 Research Scholar Honoree Program is dedicated to the education of retina fellows and residents by providing a unique opportunity for fellows and residents to share notable research and challenging cases with their peers and mentors. The program is supported by an unrestricted grant from Regeneron Pharmaceuticals.



Despite successful rhegmatogenous retinal detachment (RRD) repair, there is a degree of variability in long-term visual recovery. 

To date, a number of factors are predictive of poor visual outcomes, including baseline visual acuity, macular involvement, height and duration of macular detachment, and timing of the surgical repair.

Preoperative outer retinal corrugations and intraretinal cystic cavities may be manifestations of chronicity and indicate more severe photoreceptor damage at the time of detachment.

On structural en face and cross-sectional SD-OCT, presence of ORFs as hyperreflective curvilinear or oblique lines that project above the retinal pigment epithelium has been described as the “jumping fish” sign.

The purpose of the study is to explore the association of early outer retinal pathology after macula-off RRD on structural en face and cross-sectional SD-OCT images with long-term postoperative retinal microstructural changes and functional outcomes. 

Patients enrolled in the PIVOT trial (NCT01639209) had a primary macula-off RRD with a single retinal break or group of breaks within 1 clock hour in detached retina (above the 8 and 4 o’clock meridians) associated with any number, location, and size of breaks or lattice degeneration in the attached retina.


The PIVOT trial compared long-term outcomes of RRD repair in patients undergoing pneumatic retinopexy (PnR) versus pars plana vitrectomy (PPV). 

Patients were followed for up to 1 year with standard study visits at 1 month, 3 months, 6 months, and 12 months.

Five-line raster and macular-cube scans in the horizontal meridian performed for each eye with SD-OCT (Cirrus high-definition [HD] OCT; Carl Zeiss Meditec) were reviewed and graded using Cirrus HD-OCT analysis software. 

Preoperative outer retinal corrugations, intraretinal cystic cavities, and subretinal fluid (SRF) height were documented. Integrity of the outer retinal layers were assessed at 6 and 12 months by 2 graders. 

En face images were manually segmented with slabs at a thickness of 35 to 65 µm and positioned between the outer nuclear layer and the EZ.

The presence of the “jumping fish” sign on dynamic-video SD-OCT imaging through the ORFs at 1, 3, 6, and 12 months was documented. 

Visual acuity was assessed at baseline using the Snellen chart and at 3, 6, and 12-month follow-up using Early Treatment Diabetic Retinopathy Study (ETDRS) letters. 

Mean vertical and horizontal metamorphopsia scores were assessed using M-charts scores at 12-month follow-up.

Tests of association were done using the chi-square test and t-tests for categorical and continuous data, when the data were normally distributed. The Mann-Whitney 

 test was used for continuous data not normally distributed. 

For categorical analyses, the Fisher’s exact test was used when cell counts were below 5.

Eighty-eight eyes with macula-off RRD from 88 patients (median age, 62 years; interquartile range [IQR], 57-67) were used for this study. Fifty percent of cases had been randomized to PnR and 50% to PPV for RRD repair. The median duration of visual symptoms from onset to RRD repair was 95 hours (IQR, 38-478) and was significantly longer in eyes with presence of outer retinal corrugations (

 = .001). The presence of preoperative outer retinal corrugations was associated with lower baseline visual acuity (

 = .021). Eyes with preoperative SRF height of more than 500 m were more likely to have outer retinal corrugations (

 < .001) and intraretinal cystic cavities (

Regarding visual outcomes, the median ETDRS and metamorphopsia scores at 12-month follow-ups were 77 (IQR, 71-83) and 0.15 (IQR, 0-0.28), respectively. Adjusting for lens status, larger SRF height was associated with lower ETDRS at 3- and 6-month follow-ups (

 values = .011). Furthermore, eyes with retinal corrugations at baseline had higher metamorphopsia scores at 12 months (

 = .013). The presence of ORFs as the “jumping fish” sign was detected in 47% of eyes at 1 month postoperatively. Detectable ORFs decreased to 19%, 8%, and 3% at subsequent 3-, 6- and 12-month follow-ups, respectively.

The presence of ORFs at 3 months was associated with interruptions in ELM and IZ on cross-sectional SD-OCT scans at 6 months (

 = .024). Persistent ORFs at 6 months were suggestive of a lower ETDRS (

 < .004) and increased chance of having any metamorphopsia at 12 months (


The primary baseline feature indicative of lower ETDRS post macula-off RRD repair is presence of SRF height more than 500 µm. 

Preoperative outer retinal corrugations are also suggestive of detachment chronicity and postoperative metamorphopsia. 

Prevalence of the “jumping fish” sign decreases during the 12-month period postoperatively. 

However, persistent ORFs beyond 3 months are associated with interruptions in outer retinal layers and decreased long-term functional recovery. 

These early outer retinal findings on en face and cross-sectional OCT may serve as useful biomarkers for long-term visual prognosis.

Articles

Rhegmatogenous retinal detachment studied.

Early outer retinal findings on en face and cross-sectional OCT 

The Tecnis Synergy and Tecnis Synergy Toric II

 (Johnson & Johnson Vision) received FDA clearance in early May 2021 and are now commercially available in the United States.

As an early adopter of these new implants, which are designed to provide a continuous range of vision, Eric D. Donnenfeld, MD, said that he is extremely pleased with the outcomes he has achieved during his initial experience.

Johnson + Johnson kicks off TECNIS Eyhance Toric II IOL in Europe

“The optic of the Synergy IOLs is very interesting, as it combines trifocal and extended depth-of-focus [EDOF] designs and brings the benefits of both technologies to give patients a full range of quality vision,” he said. “In particular, the Synergy IOLs stand out for providing an improved level of near vision.”

Overall, Donnenfeld said the IOLs seem to give the highest likelihood of achieving spectacle independence of any currently available presbyopia-correcting IOLs.

“I have had the opportunity to use the Synergy IOLs for about 1 month, and I am looking forward to gaining more experience and seeing the outcomes in a larger group of patients and after longer follow-up,” he said.


The near vision benefit of the Synergy IOLs is particularly impressive, according to Donnenfeld, founding partner of Ophthalmic Consultants of Long Island and Ophthalmic Consultants of Connecticut, Garden City, New York, and clinical professor of ophthalmology at New York University Medical Center, New York.

“Patients [in whom] I have implanted the Synergy IOL are reading J1 effortlessly, even in situations with moderate lighting,” he noted. “Achieving that level of near vision with other IOLs usually requires an abundance of light.”

Advancements with preloaded IOL injectors

Distance vision with the Synergy IOL is comparable to that of trifocal IOLs, and with the Synergy IOL there is no drop-off in visual acuity or quality in the intermediate range.

“Patients implanted with the Synergy IOL have experienced no problems with driving nor concerns with driving at night,” Donnenfeld said. “They still may notice some halos around lights, which would be expected with any diffractive trifocal design, but the halos are not bothersome. I have not had any patient complain.”

The novel optic design of the Synergy IOL also seems to explain another interesting feature of the lens that sets it apart from other IOLs.

“Results from bench testing showed that contrast sensitivity performance was better with a large aperture and dim illumination than in bright light with a smaller aperture size,” Donnenfeld explained.

The Synergy IOLs incorporate technologies for violet light–filtering and chromatic aberration improvement that may reduce dysphotopsias and improve contrast and visual clarity.

Light adjustable IOLs: Treat patients with Star Trek-like technology

Donnenfeld observed that the features of the Tecnis Synergy IOL optic suggest that the visual outcome should be forgiving to small amounts of decentration or residual refractive error.

The Tecnis Synergy IOLs are made of the same hydrophobic acrylic material found in other Tecnis lenses and have the same A-constant as the Tecnis monofocal (ZCB00) and Tecnis Eyhance IOLs.

“The Tecnis IOL hydrophobic acrylic material is glistening free and provides crisp quality vision," Donnenfeld said.

Donnenfeld said he expects that the Tecnis Synergy IOLs will be an extremely valuable addition to existing presbyopia-correcting IOL options. He noted he has also been very happy with the Tecnis Eyhance IOL (Johnson & Johnson Vision) and the AcrySof Vivity IQ (Alcon) IOLs that are now available.

Presbyopia-correcting IOL with nondiffractive design offers gains

“Both of these IOLs give patients some improved near vision without compromising the quality of distance vision because there is no loss of contrast at distance,” he said.

Donnenfeld said he is still fastidious about selecting appropriate candidates for a trifocal IOL.

“I am very comfortable recommending the Synergy IOL to a broader pool of patients, but at the same time, I am still very careful about evaluating patients for conditions that can affect the outcome, such as significant dry eye disease and macular pathology,” he explained.

Trifocal and EDOF IOLs available in Europe are expected to enter the US market. However, the next big advance in presbyopia-correcting IOLs will come with the approval of an accommodating IOL, Donnenfeld said. The Juvene (LensGen) may begin investigation in a phase 3 trial in 2021.

“I had the opportunity to implant this fluid-optic IOL in Mexico and was impressed by the quality of vision it provides,” he concluded. The Juvene IOL gives true spectacle independence without light splitting. It offers the range of vision of a trifocal IOL with the contrast sensitivity of a monofocal lens,” he said.


Donnenfeld is a consultant for Alcon, Johnson & Johnson, and LensGen.

Early experience with next-generation lens engenders positive perception.

Presbyopia-correcting IOL improves vision for patients

Retinal degenerative diseases are a major cause of visual impairment and blindness in humans. 

The retinal degenerative processes that result from genetic mutations generally affect the retinal pigment epithelium (RPE) and retina. 

The development of a new animal model for gene therapy may make studying these genetic mutations easier.

Study: Gene therapy could preserve vision in patients with retinal disease, serious retinal injury

With the development of hypoxia, the photoreceptors progressively apoptose, and metabolic changes in the retina develop. 

Microglial cells that are activated by the dead photoreceptors can alter their location in the retinal tissue, resulting in further photoreceptor degeneration due to the release of proinflammatory cytokines.

Elif Ozgecan Sahin, MS, under the supervision of Salih Sanlioglu, VMD, PhD, from the Department of Gene and Cell Therapy at Akdeniz University in Antalya, Turkey, explained during a presentation at the American Society of Gene & Cell Therapy 2021 Virtual Annual Meeting that because the type of mutation present controls the photoreceptor degeneration, the pathologies seen in the hereditary retinal dystrophies are similar.

Realization of this similarity sparked the need for development of a new animal model of retinal degeneration that exhibits the pathologies seen in all the inherited retinal dystrophies, she said.

Targeting human retinal progenitor cell injections for RP

The investigators then set out to create an in vitro retinal degeneration model by treating ARPE-19 cells with cobalt chloride (CoCl2), an agent that triggers hypoxia.

Western blot analysis confirmed the hypoxia and degeneration using antibodies against HIF1A. 

The next step then was generation of hypoxia in vivo by injecting CoCl2 intravitreally into Wistar rats.

Sahin pointed out that evaluation of their efforts via hematoxylin and eosin staining and TUNEL assay results “indicated that progressive retinal degeneration initiated in the outer segment of the photoreceptors and then further extended into the other retinal layers over time.” 

Changes began to be observed in the first 48 hours following the CoCl2 injection.


She also reported that the CoCl2 activated microglia cells that were visualized by CD68 immune staining; the cells were scattered throughout the retinal layers.

“All these results indicate that this chemical agent–induced animal model can be used successfully for gene therapy studies targeting retinal degeneration,” she concluded.

This article is adapted from Sahin’s presentation at the American Society of Gene & Cell Therapy 2021 Virtual Annual Meeting. She has no financial interest in this subject matter.

Sanlioglu has no financial interest in this subject matter.

Development of new animal model enhances study of potential mutations.

Gene therapies are explored as potential treatment for retinal diseases

Treating noninfectious uveitis can feel like a losing battle because the available treatments are self-limited because of their adverse effect profile. 

Establishing a single-dose treatment that can mediate long-term immunosuppression without hampering the patient with adverse effects would fill an important treatment gap for these patients, according to Brian Gilger, DVM, MS, a professor of ophthalmology at North Carolina State University in Raleigh.

Case report: Intermediate uveitis caused by black ink tattoo

Gilger and colleagues conducted an animal study in rats to evaluate immunomodulatory gene therapy as a long-term treatment for noninfectious uveitis. 

They used intravitreal adeno-associated virus (AAV) gene therapy to test the effects of 2 immunomodulatory transgenes, 

), to treat a rat model of autoimmune uveitis.

Treatment-naive Lewis rats received either 1 intravitreal injection of 3 uL of saline (control) or AAV particles harboring codon-optimized cDNA encoding 

 (1e9-1e10 vg) 7 days before autoimmune uveitis was induced.

The animals were then examined daily for 14 days to evaluate the effect of treatment on the degree of inflammation and to measure the aqueous humor cell counts.

 < .05) reduction in the autoimmune uveitis scores and the numbers of aqueous humor cells in the eyes that received active treatment versus control eyes treated with a saline injection. 

AAVCOVID vaccine: A combination of factors harnessing COVID-19

The histologic inflammatory scores also decreased significantly (

 < .05) in the active-treatment eyes compared with the controls.

The results of vector genome biodistribution studies indicated that the AAV vector genomes remained in the ocular tissues; however, a very low neutralizing antibody response was elicited against the AAV capsid, Gilger reported.

Based on their results, the investigators concluded that 1 intravitreal injection of an AAV encoding an immunosuppressive transgene, either 

, significantly reduced the clinical and histologic inflammation in a well-established model of autoimmune uveitis. 

They believe that the current results warrant further study of intravitreal delivery of AAV gene therapy for a single-dose treatment of noninfectious uveitis.


The article was adapted from Gilger’s presentation at the American Society of Gene & Cell Therapy 2021 Virtual Annual Meeting. Gilger is a cofounder of Bedrock Therapeutics and serves as a consultant to and speaker for the company, from which he receives honorarium.

Study examines immunomodulatory therapy as a potential long-term treatment option.

AAV gene therapy targets autoimmune uveitis 

 is a recently formed nonprofit organization created to support ophthalmic education internationally—particularly in low-resource and underserved countries—to improve global eye care, advance scientific ophthalmology, and ultimately preserve and restore vision for people of all nations.

 International Council of Ophthalmology Foundation

 (ICOF), the Ophthalmology Foundation’s programs for advancing and facilitating ophthalmologists’ learning and skills development are moving in a new direction designed to align with contemporary needs and approaches to education, said David E. I. Pyott, MDhc, president of the Ophthalmology Foundation’s Board of Directors.

During the more than 6 months since it was formed, the Ophthalmology Foundation has had many accomplishments and programs under way. 

Considering what has been achieved in such a short time, the enthusiasm of its board members and volunteers, and the expectation that more will be joining the effort, the future looks very bright for the foundation.

“As is the case for any new organization, our aim for creating the Ophthalmology Foundation was to introduce something better,” Pyott said. “It seems we are well on our way to success judging from the passion and interest displayed by our board members.”

Pyott also noted that as the organization moves forward with its mission, it is inviting ophthalmologists who would like to help colleagues in less-developed countries to reach out to learn about becoming volunteers.

The Ophthalmology Foundation was officially established at the end of 2020 and has a board of approximately 35 members, representing an international group of renowned ophthalmologists of all subspecialties from different practice settings as well as leaders in industry.

“The common denominator for the members of our diverse board is their enthusiasm for educating ophthalmologists in lower-income and middle-income countries,” Pyott pointed out.

The organization is being built using the antecedents of the ICOF, but with the clear intention of making it different. 

The Ophthalmology Foundation has 2 major arms: a fellowship program, which is administered by the International Ophthalmological Fellowship Foundation in Germany, and ophthalmic education, which focuses on improving educators’ competencies.

Discussing the fellowship program, Pyott said the Ophthalmology Foundation already has funding to support a greater number of fellowships than were available at any point in the history of the ICOF.

Assuming travel restrictions related to COVID-19 will not interfere, there are now 80 fellowships available including a pair of 12-month fellowships offered by the Retina Research Foundation Helmerich Fellowship, with the remainder being 3-month fellowships. 

The fellowships are in 50 host countries with most in the United States, Germany, and the United Kingdom.

“We will be securing more financing shortly that will be applied to increase the number of fellowships offered, and we hope to be building onto the number of host countries,” according to Pyott.

The ophthalmology education arm targets educating physicians around the world so that they can teach fellows and colleagues. Pyott noted specifically that it does not involve production of ophthalmic educational content.

“There are already great programs that produce educational content, such as the American Academy of Ophthalmology’s Ophthalmic Network of Education,” he explained.

“Our aim is to provide volunteers the teaching skills they need so that they can share their knowledge and expertise.”

The education arm is being led by Karl C. Golnik, MD, Cincinnati, Ohio, and he is being joined by board members Eduardo P. Mayorga, MD, Buenos Aires, Argentina; Ana Gabriela Palis, MD, Buenos Aires, Argentina; and Helena Filipe, MD, Lisbon, Portugal; and a group of another 20 volunteers around the world.

The education programs are being developed and will include online content and in-person learning. In July, online programming was launched with a series called “Teaching Skills for Ophthalmic Educators.” 

It consists of 12 monthly modules, and the content is available on the Ophthalmology Foundation Education Consortium website (

In-person education programs are planned for the Malaysian Ophthalmology Society meeting in August 2021 and the American Academy of Ophthalmology meeting in November 2021.

Future plans include establishing a mentorship program that will pair ophthalmologists who are early in their careers with experienced colleagues who can provide insights on how younger professionals can advance their careers and their educational skills. 

In addition, the Ophthalmology Foundation hopes to hold the 4-day Eyexcel meeting that will have a mix of virtual programming and in-person learning (travel permitting) at an Aravind Eye Hospital in India.

The Ophthalmology Foundation is also publishing a free monthly educators newsletter. It provides resources from around the world that have been reviewed and approved by the Ophthalmic Education Editorial Board and lists upcoming opportunities for fellowships, workshops, and other events of interest to ophthalmic educators. Individuals who are interested in receiving the newsletter can access it on the Ophthalmology Foundation’s website (ophthalmologyfoundation.org), and they can also sign up on the website to receive the monthly newsletter by email.

Individuals interested in learning more about the Foundation’s programs can look to its social media pages on Facebook and LinkedIn.


Ophthalmologists who would like to help their colleagues in lesser developed countries are welcome to become involved with the Ophthalmology Foundation and can do so in various ways. 

If they would like to host a fellow, ophthalmologists working in an academic setting that does not already have a fellowship agreement with the International Ophthalmology Fellows Foundation can reach out to Cordula Gabel-Obermaier, IOFF executive for fellowships, at 

Ophthalmologists who are enthusiastic about educating colleagues are encouraged
to reach out by clicking on the “Contact Us” tab that can be found on the Ophthalmology Foundation’s website to learn about potential educator opportunities.

Pyott also pointed out that the organization would like to hear from anyone who could help its mission by sharing their knowledge and expertise.

“Our current education team includes members with decades of experience as ophthalmic educators,” he said. “However, we hope to build the next generation of volunteers by hearing from younger ophthalmologists who have established themselves in their career and want to devote time to helping colleagues in the rest of the world."

The Ophthalmology Foundation is also grateful to receive donations that will help support the organization’s mission of serving ophthalmic educators around the world.

“The road to building organizations is paved by small donations,” Pyott concluded.

Organization looks to improve global eye care through ophthalmic education.

Ophthalmology Foundation focuses on mission of vision

Eye contraptions

Management of dry eye disease (DED) was the focus of a recent tele-roundtable of experts in the field, moderated by Cynthia Matossian, MD. The panel included Milton M. Hom, OD, FAAO; Kelly K. Nichols, OD, PhD, MPH; and Rahul S. Tonk, MD, MBA.

The group reviewed the contemporary definition of DED, its causes, and the multiple ways it affects visual function and quality of life, underpinning the importance of diagnosing and treating the condition.

Reviewing the approaches for patient screening and DED detection, the participants emphasized that DED prevalence is increasing, including in younger individuals, as a consequence of increased digital screen time.

“I’ve heard some of our colleagues say to suspect dry eye in everyone until proven otherwise,” said Nichols, dean and professor at the University of Alabama at Birmingham School of Optometry.



The group noted that DED diagnosis does not have to be complicated. Screening for symptoms and their frequency is key, said Hom, of Canyon City Eyecare, a private practice in Azusa, California.

“There is always that question, ‘If you’re on a deserted island and you could only have 1 test for dry eye, what test would that be?’ And my first choice would absolutely be case history,” he said.

“If you have an engaging way of asking questions, a slit-lamp, and fluorescein and lissamine green vital dyes, those alone will help you diagnose basic DED,” said Matossian, founder and medical director of Matossian Eye Associates in New Jersey and Pennsylvania.


The participants agreed about the importance of a thorough consultation to understand details of past therapies, to aid in identifying possible reasons for patient-perceived treatment failures.

 Educating patients is also critical to help them understand what to expect from recommended treatments and that additional procedures and medications may be required in the future.

Discussing specific treatment options, the group concurred that a short course of a topical corticosteroid plays a key role in quickly controlling inflammation and improving symptoms. 

They noted that because of the latter benefit, treatment with a topical corticosteroid can build patient confidence in the prescriber and may improve adherence with additional therapies.

In particular, short-term treatment with a topical corticosteroid is useful as induction therapy when starting immunomodulatory treatment with cyclosporine or lifitegrast and for controlling episodic flares of DED.

Omega supplements were considered to have potential benefit, but the group highlighted the importance of making specific recommendations regarding the dose and form of omega. 

Similarly, they advocated for giving patients specific recommendations for artificial tear products and instructions on frequency of use.

VIDEO: Consequences of untreated dry eye disease

For managing meibomian gland dysfunction (MGD), which affects the majority of patients with DED, the panelists considered a dual-pronged approach as optimal. 

This involves using one or more modalities to address thickened meibum and gland obstruction combined with a treatment targeting inflammation.

Showing patients slit-lamp photos, meibography images, and scores from symptom questionnaires helps them to understand their condition and document objective improvement with therapy.

“Patients like numbers. Dry eye patients want to know metrics,” Matossian said.

“We have incredible products now…. Patients can take care of their dry eye and do self-care better than ever. We just have to trust them and point them in the right direction,” said Tonk, an assistant professor of clinical ophthalmology and associate medical director at Bascom Palmer Eye Institute at the University of Miami in Florida.

VIDEO: Evaluating patients for dry eye disease


A review of products in the clinical trial phase shows a robust pipeline of investigational products for DED.

Targeting inflammation is a novel corticosteroid formulation that combines betamethasone with mycophenolic acid, which enhances the steroid’s effect to enable the use of a lower concentration of betamethasone. This product is being evaluated in phase 2 studies.

Reproxalap, which is entering into phase 3 trials, targets reactive aldehyde species that are implicated in inflammation.

Visomitin (SkQ1 eye drops) is a cardiolipin peroxidation inhibitor that reduces oxidative stress. It is also in phase 3 development.

Tanfanercept (HL036) is a TNF receptor 1 fragment that acts by decreasing the release of proinflammatory cytokines. A phase 3 study did not meet its primary end point and the company said it is currently considering further development.

VIDEO: Educating patients about dry eye disease

Silk-derived protein-4 is a protein derived from the silkworm cocoon that has been found to have anti-inflammatory activity by downregulating nuclear factor kappa B activation. It has been studied as a topical treatment for DED in 2 phase 2 clinical trials.

PaniDrop contains PP-001, a nonsteroidal immunomodulatory small molecule, and uses nanocarrier technology to improve delivery to ocular tissues. The formulation is in early clinical development. In addition, there are 2 investigational treatments targeting increased natural tear secretion.

“We have a number of anti-inflammatory and immunomodulatory treatments already and several more in the pipeline,” Tonk said. “But I think the DED space is ripe for innovation in boosting natural tear production.”

OC-01 is a nasal spray containing the highly selective nicotinic acetylcholine receptor agonist varenicline. It stimulates natural tear production by activating the trigeminal parasympathetic pathway. OC-01 has completed phase 3 investigation.

AR-15512, which activates the TRPM8 receptor, may relieve surface discomfort and stimulate tear production. A phase 2b study of the product is currently under way.

VIDEO: Laying therapy for dry eye disease

The pipeline also includes novel agents for treating MGD. AZR-MD-001 is a keratolytic agent targeting impacted meibum that is being investigated in a phase 2 study.

NOV03 (100% perfluorohexyloctane) is being studied in a second phase 3 trial as a treatment for MGD. It stabilizes the lipid layer of the tear film to reduce evaporation and penetrates the meibomian glands where it is thought to improve the quality of meibum secretions.

ECF843, another novel investigational agent, is a recombinant form of human lubricin being investigated in a phase 2 study. The agent aims to increase the level of lubricin, a naturally occurring glycoprotein with lubricating properties that is reduced in dry eye.

“We should keep our eyes on the pipeline. In the meantime, keep the approach to diagnosis and treatment simple, ask questions, look, and then do something,” Nichols said. “Use treatments in a sequential order and explain them very well to your patients to encourage [adherence].”

Matossian is a consultant to Allergan, Novartis, and Sun.


Tonk has no relevant financial interests to disclose.


During the past year, Nichols has consulted for and/or received honoraria from Aerie, Allergan, Bruder, Dompé, HanAll Biopharma, Kala, Novartis, Osmotica, Oyster Point, Sight Sciences, Tarsus, Thea, Tear Film Innovations/Alcon, TearSolutions, TopiVert, and Visionology, and received research funding from Allergan, Kala, and TearScience.

During the past year, Hom has consulted for and/or received honoraria from Aldeyra Therapeutics, Allergan, Aperta Biosciences, AstaReal Inc, Aurinia Pharmaceuticals, Azura Therapeutics, Bausch Health, Eyenovia Bio, Eyevance Pharmaceuticals, Hovione Scientia, Kala Pharmaceuticals, Nevakar Inc, Novartis, SilkTech, Sun Pharma, Surface Pharmaceuticals, Syndexis, Tarsus Pharmaceuticals, Théa Laboratories, Topcon, Visus Therapeutics, and Vyluma.

Experts provide perspectives on current care and pipeline products.


Optimizing the management of DED

Evaluating safety, efficacy of TP03 for Demodex blepharitis treatment

blepharitis demonstrates that this common condition has important negative functional and psychosocial effects, according to Elizabeth Yeu, MD.

The study, known as ATLAS, analyzed data from questionnaires that were completed by 311 patients who had objective signs of 

mites, collarettes on the lashes, and lid margin erythema. 

The results showed that 80% of patients said that blepharitis negatively affected daily life and that the impacts were felt in multiple ways.

“Many clinicians underestimate the prevalence and impact of 

blepharitis due to symptom overlap with other ocular surface diseases that are often comorbidities, such as dry eye disease,” said Yeu, an assistant professor of ophthalmology at Eastern Virginia Medical School and a partner at Virginia Eye Consultants in Norfolk. “However, it has been estimated that blepharitis affects approximately 20 million Americans, of whom about 45% have an associated infestation with 

Yeu pointed out that ATLAS is a pioneering study investigating the consequences of 

blepharitis, and its results indicate that affected patients may struggle for years with significant clinical, functional, and psychosocial impacts.

“Therefore, it is important that clinicians be proactive about diagnosing 

blepharitis and offering treatment,” she said.

The data for the ATLAS study were derived from participants in SATURN-1, a multicenter, phase 2b/3 clinical trial investigating the efficacy and safety of TP-03 (lotilaner 0.25% ophthalmic solution; Tarsus Pharmaceuticals) for treating 

To be eligible for enrollment in the SATURN-1 study, patients had to have 10 or more collarettes on the upper lashes, 1.5 or more mites per lash, and at least mild lid margin erythema.

The ATLAS participants’ questionnaire responses showed that women were more likely than men to experience a negative impact from their 

blepharitis, but the majority of both men (72%) and women (84%) suffered adverse consequences.

Having difficulty driving at night and feeling or being conscious of their eyes all day were the most common issues, both noted by 47% of patients.

“Notably in terms of emotional impact, about 23% of both males and females said they were constantly worrying about their eyes, and 6% of the participants indicated that their blepharitis affected their mental state, with this impact felt more often by males than females,” Yeu said.

Approximately 30% of both males and females said that blepharitis added time to their daily hygiene routine, 8% reported having discomfort with their contact lenses or having to reduce wear time because of the condition, and 5% noted that they avoided ocular surgery because of the blepharitis.

The cosmetic consequences were also common. Twenty-three percent of respondents (females 27%, males 16%) felt blepharitis had an adverse effect on the appearance of their eyes or eyelids. 

One-third of women indicated the condition interfered with their ability to wear makeup, and 5% of women noted discomfort when wearing artificial lashes.

Tarsus execs discuss origins, treating Demodex blepharitis


Yeu also noted that the identification of collarettes, which are a pathognomonic sign for 

Ophthalmology Times: August 2021

Early outer retinal findings on en face and cross-sectional OCT

Presbyopia-correcting IOL improves vision for patients

Gene therapies are explored as potential treatment for retinal diseases

AAV gene therapy targets autoimmune uveitis

Ophthalmology Foundation focuses on mission of vision

Eye contraptions

Optimizing the management of DED

Detailing consequences of Demodex blepharitis

Editorial: Yes, ophthalmologists are real doctors

Four tips for growing a proactive practice

FDA approves cyclosporine A eye drop for vernal keratoconjunctivitis

Swept-source OCT imaging assists dry AMD treatment

How novel autoantibodies may improve screening dry eye patients for Sjogren's syndrome

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