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The diagnosis of acute infectious conjunctivitis can be difficult. Clinical ambiguity exists between the acute viral and bacterial as well as the allergic forms, which can confound diagnosis. Also, discrimination between viral or bacterial origins of infectious conjunctivitis based on historical, nonspecific, clinical signs and symptoms contributes to a high rate of misdiagnosis and overuse of antibiotic treatment. Therefore, in order to effectively treat acute infectious conjunctivitis, physicians must be aware of the clinical signs and symptoms and available diagnostic tests that can provide a more accurate differential diagnosis.

PurposeTo evaluate the impact of lotilaner ophthalmic solution, 0.25%, compared to vehicle, on disease severity in patients with Demodex blepharitis and meibomian gland disease.MethodsThis post-hoc analysis pooled data from two prospective, randomized, double-masked studies evaluating lotilaner ophthalmic solution, 0.25% (Ersa, N = 39) and vehicle (Rhea, N = 40) in Demodex blepharitis patients with meibomian gland disease. The study utilized a modified International Workshop on Meibomian Gland Dysfunction (IWMGD) severity scale, integrating meibomian gland secretion score (MGSS) and patient-reported visual analog scale for fluctuating vision (VASFLVIS), and categorized meibomian gland disease severity as Grade 1 (subclinical), Grade 2 (mild), Grade 3 (moderate), or Grade 4 (severe). The main outcome was changes in severity grades from baseline.ResultsAt baseline, meibomian gland disease severity was comparable between groups. At Day 43, 47% of lotilaner-treated patients achieved Grade ≤2 (mild or better), significantly greater than 21% of vehicle-treated patients (p = 0.02). At Day 85, the difference increased, with 63% in the lotilaner group achieving Grade ≤2 versus 24% in the vehicle group (p = 0.001). For grade improvement, at Day 43, 63% of lotilaner-treated patients versus 38% of vehicle-treated patients achieved ≥1 grade improvement (p = 0.035); and at Day 85, 74% versus 39%, respectively, achieved ≥1 grade improvement (p = 0.004). No serious treatment-related adverse events were observed.ConclusionLotilaner ophthalmic solution, 0.25% significantly improved meibomian gland disease severity in patients with Demodex blepharitis and concomitant meibomian gland disease at 6 and 12 weeks compared to vehicle.

Objectives To investigate the effect of adjunct micro-interventional pre-treatment for nucleus disassembly on the surgical efficiency of non-cavitating lensectomy during cataract surgery. Methods and analysis 12 surgeons performed 512 consecutive cataract extractions using a sonic cavitation-free lensectomy with or without adjunct pre-treatment for nucleus disassembly. There were 2 interventional arms including (1) lensectomy without adjunct pre-treatment and (2) lensectomy with micro-interventional miLOOP pre-treatment. Results Successful lensectomy was achieved in all eyes using cavitation-free sonic lensectomy. Average baseline cataract density was 2.28 and 2.39 in the three groups, respectively. Compared to no pre-treatment, nucleus evacuation time was 24% (p = < 0.001) faster with micro-interventional nucleus disassembly. Irrigation/aspiration (I/A) time was 14% faster with the micro-interventional pre-treatment (p = < 0.001). Irrigation fluid use was 24% less with micro-interventional. There was a low rate of capsular tear of 1 case across 512 cases with no other unanticipated complications. Conclusion Micro-interventional pre-treatment for nucleus disassembly was associated with improved lensectomy time and fluidic efficiency compared to no pre-treatment. Non-cavitating lensectomy with the miCOR lens pen achieved effective fragmentation and extraction in all grades of cataract.

Purpose. Evaluate safety and efficacy of topical lotilaner ophthalmic solution, 0.25% for the treatment of Demodex blepharitis. Patients and Methods. 15 patients with Demodex blepharitis, defined as >10 collarettes on the upper lid, lid margin erythema, and Demodex density of ≥1.5 mites/lash on microscopy, were treated bid for 28 days with lotilaner ophthalmic solution, 0.25%. Contact lens wear, artificial eyelashes, and lid structural abnormalities were among the exclusion criteria. No other antibacterial, antiparasitic, or anti-inflammatory treatment or lid hygiene products were permitted. Patients were assessed on Days 7, 14, 28, 60, and 90. Outcome measures were changes in collarette grade and mite density on Day 28. Adverse events and changes in intraocular pressure (IOP), corrected distance visual acuity (CDVA), and slit-lamp biomicroscopy were assessed. Results. Mean collarette grade (upper lids) improved from 3.07 ± 0.21 to 0.79 ± 0.19 on Day 28; the change was statistically significant for both upper and lower lids from Day 14 on. Mean mite density per lash decreased from 2.28 ± 0.16 at baseline to 0.14 ± 0.05 at Day 28 p<0.0001. Mite eradication (0 mites) was documented in 57.1% of eyes. The effects were durable through Day 90. There were no adverse events and little to no change in CDVA or IOP. The drop was well tolerated, with no discontinuations due to ocular irritation. Conclusion. Topical lotilaner ophthalmic solution, 0.25% for 4 weeks, showed promising efficacy for the treatment of Demodex blepharitis. This novel treatment appears to be safe and well tolerated. Randomized controlled studies are needed to confirm the results.

Background/aimsWith a paradigm shift in geographic atrophy (GA) treatments now available, establishing consensus on the identification and diagnosis of the disease along with considerations for management of patients with GA will assist eye care professionals (ECP) in their day-to-day practices, leading to improved patient outcomes.MethodsA modified Delphi panel process (Geographic Atrophy Management Consensus) consisting of three total surveys and one virtual live meeting held between survey 2 and survey 3. Data were collected from July to October 2022. Participants included expert members of the eye care community that have demonstrated outstanding leadership among peers: a steering committee with three ECPs and a 15-member panel divided between five optometrists, five comprehensive ophthalmologists and five retina specialists. Consensus on statements related to the management of patients with GA was calculated using the RAND/UCLA Appropriateness Method.ResultsAt the conclusion of the third survey, consensus was reached on 91% of the 77 statements. Critical consensus topics include: (1) optical coherence tomography as the favoured method to diagnose and monitor GA, (2) preferred practice patterns regarding referral of patients to retina specialists and (3) treatment criteria given the advent of emerging therapeutics for GA.ConclusionsGenerating awareness of early signs of disease development, progression and identifying the best tools to evaluate GA establishes ideal management and referral strategies. Given the paradigm shift in GA management driven by approved therapies, coupled with the fact that the disease is progressive resulting in devastating vision loss, these strategies are critical to ensure best overall outcomes.

To evaluate the prevalence of blepharitis by its pathognomonic sign, collarettes, in patients presenting for any reason to eye care clinics in the United States. In this retrospective study by 7 investigators at 6 eye care clinics, case records of consecutive patients who underwent a slit-lamp examination, regardless of chief complaint, were reviewed for blepharitis, as identified by the presence of collarettes. Patient characteristics, including age, gender, race, relevant ocular and systemic diagnoses, ocular medications, lid hygiene practices and contact lens wear, were also recorded. Of 1032 patients (mean age: 60.2 ± 17.8 years), 57.7% had blepharitis. While the prevalence of blepharitis in patients with dry eye disease (DED) (58.9%) and cataract (55.7%) was similar to the overall prevalence of blepharitis, it was higher in patients with blepharitis (69.1%) and glaucoma (64.8%). Among patients with collarettes, 44.0% had never been diagnosed with blepharitis. Among those on anti-inflammatory DED treatment, 60.0% had blepharitis. blepharitis prevalence was significantly higher among those using topical tea tree oil versus those who were not (74.5% versus 56.7% p = 0.014); prevalence was comparable among those using/not using lid wipes (56.9% versus 55.5%). blepharitis, based on the pathognomonic finding of collarettes, is common and likely underdiagnosed among patients seeking eye care. These collarettes are still found in patients using over-the-counter treatments for blepharitis. The present study highlights the importance of screening patients for collarettes and blepharitis as part of every slit-lamp examination.

To assess the effectiveness of cryopreserved amniotic membrane (CAM) after debridement in treating epithelial basement membrane dystrophy (EBMD) prior to cataract surgery. This pilot study included 2 treatment groups: a prospective study group of 9 subjects with significant EBMD who received debridement followed by self-retained CAM, and a retrospective, control group of 10 consecutive subjects who received debridement followed by a bandage contact lens (BCL). Slit-lamp photography after fluorescein staining were used to monitor healing. Corneal topography and IOL calculation were compared at baseline and 1 month after the procedure. Refraction and ocular surface stability were also compared after cataract surgery. Corneal reepithelialization after debridement occurred in 4.6 ± 0.8 days in the study group and 6.8 ± 0.6 days in the control (p < 0.05). Corneal topography showed changes in curvature from 43.5 ± 1.2D at baseline to 44.6 ± 1.2D at 1 month in the study group and from 45.0 ± 0.6D to 45.7 ± 0.8D in the control (p = 0.38). Average change in IOL calculation was 1.56 D in the study group, compared to 0.95 D in control (p = 0.29). Post-cataract refraction in both groups was within ±0.5 Diopter of the anticipated, and corneal surface remained stable without EBMD recurrence. Management of ocular surface disorders prior to cataract surgery stabilizes IOL calculation and reduces postoperative refractive surprises. CAM relatively accelerated healing after debridement; however, it was not better than BCL in stabilizing the ocular surface and improving visual outcome. The use of CAM in cases of EBMD remains speculative.

BackgroundTwelve ocular surface disease experts convened to achieve consensus about Demodex blepharitis (DB) using a modified Delphi panel process.MethodsOnline 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.ResultsTwelve practitioners comprised the DemodexExpert Panel on Treatment and Eyelid Health (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.ConclusionsThe 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.