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To compare refractive and visual outcomes between robotic laser-assisted arcuate keratotomy (AK) guided by the Wörtz-Gupta Formula and low-power toric intraocular lens (IOL) implantation using the Barrett Toric Calculator for the management of low-magnitude regular corneal astigmatism during cataract surgery. This retrospective, single-surgeon case series included 105 eyes with robotic laser-assisted AK using the ALLY platform with iris registration (LENSAR, Inc, Orlando, FL), and 53 received a toric IOL, using ALLY's IntelliAxis refractive capsulorhexis for intraoperative toric IOL alignment. The primary outcome measure was postoperative residual refractive cylinder at postoperative week 4. Secondary outcomes included uncorrected distance visual acuity (UDVA), best-corrected distance visual acuity (CDVA), and spherical equivalent (SE) refraction. Subgroup analyses evaluated outcomes by astigmatism orientation (with-the-rule [WTR] versus against-the-rule [ATR]). Postoperative residual refractive cylinder did not differ significantly between groups (-0.14 ± 0.16 D AK vs -0.21 ± 0.28 D toric, = 0.103), nor did SE refraction (-0.08 ± 0.32 D AK versus -0.11 ± 0.28 D toric, = 0.361), UDVA (0.05 ± 0.08 logMAR both groups, = 0.507), or CDVA (-0.006 logMAR AK versus -0.004 logMAR toric, = 0.623). More than 90% of eyes in both cohorts achieved ≤0.50 D of residual astigmatism, and ≥87% attained UDVA of 20/25 or better. Subgroup analyses by astigmatism orientation showed no statistically significant differences in residual cylinder, SE, or VA. In eyes with low-magnitude regular corneal astigmatism undergoing cataract surgery, robotic laser-assisted AK guided by the Wörtz-Gupta Formula achieved non-infereior refractive and visual outcomes to those of low-power toric IOL implantation.

To evaluate the safety and efficacy of lotilaner ophthalmic solution, 0.25% compared with vehicle in blepharitis patients with meibomian gland disease. This was a pooled analysis of two prospective, randomized, double-masked studies of blepharitis patients with meibomian gland disease, Ersa (N=39), and Rhea (N=40). The two studies had the same design, eligibility criteria, and sample size, except Ersa studied lotilaner ophthalmic solution, 0.25% while Rhea studied the associated vehicle. Study outcomes were collarette grading, meibomian gland secretion score (MGSS), number of glands yielding any liquid secretions (MGYLS), number of glands yielding clear liquid secretions (MGYCLS), patient-reported outcomes, and adverse events (AEs). On Days 43 and 85, there was a statistically significantly higher proportion of patients in the lotilaner group versus the vehicle group with collarette reduction to grade 0 (0-2 collarettes/lid) (44.7% vs 0.0% and 65.8% vs 0.0%) and grade 0 or 1 (0-10 collarettes/lid) (81.6% vs 8.8% and 100% vs 0.0%) (all p<0.001). Mean MGSS, MGYLS, and MGYCLS in the lotilaner group were statistically significantly higher than in the vehicle group. The proportion of lotilaner patients achieving improvement to ≥ 3 glands with clear meibum (grade 3) was significantly higher than the vehicle group on Day 43 (44.7% vs 17.6%, p<0.05) and Day 85 (78.9% vs 18.2%, p<0.001). At Days 43 and 85, fluctuating vision, itching, burning, and redness were significantly better in the lotilaner group than in the vehicle group. No serious treatment-related AEs were reported. In patients with blepharitis and meibomian gland disease, lotilaner ophthalmic solution, 0.25% demonstrated statistically significant improvements in collarette reduction, meibomian gland function, and patient-reported outcomes at 6 and 12 weeks compared to baseline. Following lotilaner treatment, these parameters were also significantly better than vehicle at 6 and 12 weeks, with a similar safety profile.

Dry eye disease (DED) is a prevalent ocular surface disease. Like with any chronic disease, patients with DED can experience episodic flares. There are many existing and upcoming treatments for the chronic treatment of DED, yet treatments for DED flares are limited. Loteprednol etabonate 0.25% is an FDA approved treatment modality for the short-term treatment of the signs and symptoms of DED. This medication is formulated with the customized mucus-penetrating particle (MPP) technology, which has a greater ability to penetrate the ocular surface and more effectively deliver the active steroid to the ocular surface tissues as compared with conventional steroid preparations. There is also increasing utility of loteprednol etabonate 0.25% in the treatment of DED before and/or after cataract or refractive surgery or as induction therapy prior to starting chronic immunomodulatory medication for DED.

Dry eye disease (DED) is a common, multifactorial ocular disease impacting 5% to 20% of people in Western countries and 45% to 70% in Asian countries. Despite the prevalence of DED and the number of treatment approaches available, signs and symptoms of the disease continue to limit the quality of life for many patients. Standard over-the-counter treatment approaches and behavior/environmental modifications may help some cases but more persistent forms often require pharmacological interventions. Approved and investigational pharmaceutical approaches attempt to treat the signs and symptoms of DED in different ways and tend to have varying tolerability among patients. While several pharmacological approaches are the standard for persistent and severe disease, mechanical options provide alternate treatment modalities that attempt to balance efficacy and comfort. Newer approaches target the causes of DED, utilizing novel delivery methods to minimize irritation and adverse events. Here, we review approved and investigational approaches to treating DED and compare patient tolerability.

To evaluate the impact of TearCare (TC) treatment on clinical, quality of life, and functional visual outcome metrics in patients with dry eye disease (DED) and meibomian gland disease (MGD). This is a prospective, single-center clinical trial. Adults with MGD and a DED diagnosis and tear break-up time (TBUT) <10 seconds were included. All subjects had at least 20/40 vision and no surgery or new treatment for DED within 60 days prior to enrollment. All patients had one baseline visit prior to undergoing TC and one follow-up visit 1 month after TC. At each visit, the meibomian gland secretion score (MGSS), TBUT, and corneal fluorescein staining (KFL) were assessed. DED symptoms were evaluated using the Ocular Surface Disease Index (OSDI) questionnaire, Visual Function Questionnaire 25 (VFQ-25), and the Fatigue Severity Scale. Reading speed was determined through the International Reading Speed Texts (IReST), Minnesota Low Vision Reading Test (MNREAD), and Wilkins Rate of Reading Test (WRRT). Thirty-two subjects were included. The average age was 55.9 years. Sixteen (52%) participants had a clinically significant improvement in reading speed after treatment with TC, defined as >10 words per minute increase in their IReST score. Improvement on the IReST and the MNREAD reached statistical significance (p = 0.012 and p = 0.028, respectively). OSDI scores significantly decreased and VFQ-25 scores significantly increased after TC treatment (p < 0.001). All of the clinical exam parameters showed statistically significant improvements after treatment (p < 0.001). TC is an effective treatment both clinically and with respect to visual function. Patients who had TC exhibited improvements in quality of life and improved reading speed after a single treatment. This treatment should be frequently considered and utilized to reduce the disease burden of DED related to MGD.

Inflammation and pain are two prevalent findings after ocular surgery. Corticosteroids are widely administrated as a core treatment to control post-surgical inflammation and pain. Improper patient adherence to post-operative eye drop regimens, limited bioavailability of topical eye drops, and the negative impact of preservatives used in many of these eye drops, has made a strong case for novel therapies in the treatment of post-operative pain and inflammation. This review of the literature will focus on the role of intracanalicular sustained-release dexamethasone (Dextenza, Ocular Therapeutix, Bedford, MA, USA) for the management of ocular inflammation and pain.

Background Twelve ocular surface disease experts convened to achieve consensus about Demodex blepharitis (DB) using a modified Delphi panel process. Methods Online surveys were administered using scaled, open-ended, true/false, and multiple-choice questions. Consensus for questions using a 1 to 9 Likert scale was predefined as median scores of 7–9 and 1–3. For other question types, consensus was achieved when 8 of 12 panellists agreed. Questions were randomized, and results of each survey informed the following survey. Results Twelve practitioners comprised the D emodex E xpert P anel on T reatment and Eyelid H ealth (DEPTH). Following 3 surveys, experts agreed that DB is chronic ( n  = 11) and recurrent ( n  = 12) and is often misdiagnosed. Consensus was achieved regarding inflammation driving symptoms (median = 7; range 7–9), collarettes as the most common sign ( n  = 10) and pathognomonic for DB (median = 9; range 8–9), and itching as the most common symptom ( n  = 12). Panellists agreed that DB may be diagnosed based on collarettes, mites, and/or patient symptoms ( n  = 10) and felt that patients unresponsive to typical therapies should be evaluated for DB ( n  = 12). Consensus about the most effective currently available OTC treatment was not reached. Conclusions The Delphi methodology proved effective in establishing consensus about DB, including signs, symptoms, and diagnosis. Consensus was not reached about the best treatment or how to grade severity. With increased awareness, eyecare practitioners can offer DB patients better clinical outcomes. A follow-up Delphi panel is planned to obtain further consensus surrounding DB treatment.

The tear film, which includes mucins that adhere to foreign particles, rapidly clears allergens and pathogens from the ocular surface, protecting the underlying tissues. However, the tear film’s ability to efficiently remove foreign particles during blinking can also pose challenges for topical drug delivery, as traditional eye drops (solutions and suspensions) are cleared from the ocular surface before the drug can penetrate into the conjunctival and corneal epithelium. In the past 15 years, there has been an increase in the development of nanoparticles with specialized coatings that have reduced affinity to mucins and are small enough in size to pass through the mucus barrier. These mucus-penetrating particles (MPPs) have been shown to efficiently penetrate the mucus barrier and reach the ocular surface tissues. Dry eye disease (DED) is a common inflammatory ocular surface disorder that often presents with periodic flares (exacerbations). However, currently approved immunomodulatory treatments for DED are intended for long-term use. Thus, there is a need for effective short-term treatments that can address intermittent flares of DED. Loteprednol etabonate, an ocular corticosteroid, was engineered to break down rapidly after administration to the ocular surface tissues and thereby reduce risks associated with other topical steroids. KPI-121 is an ophthalmic suspension that uses the MPP technology to deliver loteprednol etabonate more efficiently to the ocular tissues, achieving in animal models a 3.6-fold greater penetration of loteprednol etabonate to the cornea than traditional loteprednol etabonate ophthalmic suspensions. In clinical trials, short-term treatment with KPI-121 0.25% significantly reduced signs and symptoms of DED compared with its vehicle (placebo). Recently approved KPI-121 0.25%, with its novel drug delivery design and ease of use, has the potential to effectively treat periodic flares of DED experienced by many patients.

blepharitis is an ocular disorder caused by the infestation of mites that reside on the eyelash follicles. This study assessed the clinical, humanistic, and economic burden of blepharitis from a patient perspective. This cross-sectional, observational study used a web-enabled survey to collect data from US adults with blepharitis in 2022. Patients with unique burdens, including those receiving dry eye disease medications, wearing contact lenses, or experiencing cataracts or glaucoma were also examined. Among 113 patients, mean age was 48.5 years (standard deviation [SD] ± 13.6). Half had private/commercial insurance, and 55% had Medicare and/or Medicaid. Patients had blepharitis for an average of 4.3 years (SD ± 6.7 years) before the study, and 1.2 years (SD ± 3.0 years) elapsed between the appearance of symptoms and diagnosis. Common symptoms, including redness, dryness, itchiness of the eyelids, and itchiness of the eyes, persisted or returned shortly after diagnosis and disease management in most patients, and they were associated with a negative impact on quality of life. Patients visited their healthcare practitioner for blepharitis a mean of 3.9 times (SD ± 4.8) in the preceding year. Patients were often managed with off-label prescription medications, such as medications indicated for dry eye disease, in-office procedures, or over-the-counter management options. Patients with blepharitis reported symptoms impacting their quality of life and activities of daily living, which persisted after diagnosis and disease management. This suggested that the effectiveness of the reported symptom management options was temporary and highlighted an unmet need in treating the root cause of the disease. Patients with blepharitis were symptomatic, and the commonly used management options for blepharitis lacked long-term symptom relief or mite eradication, demonstrating a high unmet need in treating patients with blepharitis.

To report the prevalence of meibomian gland atrophy and gland tortuosity in patients presenting for refractive surgery evaluation. Cross-sectional study of consecutive patients presenting for refractive surgery evaluation at the Duke Eye Center from December 2018 through January 2020. All patients underwent clinical examination and meibography imaging (Lippiview II, Johnson and Johnson Vision, CA) of the lower eyelids bilaterally. Images were graded by a masked rater using a previously validated 5-point meiboscale (0-4) for gland atrophy and 3-point scale for gland tortuosity (0-2). Lipid layer thickness and partial blinks were also recorded. One hundred and twenty patients (49 male) aged 21 to 62 years (mean 35.2 ± 9.2 years) were reviewed. The mean meiboscale was 1.1 ± 1.0 and the mean tortuosity score was 1.0 ± 0.7. Among all patients, 72.5% (n = 87) had any evidence of meibomian gland atrophy (meiboscale >0) and 69.2% (n = 83) had any evidence of meibomian gland tortuosity (tortuosity grade ≥1). The majority of patients (n = 52) with gland atrophy had mild gland atrophy (meiboscale = 1). The mean meiboscale was 0.89 ±0.79 and 1.38 ±1.07 for those <35 years and >/= 35 years old, respectively (p = 0.01). There was a moderate positive relationship between meiboscale and tortuosity (Spearman's rho 0.3829, p <0.001). Meibomian gland atrophy is a common occurrence in patients presenting for refractive surgery evaluation. Clinicians should consider incorporating meibography as part of refractive surgery evaluation, and proactively treat meibomian gland disease given the known association between meibomian gland dysfunction, dry eye disease, and the potential for suboptimal post-operative outcomes.