have a lot of patients who have had chronic kind of relentless blepharitis or meibomian gland disease. It's very common in rosacea patients, and these patients have not responded to any treatment and quite aggressive treatments. I'm excited to try it for my patients. I have a list of patients that are waiting for it. So I think it's going to be available by the end of this month or next month. So it's really around the corner.

 It'll be a real opportunity to improve quality of life for so many of our patients. You help out a patient and it may not be the same as doing cataract surgery or whatever, but they'll be grateful and loyal patients, hopefully, going into the future. I think it's wonderful to see this available and for both ophthalmologists and optometrists, I think we'll be able to serve a much larger group of patients. Let's face it, scrubbing with a washcloth, maybe with some baby shampoo will only get you so far. I think the data from the clinical trials that I've seen are pretty convincing that this really is a substantial improvement over the nonspecific treatments we've had before.

 I think for my refractive surgical patients as well as my cataract surgical patients, I am looking for 

 because it can affect the ocular surface. It could become...it could be an -itis for inflammation and infection. I am excited to have a kind of a short-treatment course to be able to treat these patients in preparation for surgery. So that, the demographics of patients coming in for surgery, are also the same kind of demographics that tend to have the 

I urge all our colleagues to have the patients look down; look for the collarettes. Now that we have a treatment that's been FDA approved, as you said, I think the onus is on us to find those patients and offer them the treatment that could potentially have a really huge impact on their eye health.

With that, I think we're going to end our EyePod here. This is a lot of fun, Peter. Thank you so much for chatting with me.

 Always a pleasure, Neda. Maybe we'll touch base after the launch and see what your real-world experience is with this exciting new therapy.

In this podcast episode, Ophthalmology Times' co-chief medical editors Peter J. McDonnell, MD, and Neda Shamie, MD, delve into the clinical nuances of Demodex blepharitis. Through personal anecdotes, they stress its underrecognized gravity and discuss diagnostic cues like collarettes. The experts share their enthusiasm for improved treatments, echoing the transformative impact seen in dry eye care.

(Podcast) Confronting Demodex blepharitis: From rude awakening to FDA-approved solution

In this EyePod® podcast episode, William B. Trattler, MD, sits down with Sheryl Stevenson, 

®' group editorial director, to highlight some of the novel therapies for dry eye that have recently been approved by the FDA, along with various treatment approaches that are in development.

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

This transcript has been edited for clarity.

 Hi, everyone, and welcome to this episode of the 

® EyePod® podcast series. This is Sheryl Stevenson, group editorial director with the Eye Care Group here at MJH Life Sciences. It’s been a busy first half of the year for the ophthalmology community in terms of FDA approvals and innovations within the dry eye space. Dr. William Trattler, who is a refractive, corneal and cataract eye surgeon with the Center for Excellence in Eye Care in Miami, Florida, joins me for this EyePod® podcast discussion on some of the many treatment approaches and advancements for physicians and their patients with dry eye. It’s not an exhaustive list of all that is in development, but it does speak to the depth of the pipeline. Let’s take a listen…

Hi, Dr. Trattler. It's so nice to have you join us today. I'm so excited to talk about dry eye and ocular surface disease. There's so much going on in this space right now. It's a delight to have a chance to chat with you about some of these developments.

 Thank you so much, Sheryl. I just love all the new technologies, because we need them. We have a lot of patients that really need a lot of help. While many of our patients do just fine with what we have available now, these new advances are really going to make a big difference for a lot of patients. So I'm very, very excited and optimistic that we're going to get a lot of help in the near future. So I'm very excited.

Yeah, for starters, there were two recent approvals in the month of June, as you well know. So we had Novaliq with their approval of CyclASol, [Vevye], which is now approved for [the treatment of the signs and symptoms of] dry eye disease.

 It's so exciting. We're really excited to work with Novaliq technology. It's a new version of a drop where it's really waterless, which it sounds strange. It's a drop that doesn't have water or oil in it. It just contains either just lubricants or actually lubricates and contains a medication like cyclosporine. The fact that we're going to have this to available to our patients...hopefully this will be helpful just to make the patients feel better, but then also give that extra treatment of an anti-inflammatory to help with their dry eye. So I'm very excited for this approval.

 Yeah, and then right around the same time we had Miebo from Bausch + Lomb and Novaliq also approved earlier this month.

: Yes. This technology is really going to make a big difference. We have so many patients that their eyes just don't feel good. We've tried so many different things to make them feel better...anti-inflammatories, different lubrication drops, and I'm really hopeful that this will fill in the gap for a lot of these patients that just are uncomfortable. It was kind of geared towards patients with more than a Meibomian gland dysfunction type of situation where they have a rapid tear film breakup. Hopefully, this is going to help just lock in the moisture in the eye as almost an outer layer and really make these patients feel a lot better. So I'm very excited for our patients to have this available.

Yeah, and dry eye...there's just more and more options becoming available and different ways of looking at it. It used to be treated almost like a nuisance disorder, but now it's just becoming more understood with continuing research into the corneal surface. It's even been connected to neuro-ophthalmology disease. There's all kinds of things going on. Allgenesis [Biotherapeutics] has AG-80308, which is also in development. Any thoughts on some of these other therapies that are in the works?

I'm really excited. Let's go back to the basics, which is, that dry eye is very complex. We have aqueous-deficient dry eye; we have the poor tear film quality version of dry eye; we have Demodex, which is also a major issue that is also associated with dry eye. We have all these different factors that are really affecting these patients. Oftentimes we focus on one area, and we need help in other areas. All these extra technologies that are getting approved, they're going to help us treat the patients. Sometimes it's going to be more helpful for one type of patient than the other. But overall, having these new technologies available will make a big difference.

For the Allgenesis technology, I'm obviously very optimistic. I don't know a lot about this technology. It's still very early on in development, but it's really I'm hoping will treat the inflammation linked with dry eye disease. I'm really hopeful that's going to be a helpful technology for us. It still has a way to go. We know inflammation, whether it's from aqueous-deficient dry eye or poor tear film quality dry eye, we know that inflammation is underneath it all. Anti-inflammatories are quite helpful for these patients.

Right. There's so many other things. Obviously, we know nutritional strategies have always been in place...the importance of omega-3s and so forth. There's also an oral probiotic that was recently presented at the American Society for Microbiology had a presentation about that as well. There's so many different aspects to this and even neuro-optometry and neuro-ophthalmology clinics are looking at this. What are your takeaways from some of these different approaches?

Well, I think you're clearly right. It's not just one approach for dry eye. We need to take different approaches and every patient is unique. They have different factors impacting their overall health of their eye... again, there are different types of dry eye. We're actually utilizing a technology that's somewhat new as well, it's recently launched, called CSI Dry Eye. It actually uses artificial intelligence to help us categorize the patient into different versions of dry eye so we can more effectively provide effective treatments in first round. It's early work with this company. It looks very exciting with them. With what you just presented on the oral impact...we know that omega-3s for a while have been helpful. The concept of probiotics sounds really interesting and not something I would have expected that a probiotic can help with dry eye disease. But again, there's always room for us to learn more and more. So I'm looking forward to seeing more results on these new technologies.

Yeah, and that's not it. We're not done yet, right? We've got more PDUFAs coming. There's a PDUFA date of November 23. Aldeyra [Therapeutics], they have reproxalap for the treatment [of the signs and symptoms] of dry eye disease. So that's also something in the pipeline to look forward to.

Yes. I consult with pretty much all the dry eye companies. It's just probably best for me to say it that way, including Aldeyra. I've had a chance to understand a bit more about this company, just because I've looked into company. I don't have anything confidential from them. It looks really promising. They just released their Phase 3 results from their allergic conjunctivitis study, which often goes hand in hand with dry eye disease and will prove to be quite effective in that scenario as well. Aldeyra's is like an anti-inflammatory that suppresses inflammation, but doesn't have some of the side effects of steroid drops. We're really hopeful that it'll really be an impactful treatment for patients with dry eye by suppressing inflammation and making patients feel better. The clinical trial results have been really positive, and we're hoping for approval to give our patients more opportunities for treatments in the future.

As a clinician in this area, I'm sure you must be super excited about all these developments and just looking forward to having these in your regimen to offer to patients with dry eye disease. Just to have as we progress forward into more and more and learning more about dry eye disease and even other approaches.

It's so critical because, again, we often catch dry eye early. It's easy to treat patients who have early dry eye disease, and we can manage this quite nicely with what we have available today. There are patients that have more moderate to severe dry eye that we're still struggling with, and we'll come up with different treatment plans and sometimes it'll be effective and we feel really positive. But sometimes they start better and then they get worse again, and okay, now what do we use next. We're kind of running out of options sometimes. Having these new technologies become available will help not only their patients with early disease, but also patients with moderate to severe disease. We're really excited that we have more options for our patients.

Absolutely. Is there anything else that you'd like to add that we have not even touched upon?

This is a great overview of some of the new things that are coming out in the near future. Another company's product, Tarsus, is hoping to get approval soon for Demodex, which is associated with poor tear film quality dry eye. I just think that 2023 is going to be really strong year for our patients. When we get into 2024, we'll have just so many more choices for our patients and more ways that we can help them, and I really am very appreciative of all the work that's being done by all the companies and researchers to help bring these technologies to our patients.

That's right, as you say, I mean, we're only halfway through the year and look at all that's already happened. There's so many developments and really encouraging therapies going on. Who knows what the next 6 months will bring and even beyond. We're really well positioned for growth in the coming months for sure.

Yes, absolutely. Thank you so much for having me and I can't wait to talk again to share the next round of exciting news.

 Yeah, absolutely. Thank you so much for your time today, Dr. Trattler.

William B. Trattler, MD, highlights some of the novel therapies for dry eye that have recently been approved by the FDA, along with various treatment approaches that are in development. 




EyePod: The dry eye pipeline is more than a topical discussion

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

®. 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.

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