PolyActiva and RareSight partner to develop treatments for rare pediatric retinal diseases

PolyActiva and RareSight have announced a “strategic collaboration” to develop first-in-class therapies for rare pediatric retinal diseases with no current approved drug treatments.

The research collaboration agreement will leverage PolyActiva’s proprietary PREZIA platform to offer “first-of-its-kind, new chemical entity (NCE)-eligible pro-drug candidates.” According to the company, this approach will allow for sustained release directly to the retina, requiring no patient administration.

PREZIA uses covalent bonding to attach therapeutic agents to a polymer backbone, enabling “precise, consistent, and fully customizable drug release” from 1 week to over 1 year. PREZIA is biodegradable, eliminating residual buildup supporting repeat dosing.

Carmen Caricchio, CEO and Founder of RareSight, commented on the partnership, saying, “By combining RareSight’s therapeutic discovery and development expertise with PolyActiva’s novel drug delivery platform, this collaboration represents a major step toward transforming how inherited eye diseases are treated. Together, we are advancing a new class of long-acting pharmacologic therapies to address early-onset vision loss, with the potential to change a child’s life and bring hope to generations to come.”

Sandeep Grover, MD, medical retina, inherited retinal disease specialist, and professor of ophthalmology based in Jacksonville, Florida, commented on the impact that inherited retinal diseases (IRDs) have, saying, "Children with inherited retinal diseases face lifelong visual challenges with no approved drug therapies. As a pioneer of the earliest research in this field and caring for kids and their families for more than two decades, I am encouraged by novel therapeutic strategies that support our goal of helping patients maintain vision, function, and independence as long as possible."

Earlier this year, PolyActiva announced the enrollment of the first patient in its phase 2b clinical trial evaluating PA5108, an investigational, new chemical entity (NCE), intracameral ocular microimplant, for reducing IOP in patients with primary open-angle glaucoma (POAG) and ocular hypertension (OHT). The trial is currently underway in approximately 75 patients across 12 sites to evaluate PA5108’s safety, tolerability, and durability in controlling intraocular pressure over time

Additionally, the company secured AUD $40 million in Series C funding to support the continued clinical advancement of PA5108.

References:

  1. PolyActiva and RareSight Form Strategic Collaboration to Develop Breakthrough Treatments for Rare Pediatric Retinal Diseases. Published November 5, 2025. Accessed November 5, 2025.

 https://www.businesswire.com/news/home/20251105185248/en/PolyActiva-and-RareSight-Form-Strategic-Collaboration-to-Develop-Breakthrough-Treatments-for-Rare-Pediatric-Retinal-Diseases

  1. Harp MD. PolyActiva enrolls first patient in phase 2b clinical trial of PA5108 ocular implant. Published August 12, 2025. Accessed November 6, 2025.

 https://www.ophthalmologytimes.com/view/polyactiva-enrolls-first-patient-in-phase-2b-clinical-trial-of-pa5108-ocular-implant

 

 

Exploring presbyopia progression in patients with glaucoma treated with PF receptor agonists:

Patients with glaucoma who are using prostaglandin F (FP) receptor agonists to control their disease may experience accelerated progression of presbyopia as a result,1 according to Masahiko Ayaki, MD, and Kazuo Ichikawa, MD, PhD. The authors are, respectively, from the Otake Eye Clinic, Kanagawa, Japan, and the Chukyo Eye Clinic, Nagoya, Japan.

While the FP receptor agonists, which include latanoprost and Bimatoprost, are the go-to medications to treat glaucoma, they are associated with adverse reactions that include dry eye,2 eyelid pigmentation, eyelash growth, iris pigmentation, and deepening of the upper eyelid sulcus.3

In addition, a few studies have reported that glaucoma medications are associated with surgical failure of trabeculectomy4 and accelerations of presbyopia progression.5-8 Clinical studies have suggested that the use of latanoprost reduces the accommodative amplitude6-8 and that patients with glaucoma using antiglaucoma eyedrops reached a specific near add power significantly earlier than controls,7,8 Ayaki and Ichikawa explained.

Research direction

With these effects in mind, they designed a study with 2 goals. First, they wanted to compare the frequency of ocular symptoms and the near add power between individuals with medically managed glaucoma and a control group in the early stages of presbyopia. In addition, they wanted to determine which specific glaucoma medications significantly affected near add power.

This study differed from others in that the investigators focused their efforts on detecting early presbyopia. The patients in the study were aged 40 to 49 years, which, the authors explained, is “an age range in which the relationship between age and accommodation amplitude is roughly linear9-11 and most individuals become aware of focusing difficulties and first use reading glasses. This approach allows us to compare glaucoma and control groups at an earlier age and identify potential factors contributing to the progression of presbyopia.”

 

Study groups and results

This cross-sectional study,1 published in the Journal of Clinical Medicine, included 105 patients (mean age, 46.4 years) with primary open-angle glaucoma and 114 controls (mean age, 46.1 years). All participants were phakic bilaterally and all had been treated with FP receptor agonists, β-blockers, or carbonic anhydrase inhibitors for at least 6 months. The investigators compared the near add power between the 2 groups.

 

The results showed that for the patients with glaucoma, the mean near add power and the prevalence of symptomatic presbyopia (near add power ≥ 1.50 diopters [D]) were 1.77 ± 0.71 D (P < .01) and 79.0% (P < .01). In contrast, the values for the controls were 1.16 ± 0.74 D and 42.1%.

The researchers found that the odds ratio (OR) and CI for symptomatic presbyopia were associated with age (OR, 1.36; CI, 1.21-1.52), ganglion cell complex thickness (OR, 0.96; CI, 0.94-0.99), presence of glaucoma (OR, 6.19; CI, 3.13-12.23), and number of glaucoma medications (OR, 4.26; CI, 2.42-7.43).

Among the medications studied, only the FP receptor agonists (OR, 5.79; CI, 2.68-12.32) produced significant results. Survival analysis showed that the patients with glaucoma reached the threshold of a near add power of +1.50 D significantly sooner than the controls (P < .05; log-rank test), the researchers reported.

The results led the authors to conclude that near add power increased exclusively with FP receptor agonists in patients with glaucoma during early presbyopia; however, this result was not observed with β-blockers or carbonic anhydrase inhibitors. For specific workers requiring intense accommodation, such as drivers, e-sports gamers, and athletes, cautious prescription of FP receptor agonists may be advisable.

They pointed out that research has suggested that bimatoprost had the most substantial effect on ciliary muscle contraction.12-14 It could be speculated that continuous muscle contraction due to FP receptor agonists may lead to decreased accommodative amplitude, they noted.

References:

Charters L., fact‑checked by Stevenson S.

Exploring Presbyopia Progression in Patients With Glaucoma Treated With PF Receptor Agonists.

Journal of Clinical Medicine, 2025.

https://www.ophthalmologytimes.com/view/exploring-presbyopia-progression-in-glaucoma-patients-treated-with-pf-receptor-agonists

 

 

 

 

 

 Low-dose atropine causes esotropia in patient case

Myopia has become a worldwide public health challenge that has been increasing exponentially with the use of electronic screens across a wide range of ages. A number of treatments for myopia are being explored, such as orthokeratology lenses and peripheral defocus contact lenses. Instillation of low-dose atropine has also been a focus of interest in the efforts to stop myo­pia progression. All treatments are associated with pros and cons that ophthalmologists and optometrists should recognize. David L. Guyton, MD, who spoke at the Johns Hopkins Wilmer Eye Institute’s 37th Annual Current Concepts in Ophthalmology meeting in Baltimore, Maryland,1 described a potential complication associated with the use of low-dose atropine about which physicians should be aware.

 

Although the use of atropine to control myopia can cause ocular dryness, photophobia, and headache among other conditions, Guyton described what may be a previously unreported complication of the use of atropine drops, ie, esotropia in a teenaged patient. Guyton is the Krieger Professor of Pediatric Ophthalmology at the Zanvyl Krieger Children’s Eye Center at the Wilmer Eye Institute at Johns Hopkins Univer­sity School of Medicine in Baltimore, Maryland.

 

Case study

A 15-year-old boy developed myopia at 8 years and was treated with 0.01% atropine daily in both eyes. The atropine dose was increased yearly as the myopia progressed.

At 14 years, he developed intermittent esotropia of the left eye, and at the same age, he started to have difficulty with his near vision, such that he needed to remove his glasses to see nearby. He also reported that his depth perception was affected negatively. By 15 years, the atropine dose was 0.2%, with daily instillation in both eyes. Constant diplopia developed after 3 months, and the atropine was stopped.

He underwent a strabismus surgery for tight medial rectus muscles; 6-mm recessions were performed bilaterally. At 7 weeks post-operation, the eyes were well aligned, the diplopia resolved, and he regained his depth perception.

Presumed cause of esotropia

Guyton explained that the increasing doses of atropine required increased accommodative effort, causing unwanted convergence. The patient’s habit of removing his glasses to see nearby binocularly, at his far point of 12.5 cm, required approximately 

48 prism diopters (D) of convergence. Shortening of the medial rectus muscles over time is the normal response to prolonged inappropriate convergence, he explained.

Practical recommendations

Guyton suggested the following pearls in such cases:    

If the dose of atropine exceeds 0.05%, patients should also use bifocals.

Physicians can consider computer bifocals with effective additions: upper segments, +1 to +1.5 D; lower segments, a total of +2.5 D.

Patients with moderate to high myopia should stop removing glasses to see very close with both eyes or at least cover one eye when doing so.

Guyton believes this is the first such case of esotropia to develop as the result of dosing with atropine to control myopia progression. “In the past, when 1% atropine was used to slow the progression of myopia, bifocals were used as well,” Guyton said. “I used highly placed flattop bifocals without atropine, which I found to work quite well until the advent of smartphones, with their tiny print, which forced very close viewing, and this defeated the mechanism of the bifocals.”

Reference:

https://www.ophthalmologytimes.com/view/low-dose-atropine-causes-esotropia-in-patient-case

Ophthalmology Times, Vol. 50, Issue 1, January/February 2025 – Lynda Charters (Fact‑checked by David L. Guyton MD, Sheryl Stevenson)*.

 

 

 

The search for drugs suitable for use with glaucoma drainage devices (GDDs) is ongoing:

The challenge is to identify drugs and associated substances that do not cause adverse effects or complications in pediatric patients with GDD implants. Maryo Kohen, MD, assistant professor in the Department of Ophthalmology at Case Western Reserve University School of Medicine and a pediatric ophthalmologist and adult strabismus specialist at University Hospitals Rainbow Babies and Children’s Hospital, both in Cleveland, Ohio, described his team’s most recent research in this area at the Fourth Annual Cleveland Eye Bank Foundation Virtual Vision Research Symposium.1

He explained that in pediatric cases of glaucoma, when surgery to open the angle fails, a GDD is inserted. In his practice, he and his colleagues regularly use Ahmed Glaucoma Valves (New World Medical, Inc). However, they frequently encounter complications related to the development of fibrotic scarring around the GDD plates and the bleb wall, which can impede outflow and necessitate subsequent surgeries to remove excessive scar or capsule formation. Multiple surgeries are costly and can negatively affect the patient’s vision, he noted.

To address this, Kohen and colleagues, in collaboration with the departments of Biomedical Engineering and Pathology at Case Western Reserve University, began searching for a drug that would not cause scarring around GDDs. They had previously used mitomycin C and 5-fluorouracil to inhibit fibrosis and scarring in this scenario, but these drugs are associated with high levels of toxicity. The investigators subsequently focused on pirfenidone (PFD; Esbriet; Genentech), an FDA-approved drug, with the hope of minimizing adverse effects due to its antifibrotic activity.

PFD activity

“We believe that the drug affects multiple fibrogenic pathways to reduce fibrosis in the lungs by downregulating the production of growth factors, decreasing fibroblast proliferation, influencing transforming growth factor β, and interrupting the differentiation of fibroblasts into myofibroblasts,” Kohen said. The investigators sought to move beyond the use of PFD drops or subconjunctival injections and hypothesized that creating a polymeric GDD sheath capable of sustained PFD release might mitigate fibrosis development.

They fabricated a PFD-doped sheath using blow-molded polycaprolactone (PCL), a synthetic, biocompatible polyester. In their study, they investigated the effects of various PCL concentrations, spray distances, and molecular weights on nanofiber morphology and PFD release, Kohen recounted.

The aim was to cover the GDD valve without inhibiting outflow while ensuring that capsular formation was not completely suppressed, as bleb formation around the GDD is desirable. Using a solution blow-spinning method developed by bioengineers, a PCL scaffold was devised to serve as the biodegradable surface around the GDD. During testing, PCL concentrations of 6%, 8%, and 10% were evaluated, resulting in different fiber diameters and varying PFD release rates.

Experimental results

“Our in vitro results were successful and showed that fibroblast proliferation and collagen production were reduced,” Kohen explained. However, a different result was observed in vivo in rabbits. PCL was found to be highly inflammatory, and the scaffold increased inflammation.

Moving forward

“In another experiment, we may use a poly (lactic-co-glycolic acid) [PLGA] scaffold. PLGA is another synthetic polymer that is biocompatible and biodegradable and can be combined with pirfenidone,” Kohen concluded. “Blow-spun PLGA may be a better option for reducing fibrous encapsulation around GDD plates.”

Reference:

https://www.ophthalmologytimes.com/view/the-search-for-an-antifibrotic-drug-for-use-with-pediatric-glaucoma-devices

 

 

 

 

EyeCool Therapeutics Announces Results of Pilot Study of Novel Chronic Ocular Surface Pain Treatment

Author: Hattie Hayes

Key Points

  • EyeCool Therapeutics’ ETX-4143 device demonstrated positive results in a pilot study for the treatment of chronic ocular surface pain (COSP).

  • The device targets myelinated long ciliary nerves, providing rapid and lasting pain relief, and may improve corneal sensitivity.

 

Clinical-stage medical technology company EyeCool Therapeutics, based in Cambridge, Massachusetts, has announced positive results from a pilot study on its investigational ETX-4143 device for the treatment of chronic ocular surface pain (COSP).

According to the company, this randomized, double-masked pilot study (NCT06479382) was conducted in 31 patients in Australia. The initial results were presented at the American European Congress of Ophthalmic Surgery Winter Symposium in Aspen, Colorado, and published in a press release in May. The study evaluated the safety and efficacy of ETX-4143 in patients with COSP—often a persistent symptom in dry eye disease.

The ETX-4143 is an investigational device designed for use in a brief, in-office outpatient procedure. The device gently cools the surface of each eye for four minutes. This cooling targets the myelinated long ciliary nerves that are associated with ocular pain. EyeCool Therapeutics reported that most patients experienced immediate pain relief as well as longer-lasting improvements over the following weeks.

Although the study was not powered for statistical significance, EyeCool Therapeutics reported a statistically significant reduction in eye pain severity. The device’s performance was measured using a recently validated patient-reported outcome instrument specifically developed for COSP. The full results are on file with the company and will be submitted for peer review in the near future.

The company noted that treated nerve fibers gradually regenerate their myelin; as a result, after 2 to 3 months, patients may require repeat treatments if symptoms recur. Apart from pain relief, patients treated with ETX-4143 might also experience improvement in corneal sensitivity.

Rebecca Petris, co-founder and president of the nonprofit Dry Eye Foundation, remarked:

“For most patients with dry eye disease, persistent pain severely impacts their quality of life. Patients often describe their symptoms as burning, grittiness, photophobia, irritation, or dryness—essentially, all symptoms of pain. For better outcomes, we need more targeted research and industry engagement specifically in chronic ocular surface pain, and we welcome this progress.”

Preeya K. Gupta, MD, cornea and cataract surgeon at Triangle Eye Consultants, North Carolina, stated that ETX-4143 would be a “very welcome addition” to the existing armamentarium for ocular surface disease:

“Chronic ocular surface pain is a common complaint bringing patients to ophthalmologists, but it often goes undiagnosed or is misdiagnosed as dry eye, leaving patients untreated.”

Alice Epitropoulos, MD, ophthalmologist at Central Ohio Eye & Plastic Surgery, added:

“There is a clear unmet need for new treatments that can safely and effectively manage COSP. Having a reliable new option would be a significant advancement for patient care.”

 

Reference:

EyeCool Therapeutics announces promising results from double-masked randomized controlled trial in chronic ocular surface pain (COSP). Press release. EyeCool Therapeutics. May 7, 2025. Source link

 

 

 

 

 

Long-term Effects of COVID-19 on the Ocular Surface

Author: Lynda Charters

A research team from Turkey, led by Dr. Oğuzhan Kılıçarslan (FEBO, FICO), has reported that COVID-19 affects the morphology of corneal endothelial cells in patients with ocular symptoms. Dr. Kılıçarslan is with the Department of Ophthalmology at Ayancık State Hospital, Sinop, Turkey.

In this study, the investigators assessed the long-term effects of the coronavirus on corneal endothelial cell morphology in patients with ocular symptoms, seeking to evaluate potential corneal involvement in those who had recovered from the disease.

The study included two groups:

  • COVID-19 group: Patients who had been diagnosed and treated at Istanbul University Cerrahpasa Medical Faculty with a confirmed SARS-CoV-2 infection and ocular irritation symptoms.

  • Control group: Age- and sex-matched individuals with no ocular disease.

Researchers used noncontact specular microscopy (center method) 156 days after COVID-19 diagnosis to measure endothelial cell density (ECD), hexagonality (HEX), coefficient of variation, and central corneal thickness.

 

Microscopy Findings

A total of 54 patients with COVID-19 and ocular symptoms, and 72 control individuals, were included in the study.

Specular microscopy showed ocular symptoms in COVID-19 patients such as conjunctival hyperemia, foreign body sensation, tearing, ocular discharge, and chemosis.

The mean ECD was 2,770 cells/mm² in the COVID-19 group versus 2,897 cells/mm² in the control group; the mean HEX was 46.52 in the patient group and 58.22 ± 13.94 in the control group.

Patients recovered from COVID-19 had significantly lower ECD and HEX compared to controls (p = 0.003 and p < 0.001, respectively).

Conclusion

Kılıçarslan and colleagues concluded:

“COVID-19 can cause long-term alterations in corneal endothelial cells, leading to decreased ECD and HEX. Future research should focus on the long-term implications of COVID-19 on corneal health and visual outcomes.”

 

Reference:

Kılıçarslan O, Yılmaz Çebi A, Doğan C, Arslan OS. Long-term corneal endothelial parameters of COVID-19 patients with ocular surface symptoms. Cornea. 2024;43:1124-1127; DOI: 10.1097/ICO.0000000000003552

 

 

 

 

Rare Eye Complication in Paclitaxel Users — A Warning for Early Diagnosis

What Breast Cancer Patients Need to Know:

A new study shows that Paclitaxel, a drug used for the treatment of breast cancer, can, in very rare cases, cause a serious complication known as Central Retinal Artery Occlusion (CRAO). In this condition, blood flow to the retina becomes obstructed, potentially leading to sudden vision loss.

Dr. Harsh Jain and his research team warn that physicians and patients should be aware of this complication and seek prompt ophthalmologic evaluation if any ocular symptoms — such as sudden blurred vision — occur. While rare, CRAO is considered an ocular emergency requiring immediate treatment.

Paclitaxel has previously been recognized for its neurological and hypersensitivity side effects, but this study also highlights its association with Central Retinal Artery Occlusion. The researchers emphasize that, although the likelihood of this complication is extremely low and should not lead to discontinuation of the drug without consulting a physician, awareness is essential for early diagnosis and prevention of severe damage.

 

 

 

 

Red Light Therapy for Children with Myopia

Author: Linda Charters

Key Points

(Myopia, or nearsightedness, is one of the most common refractive errors in children. In this condition, distant objects appear blurry, while near objects are seen clearly.)

  • Repeated Low-Level Red Light (RLRL) therapy may help control myopia progression in children, but there are concerns about potential retinal damage, reduced cone density, and the development of abnormal retinal lesions.

  • Imaging with Adaptive Optics Scanning Laser Ophthalmoscopy (AOSLO) showed significant differences in cone cell density between RLRL users and controls, especially 0.5 mm from the foveal center.

News Summary

Chinese researchers have demonstrated that repeated low-level red light (RLRL) therapy can effectively control the progression of myopia in children. However, the therapy was associated with a decrease in cone cell density, particularly 0.5 mm from the center of the fovea, and in some cases, drusen-like lesions were observed. This was reported by Dr. Xinyi Liao from the Department of Ophthalmology and Key Laboratory for Eye Disease at Peking University.

Liao and colleagues explain that RLRL is being evaluated as a potential method to slow myopia progression in children and adolescents. The system uses red light at a wavelength of 650 ± 10 nm, with a minimum radiant power of 0.29 mW entering a 4-mm pupil, in accordance with international laser safety standards. Nevertheless, there are reports that continuous irradiation—even when adhering to safety standards—can cause photothermal effects and subsequent retinal damage.

In this study, researchers used AOSLO high-resolution imaging to assess live changes in cone photoreceptor cells. They compared cone cell changes in myopic children aged 5–14 years who underwent RLRL therapy with those in a control group. Cone density was analyzed at various retinal locations (superior, inferior, nasal, temporal) from the center of the fovea to approximately 4 degrees eccentricity.

AOSLO Findings

  • A total of 99 myopic children were enrolled. The RLRL group consisted of 52 children (97 eyes, mean age 10.3 years), while the control group included 47 children (74 eyes, mean age 9.8 years).

  • Cone Density: RLRL users showed a significant reduction in cone density 0.5 mm from the fovea, especially in the temporal area. At 0.3 mm temporal to the fovea, the mean difference in cone density between the RLRL and control groups was –2,100 cells/mm² (95% CI: –3,680 to –590; P=0.003).

  • Abnormal lesions were observed in 11 eyes (with low-frequency signals and high brightness near the fovea). The odds ratio for such lesions in the RLRL group was 7.23 times higher than in controls (P=0.02).

  • In one child, small cystoid lesions were seen in the retinal ganglion cell layer on OCT, which resolved 3 months after discontinuation of RLRL treatment.

Conclusion

Liao and colleagues concluded:

“Treatment with RLRL for at least one year was associated with decreased cone density around the fovea and some subtle retinal changes. While this therapy may help control myopia progression, more research is needed to confirm its long-term efficacy and safety. These findings highlight the importance of further evaluating the risk–benefit balance of RLRL therapy in children with myopia, with a focus on AOSLO retinal imaging outcomes.”

References:

  1. Liao X, Yu J, Fan Y, et al. Cone density changes after repeated low-level red light treatment in children with myopia. JAMA Ophthalmol. 2025

  2. Wang W, Jiang Y, Zhu Z, et al. Ophthalmol Ther. 2023

  3. He X, Wang J, Zhu Z, et al. JAMA Netw Open. 2023

  4. Jiang Y, Zhu Z, Tan X, et al. Ophthalmology. 2022

  5. Chen Y, Xiong R, Chen X, et al. Transl Vis Sci Technol. 2022

  6. Youssef MA, Shehata AR, Adly AM, et al. BMC Ophthalmol. 2024

  7. Zhou L, Tong L, Li Y, Williams BT, Qiu K. Sci Rep. 2023

  8. Xiong R, Zhu Z, Jiang Y, et al. Clin Exp Ophthalmol. 2022

  9. LIA. American National Standard for Safe Use of Lasers

  10. Ostrin LA, Schill AW. Ophthalmic Physiol Opt. 2024

  11. Liu H, Yang Y, Guo J, Peng J, Zhao P. JAMA Ophthalmol. 2023

  12. Merino D, Loza-Alvarez P. Clin Ophthalmol. 2016

  13. Wynne N, Carroll J, Duncan JL. Prog Retin Eye Res. 2021

 

 

 

 

Effectiveness of Topical Moxifloxacin Before Cataract Surgery in Reducing Corneal Surface Flora: Doubts and Key Points

Dr. Caroline Wilson, Ophthalmology Resident, University of Iowa

For many years, topical antibiotics have been administered perioperatively in cataract surgery to prevent endophthalmitis. With the increasing popularity of intracameral antibiotics, questions have been raised regarding the necessity of continuing topical antibiotic use before and after cataract procedures.

Dr. Wilson noted:

“Several studies have shown comparable effectiveness between topical and intracameral antibiotics in preventing endophthalmitis. In addition, some research indicates that using topical antibiotics (pre- and/or postoperatively) offers no proven benefit over antiseptic solutions and intracameral antibiotics for endophthalmitis prevention.”

Moreover, increasing the frequency and duration of topical antibiotic administration does not further reduce conjunctival surface flora. There are also concerns about the development of antibiotic resistance, both in the general population and in individual patients. The European Society of Cataract and Refractive Surgeons has even recommended against the use of preoperative topical antibiotics.

New Study and Results

In a study conducted by Dr. Wilson’s team, one group of patients instilled topical moxifloxacin four times daily for three days prior to cataract surgery, while the control group received no antibiotics. Conjunctival swabs were collected before and on the day of surgery (prior to antiseptic application) for culture, identification, and antibiotic resistance testing.

Findings:

Coagulase-negative staphylococci (CoNS) were the most frequently isolated bacteria in both groups. Among patients who used moxifloxacin, 52% still had bacterial growth on the ocular surface on the day of surgery (versus 100% in the control group). Notably, 17.6% of the treated patients had bacteria resistant to moxifloxacin after only three days of use.

Conclusion

“Topical moxifloxacin administered before cataract surgery does not effectively reduce ocular surface flora in most patients, and antimicrobial resistance can develop within as little as three days of use.”

Dr. Wilson suggested that future research should also examine whether preoperative topical antibiotics influence the efficacy of intracameral antibiotics against ocular bacteria.

 

 

:Refrences

  1. Friling E و همکاران، J Cataract Refract Surg. 2013;39(1):15-21.

  2. He L و همکاران، J Ocular Pharmacol Ther. 2009;25(4):373-378.

https://www.ophthalmologytimes.com/clinical/understanding-antibiotic-resistance

 

 

 

 

 

The Impact of Preservatives on the Ocular Surface in Patients with Ocular Hypertension or Glaucoma

 

The rising prevalence of Ocular Surface Disease (OSD) in patients with glaucoma is an important issue that deserves special attention. Maintaining the health of the ocular surface in these patients and preventing OSD, in addition to controlling intraocular pressure, must be a major priority in patient care.

Although glaucoma is not commonly classified as a surface eye disease, studies have shown that 30% to 70% of glaucoma patients experience some degree of ocular surface involvement—a much higher rate than the 5% to 30% seen in populations without glaucoma. It is important to note that OSD is not merely a source of discomfort; it is also associated with an increased risk of failure in glaucoma surgeries.

Several factors play a critical role in the development of OSD, including advancing age, genetics, gender, and systemic comorbidities. Many patients may already have OSD prior to the initiation of topical therapy, which can worsen with treatment. Multiple studies have indicated that up to 59% of patients develop OSD after starting topical glaucoma medications. The number of medications, frequency of administration, and duration of treatment are also major factors influencing the severity of OSD.

The Role of Preservatives

Preservatives are added to ophthalmic drops to prevent microbial contamination. While this practice helps ensure drug sterility, there is substantial scientific evidence that these substances—especially Benzalkonium Chloride (BAK)—have considerable negative effects on the ocular surface.

Benzalkonium Chloride (BAK), which is even used as a general disinfectant, is present in 70% of ophthalmic drop formulations. Research has shown that continuous or cumulative use of Benzalkonium Chloride (BAK) is associated with increased ocular surface toxicity, tear film instability, reduction in goblet cells, disruption of the corneal epithelial barrier, and even injury to deeper structures such as the trabecular meshwork.

Patients using drops containing Benzalkonium Chloride (BAK) often report symptoms such as pain, burning, dryness, itching, and irritation, and score higher on the Ocular Surface Disease Index (OSDI). These side effects can reduce patient adherence to treatment, with up to 60% of patients becoming nonadherent or irregular in their use of medication.

While most generic glaucoma medications contain Benzalkonium Chloride (BAK), preservative-free formulations are now available. These newer drops are significantly less cytotoxic than those containing Benzalkonium Chloride (BAK), lead to a reduction in OSD symptoms, improve patient adherence, and control intraocular pressure effectively, without any loss of therapeutic efficacy.

Given that preservative-free drops (free from substances like Benzalkonium Chloride (BAK)) are now readily available and equally effective, it is recommended to prefer them to maintain ocular surface health, enhance treatment compliance, and reduce complications.

In conclusion, patients should be fully informed about preservative-free options, especially the risks associated with Benzalkonium Chloride (BAK), so they can make knowledgeable choices and protect their ocular surface.

 

 

References:

  1. Baudouin C, Kolko M, Melik-Parsadaniantz S, Messmer EM. Inflammation in glaucoma: from the back to the front of the eye, and beyond. Prog Retin Eye Res. 2021;83:100916. doi:10.1016/j.preteyeres.2020.100916

  2. Chamard C, Larrieu S, Baudouin C, Bron A, Villain M, Daien V. Preservative-free versus preserved glaucoma eye drops and occurrence of glaucoma surgery. A retrospective study based on the French national health insurance information system, 2008-2016. Acta Ophthalmol. 2020;98(7):e876-e881. doi:10.1111/aos.14410

  3. Mylla Boso AL, Gasperi E, Fernandes L, Costa VP, Alves M. Impact of ocular surface disease treatment in patients with glaucoma. Clin Ophthalmol. 2020;14:103-111. doi:10.2147/OPTH.S229815

  4. Harasymowycz P, Hutnik C, Rouland JF, et al. Preserved versus preservative-free latanoprost for the treatment of glaucoma and ocular hypertension: a post hoc pooled analysis. Adv Ther. 2021;38(6):3019-3031. doi:10.1007/s12325-021-01731-9

  5. Thygesen J. Glaucoma therapy: preservative-free for all? Clin Ophthalmol. 2018;12:707-717. doi:10.2147/OPTH.S150816

  6. Goldstein MH, Silva FQ, Blender N, Tran T, Vantipalli S. Ocular benzalkonium chloride exposure: problems and solutions. Eye (Lond). 2022;36(2):361-368. doi:10.1038/s41433-021-01668-x

  7. Zhang X, Vadoothker S, Munir WM, Saeedi O. Ocular surface disease and glaucoma medications: a clinical approach. Eye Contact Lens. 2019;45(1):11-18. doi:10.1097/ICL.0000000000000544

  8. Merchel Piovesan Pereira B, Tagkopoulos I. Benzalkonium chlorides: uses, regulatory status, and microbial resistance. Appl Environ Microbiol. 2019;85(13):e00377-19. Published 2019 Jun 17. doi:10.1128/AEM.00377-19

 

https://www.ophthalmologytimes.com/view/the-impact-of-preservatives-on-the-ocular-surface-in-patients-with-ocular-hypertension-or-glaucoma

 

 

 

 

 

An Innovative Integrated Approach to Dry Eye Treatment: Focus on the Role of MGD and Demodex Blepharitis

 

Recent studies show that 86% of dry eye patients suffer from the evaporative type, which is usually caused by Meibomian Gland Dysfunction (MGD). Dysfunction of these glands leads to a reduction in both the quality and quantity of the eye’s natural oils, resulting in rapid tear evaporation and ocular surface inflammation.

Coexistence of Demodex Blepharitis (DB) with MGD is very common. Today, Demodex blepharitis can be easily diagnosed by the observation of collarettes (cylindrical dandruff at the base of the eyelashes), eliminating the need for microscopic evaluation. Recognizing this condition is particularly important in patients preparing for cataract surgery, as it can increase the risk of infection.

 

Recommended treatments for this condition include:

 

  • Lid margin cleaning (BlephEx): Removal of biofilm and accumulated debris from the lid margin in the clinic.

  • Lotilaner ophthalmic solution 0.25% (Xdemvy): A new, CE-approved therapy for complete eradication of Demodex mites and reduction of collarettes, with impressive efficacy shown in clinical trials.

  • Thermal Pulsation (such as LipiFlow): Used after mite eradication to open the meibomian glands and improve meibum quality.

  • Miebo ophthalmic solution: Reduces tear evaporation by creating a protective layer and improves the ocular surface.

 

Home care also includes the use of omega-3 (rTGC) supplements, lid hygiene with tea tree oil-based products, and warm compresses.

This comprehensive approach is compared to a combination of professional and at-home dental care—key to successfully managing lid disease and dry eye.

 

Conclusion:

An integrated treatment approach—from precise diagnosis to simultaneous treatment of MGD and Demodex, along with continuous at-home care—ensures significant symptom improvement and a better quality of life for patients.

 

Refrences:

  1. Lemp MA, Crews LA, Bron AJ, et al. Distribution of aqueous-deficient and evaporative dry eye in a clinic-based patient cohort: a retrospective study. Cornea 2012;31(5):472-8.

  2. Ayres BD, Donnenfeld E, Farid M, et al. Clinical diagnosis and management of Demodex blepharitis: The Demodex Expert Panel on Treatment and Eyelid Health (DEPTH). Eye (Lond) 2023;37(15):3249-55.

  3. Rhee MK, Yeu E, Barnett M, et al. Demodex blepharitis: A Comprehensive review of the disease, current management, and emerging therapies. Eye Contact Lens 2023;49(8):311-8.

  4. Gaddie IB, Donnenfeld ED, Karpecki P, et al. Lotilaner ophthalmic solution 0.25% for Demodex blepharitis: Randomized, vehicle-controlled, multicenter, phase 3 trial (Saturn-2). Ophthalmology 2023;130(10:1015-23.

  5. Lane SS, DuBiner HB, Epstein RJ, et al. A new system, the LipiFlow, for the treatment of meibomian gland dysfunction. Cornea 2012;31(4):396-404.

  6. Greiner JV. Long-term (3 year) effects of a single thermal pulsation system treatment on meibomian gland function and dry eye symptoms. Eye Contact Lens 2016;42(2):99-107.

  7. Tauber J, Berdy GJ, Wirta DL, et al. NOV03 for dry eye disease associated with meibomian gland dysfunction: results of the randomized phase 3 GOBI study. Ophthalmology 2023;130(5):516-24.

  8. Sheppard JD, Kurata F, Epitropoulos AT, et al. NOV03 for signs and symptoms of dry eye disease associated with meibomian gland dysfunction: the randomized phase 3 MOJAVE study. Am J Ophthalmol2023;252:265-74.

  9. Epitropoulos AT, Donnenfeld ED, Shah ZA, et al. Effect of oral re-esterified omega-3 nutritional supplementation on dry eyes. Cornea 2016;35(9):1185-96.

  10. Smith SG, Gross MB, Sandnes OE, Physicians Recommended Nutriceuticals, LLC. Methods for improving the quality of the meibum composition of meibomian glands. U.S. Patent No. 9,381 183 B2, July 5, 2016.

  11. https://www.ophthalmologytimes.com/view/managing-patients-with-mgd-and-demodex-blepharitis

 

 

 

 

 

 

Under-Eye Rejuvenation With Hyaluronic Acid Filler: New Insights and the Role of Imaging

Hyaluronic acid (HA) fillers are now very popular for improving the appearance and restoring lost volume under the eyes. However, treating this area presents unique challenges, as the aging process creates anatomical changes that make the region especially sensitive and demand careful technique.

:Key findings and highlights

  • With aging, changes such as reduced skin elasticity, fat and muscle atrophy, and ligament laxity can result in puffiness, dark circles, and other esthetic concerns under the eyes.

  • Main complications include: migration or displacement of the filler (seen as puffiness, malar mounds, or discoloration), formation of granulomas, overfilling, and negative effects from excessive hyaluronidase use.

  • Recent studies using MRI and ultrasound imaging have shown that HA fillers can remain in the tissue for several years—highlighting the need for caution with frequent reinjections.

  • Injections should be performed carefully, using appropriate technique (in the preperiosteal plane with a cannula) and with low volume (maximum 0.5 ml per eye per session).

  • Appropriate patient selection (individuals with mild to moderate volume loss and healthy skin) leads to the best under-eye results.

  • Imaging, especially MRI and ultrasound, helps physicians detect residual filler or potential complications before any additional treatments or surgery.

  • Alternative methods such as PRP, laser, and radiofrequency also provide effective, noninvasive under-eye rejuvenation.

 

Summary:

Under-eye filler treatment with hyaluronic acid demands up-to-date knowledge, experience, proper patient selection, and the use of imaging tools to minimize complications and achieve optimal results.

 

 

 

Meibomian Gland Dysfunction (MGD) Is Not Just an Elderly Disease

Although meibomian gland dysfunction (MGD) and dry eye are often associated with aging and menopause, new evidence shows that this condition is also increasing among children and adolescents. The meibomian glands (oil-producing glands located at the eyelid margin, responsible for secreting the lipid layer of the tear film to prevent rapid evaporation) play a crucial role in ocular surface health. According to a recent study, 42% of children had some degree of meibomian gland atrophy.

Frequent digital device use and reduced blink rate, imbalanced diet (low omega-3 to omega-6 ratio), obesity, and diabetes are among the key factors contributing to the earlier onset of the disease in younger people. Early screening of the meibomian glands, education on healthy nutrition, and following the 20-20-20 rule (resting the eyes every 20 minutes) are recommended to help prevent the early and progressive onset of MGD.

 

:Refrence

https://www.ophthalmologytimes.com/view/meibomian-gland-dysfunction-in-younger-populations-why-early-detection-is-critical