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Ophthalmology Times - Ophthalmology news, articles, and events

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Spotlight

Presbyopia: A part of Aging and Challenges

Clinical

1rem

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

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

Vial will be supporting RecensMedical with the phase 3 clinical trial for its Ocu-Cool system.

Vial partners with RecensMedical in phase 3 clinical trial

Several strategies exist to improve safety of injections for patients.

New therapies suggest potential alternatives to retinal biologics

According to the company, it is planning to hold an end-of-phase 2 meeting with the FDA to discuss the results.

 Ocuphire Pharma’s ZETA-1 phase 2 trial of diabetic retinopathy candidate offers mixed results

Viridian Therapeutics unveils positive data from its ongoing Phase 1/2 trial evaluating low dose VRDN-001 in patients diagnosed with TED.

Thyroid eye disease candidate proves promising in phase 1/2 trial

Rishi Singh, MD, of Cleveland Clinic Florida, touches upon the various advancements that are making a difference for clinicians and patients and reducing their progression in this disease state. 

EyeCon 2022: Emerging therapies in geographic atrophy

Lloyd Clark, MD, of Palmetto Retina Center, previews his ASRS poster, which focuses on the PANORAMA Study, which reviews the use of aflibercept in the management of diabetic retinopathy. He will present his poster during a reception on July 15 at this year’s American Society of Retina Specialists meeting in New York.

Videos

Lloyd Clark, MD, highlights his ASRS presentation focusing on the PANORAMA study detailing the use of aflibercept in the management of diabetic retinopathy. 

Therapeutics 

Use of aflibercept in the management of diabetic retinopathy

David Brown, MD, highlights his ASRS poster that includes 44-week data for a four-times-higher dose of aflibercept in a real-world setting. 

What the impact of 44-week aflibercept data may mean in a real-world setting

Rahul Khurana, MD, highlights the analysis illustrating that there's a lot of variability in clinicians’ management of age-related macular degeneration, and also the treatment needs. There are some patients who need to get treated every four weeks or every eight weeks, but there are also patients that can go longer. The analysis showed that nearly half of these patients could go about 12 weeks or greater. Khurana will present his poster during a reception on July 15 at this year’s American Society of Retina Specialists meeting in New York.

Rahul Khurana, MD, shares a preview of his ASRS poster based on an analysis of the second year of the VIEW 1 and VIEW 2 studies comparing aflibercept and ranibizumab treatment arms. 

VIEW 1 and VIEW 2 studies: taking a deeper dive

Ayellet Segrè, PhD, presented her work on trying to understand the biological causes and cell types that lead to one of the leading causes of irreversible blindness worldwide, which is primary open angle glaucoma during the 2022 ARVO annual meeting, held in Denver, Colorado.

This transcript has been lightly edited for clarity.

I presented work on trying to understand the biological causes and cell types that lead to one of the leading causes of irreversible blindness worldwide, which is primary open angle glaucoma.

It's characterized by gradual retinal ganglion cell death that leads eventually to the degeneration of the optic nerve head and visual field loss and can lead to blindness. And the underlying causes, the genes and processes that lead to the disease, are not very well understood. 

So we use the approach that integrates both very large population-based genetic study that covered over 100 regions in the genome with common DNA changes associated with risk for developing primary open angle glaucoma and integrated that with additional functional genomic information that tells us about what the different DNA changes in the genome do to gene expression, and in which cell types in eye tissues both in the front and back of the eye in which cell types they're expressed. 

By developing a method that integrates both genetic associations from these very large population-based studies, what we call genome wide association studies, together with gene expression in single cells both in tissues in the front of the eye, for example, the outflow pathway through which the aqueous humor flows and it's the blockage of its drainage has been thought to affect and lead to elevated intraocular pressure, which is one of the major risk factors of primary open angle glaucoma, as well as looking at expression in the back of the eye and in the optic nerve head and in the retina and the optic nerve head where the retinal ganglion cell death occurs, and by integrating both pieces of information we found we're able to uncover genes and biological processes we think may be affecting the risk for developing this form of glaucoma. And we found that a lot of the genes tend to be expressed both in the conventional and the unconventional outflow pathway, also genes associated with intraocular pressure, there's a major risk factor.

But also an interesting fact is that about 40% of patients with primary open angle glaucoma have an intraocular pressure in a normal range of pressure. And that suggests that there may also be intraocular pressure independent mechanisms that lead to the degeneration of the optic nerve. And we found that many of the genes that map to the genomic loci associated with risk for developing primary open angle glaucoma, enrich for expression in microglia cell types in the retina and around the optic nerve — so these are cell types that support the metabolic supply and structural support of the retinal ganglion cells that you know that may be affecting itself and ability to survive.

So it suggests that we did not see actually genes enriched for expression in the retinal ganglion cells themselves, suggesting that, you know, thinking about in the future different developing new therapies might be important to think about targeting the neuronal support cells in addition to maintaining the health of the retinal ganglion cells.

The next step we're planning on kind of following up on these results, seeing if they replicate, reproduce in an independent secondary study both of single nucleus RNA-sequencing of additional healthy eye tissues from from donors; as well as in an even larger population-based study looking for genetic risk factors associated with primary open angle glaucoma, that looked at maybe over 10,000 additional cases, and identify now over 300 genomic loci. 

So we're planning on doing this analysis with an even larger set of risk factors for glaucoma together with the single cell data and see if the results stand. And we can learn more about the underlying genes and biological processes. And then down the line we're interested in, in collaborating with experimental biologists here at Mass Eye and Ear to test some of the hypotheses of what genes and pathways may be functioning in particular cell types.

This work suggests that there may be both what is better understood, you know, pathophysiological path that's affecting a risk of POAG through regulation of intraocular pressure, and it's suggesting certain cell types in the front of the eye, some that have been more well established, and others were suggesting particular genes. 

So the hope is, currently there are medications that reduce IOP but my understanding is that some patients they might not be as effective. So having maybe this knowledge of the particular genes that are perturbed and in the particular cell types might help design even better intraocular pressure reducing medications. 

And the other thing is a kind of uncovering the potential role for particular cell types such as the neuronal support cells in the retina and the optic nerve head. This might open a new avenue for developing drugs that will will be helping the neuro protection of the retinal ganglion cells so could open a new avenue for therapies that are for helping treat patients that develop primary open angle glaucoma. And that is not dependent on the intraocular pressure being elevated, but maybe more has to do with the sensitivity of retinal ganglion cells. But that's that's uh, you know, there's work here at Mass Eye and Ear and trying to study the genetic predisposition to what we call normal tension glaucoma.

Presented at ARVO 2022, research from Mass Eye and Ear hopes to open a new avenue for therapies that are for helping treat patients that develop primary open angle glaucoma.

Glaucoma Awareness

Understanding the biological causes and cell types that lead to one of the leading causes of irreversible blindness worldwide could benefit treatment in patients

At ARVO 2022 in Denver, Colorado, Timothy Blenkinsop, MD, presented “3D Eye Organoids with Distinct Cornea.” His presentation outlined how these organoids have developed sophisticated cornea structures.

Dr. Blenkinsop is an associate professor of ophthalmology, cell development and regenerative biology at the Black Family Stem Cell Institute at the Icahn School of Medicine at Mount Sinai.

Hi, my name is Timothy Blenkinsop. I'm an associate professor at the Icahn School of Medicine at Mount Sinai and we're here presenting some of our exciting work on eye organoids.

And so one of the organoids that we developed are these organoids that differentiate into sophisticated cornea structures. We have conducted single cell RNA-Seq analysis and identified a number of different subtypes of cells, which resemble — at least in terms of the gene expression — the cell types of the cornea, and now we're using these for modeling wound healing diseases and testing compounds to see whether we can mitigate those symptoms from wound healing.

One of the objectives of this research is to develop an eye drop that a patient can use or when they're injured, that could hopefully minimize the wound healing response after injury. 

The next step is really convincing the field at large that this is an effective model, and then moving into animals to then revalidate our proof of principle in animals.


RNA-Seq analysis identifies cell subtypes to use as models for corneal wound healing

"The next challenge as more lenses become available will be to properly select the technology for the patient for individualized patient outcomes." 

Catching up after ASCRS 2022, Ora's Caitlin Black, senior director and therapeutic area head of medical devices, talks with 

 about exciting new presbyopia IOL technology coming down the pipeline.

Hi, my name is Caitlin Black, senior director and therapeutic area head of medical devices at Ora. We are a full-service clinical development organization overseeing both drug and device clinical trials.

Just returning from ASCRS, I am most excited about the innovation in presbyopia. Presbyopia is the so-called "final frontier" in refractive surgery, and there are many advancements that are providing additional options to presbyopic patients.

We know that worldwide, 1.7 billion people are affected with presbyopia and they currently have limited options. Their quality of life is diminished due to the decreased visual acuity, and many are looking to be free of glasses or obtain spectacle independence.

Since 1949, when IOLs first for implanted we've seen many advancements in IOL technology, including multifocal accommodating IOLs, pinhole IOLs, and extended depth of focus IOLs. Now we're really focused on patient-reported outcomes in our medical trials.

At Ora we work very closely with our sponsors to design study protocols that take into consideration patient's quality of life. We do this through integrating quality of life questionnaires, supplements and being mindful of patient objectives when they enter a clinical trial for a premium IOL.

At Ora we partner with many sites, we have 800 sites that we partner with worldwide and we have individuals on the ground working in 25 countries. This allows us to have really high quality oversight and monitoring of the clinical trials, which ultimately proceeds with high quality outcomes.

We know that there are many exciting advancements coming in presbyopic IOLs, many IOLs that are currently available outside of the US are entering clinical trial in the United States. I think the next challenge as more lenses become available will be to properly select the technology for the patient for individualized patient outcomes.

Catching up after ASCRS 2022, Ora's Caitlin Black, senior director and therapeutic area head of medical devices, talks about the next generation of ophthalmic device therapies and diagnostics, clinical trial updates and new innovations that are most exciting for presbyopia treatment.


Refractive Surgery

New advancements in IOL technology is exciting for presbyopia treatment

Now we have the opportunity — in a very controlled fashion by you the ophthalmologist, or the optometrist — to place a dexamethasone plug or insert into the canaliculus — or into the punctum — and will enjoy 30 days of sustained and tapering treatment with dexamethasone leeching onto the ocular surface with every blink.

I'm Dr. Steve Silverstein with Silverstein Eye Centers in Kansas City, Missouri.

As most physicians are aware by now, Dextenza, or the dexamethasone punctal insert, has been approved and widely utilized for the treatment of postoperative pain and inflammation associated with intraocular surgery. 

But now we have a second FDA indication for the treatment of allergic conjunctivitis.

For many years, doctors have shied away from the use of steroids in the cases of allergic conjunctivitis because primarily of their opportunity for abuse and overuse while patients want to achieve that level of comfort and clearing of their allergic conjunctivitis signs and symptoms. So we've been left with using non-steroidal anti-inflammatories, which have good utilization in patients with mild symptoms, but for the more moderate to severe cases of allergic conjunctivitis, the treatment has really been left short.

It really has opened up an opportunity for appropriate treatment that will bring patients tremendous relief that will help alleviate and mitigate the signs and symptoms associated with conjunctivitis from allergies, both seasonal and perennial, and also do so in a safe manner without the potential for misconduct or misutilization of the product.

A second FDA indication for the treatment of allergic conjunctivitis proves promising for patient relief.

Dexamethasone plug opens opportunity for treatment that will bring patients relief, help alleviate and mitigate the signs and symptoms associated with conjunctivitis from allergies

Mark Packer, MD, discusses the causes, factors, and treatments of negative dysphotopsia.

Cataract Surgery

The larger the "A," the more likely you are to pay the cost of negative dysphotopsia

“Ophthalmology again has the opportunity to be at the forefront of all of medicine with this idea of cell therapy.”

Something to keep your eye on: endothelial cell therapy.

This early technology, pioneered by companies like Aurion, is changing the landscape of corneal treatment.

But what is it? Typically, a single human cornea is donated and transplanted into another single human. Through this cell therapy, one single donated cornea can produce up to 100 treatments.

This advancement is critically important globally, especially with a global tissue shortage. Additionally, the surgical technique is accessible to non-corneal surgeons, which allows them to help patients regardless of surgical training, location and access to tissue in the world.

John Berdahl, MD, discusses the technique and benefit of endothelial cell therapy. An early technology, this therapy method allows for up to 100 treatments out of a single human cornea.

Endothelial cell therapy: up to 100 treatments from one human cornea

Chuck Hess, vice president and general manager, Bausch and Lomb, discusses XIPERE™, the first and only therapy available in the United States that utilizes the suprachoroidal space to treat patients suffering from macular edema associated with uveitis, and other new things rolled out recently from the company.

Therapeutics

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