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Dr. Tucker is a therapeutic optometrist at the Contact Lens Institute of Houston and Bellaire Family Eye Care in Bellaire, Texas

Videos

Ashley Wallace Tucker, OD, FAAO, FSLS, Dipl ABO, weighs in on what's on the horizon for pediatric myopia management, and provides some tips for diving into scleral lens fitting.

New developments in myopia management and tackling scleral lens fittings with Dr. Wallace Tucker

Prominent legislation includes the Corporate Transparency Act and last year's spending bill provision that was struck down.

AOA's recent legislative efforts and how to get involved with Dr Steven Reed

Articles

The agent class’s pleiotropic effects should keep optometrists vigilant.

How do GLP-1 receptor agonists affect ocular health?

Shan Lin, MD, outlines a new generation of minimally invasive glaucoma surgeries (MIGS) at Glaucoma 360.

G360 2025: The newest in MIGS and what it means for comanagement

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Effective communication is imperative for patient adherence, it increases patient outcomes, and it reduces malpractice risks.

How to overcome cultural barriers for effective patient communication

How culture plays a role in patient communications

In 2023, we made the decision to do better for our patients who have diabetes by integrating electroretinography (ERG) in our 5 clinics. We viewed the investment as a necessary step in elevating the level of care we provide. Before adding ERG, our functional assessments were subjective and relied on patient performance and feedback, leaving room for error and poor or unreliable data. We were drawn to a handheld device because it is practical and provides objective, actionable information. After performing 1,500 tests, we discovered that it is useful across multiple pathologies, including optic neuritis.

Our ERG protocol has evolved. We began by making the decision to obtain a diabetic retinopathy (DR) score on every patient who has diabetes. The goal was to test these patients annually or more often depending upon the level of severity or presence of retinopathy.This protocol applies whether the patient has diabetic retinopathy or is newly diagnosed with diabetes. The goal for us is to obtain a baseline exam.We make it standard of care in our practice because we believe it is in the best interest of our patients.

In addition to utilizing the DR score, we routinely use the RET

 device’s photopic negative response (PhNR) protocol to measure ganglion function and aid and support diagnosis, management, and treatment of optic nerve neuropathies, including glaucoma. Finally, we now also perform the Flicker 16 protocol on all macular pathologies, including drusen.

 device is the portability. In our clinics, we see a relatively high volume of patients, which means we don’t have the luxury of slowing down. Space is also a concern. Many of our instruments take up a full workup testing room. For example, our other subjective test—the visual field—needs to be carefully orchestrated because we can accommodate only 1 patient in the room at a time. This portable electroretinography (ERG) device can be used in the exam room after the workup, which works seamlessly with our general flow.

Optic neuritis case report: Patient history

An established patient presented for a comprehensive exam in 2023. This 70-year-old white female had a family history of diabetes, hypertension, and cancer. She was also positive for multiple sclerosis, thyroid dysfunction, and high cholesterol. More than 10 years ago, she had an episode of optic neuritis in her left eye. Interestingly, relative to her multiple sclerosis, she says she was told that she no longer needed treatment, nor did she need to be seen by neurology. This concerned us given what the Optic Neuritis Treatment Trial tells us about the high likelihood of recurrence in optic neuritis in patients with a history of diagnosis of multiple sclerosis.

The patient’s best corrected vision in the left eye was hand motion. Her vision in the right eye was 20/20. She had mentioned previously that she had a family history of legal blindness, which was somewhat poorly defined; she mentioned glaucoma, cataracts, and degenerative disorders of the macula.

The fundus exam showed asymmetry of the optic nerves in terms of pallor (OS>OD) as well as mild cupping and drusen in both eyes (

). We performed visual field testing, but the patient routinely failed the visual field testing based on high fixation losses, which greatly underscores the value of an objective functional test.The best visual field index we had seen was 21%.
Optical coherence tomography (OCT) showed mild drusen and macular thickening OD and poor fixation and a significant epiretinal membrane OS (

). Given the patient’s inability to focus on a target straight ahead due to poor vision, even our OCT findings were limited. Fortunately, at this more recent visit, we were able to perform a baseline ERG. We thought this would be helpful for a couple of different reasons. First, due to the history of optic neuritis, we wanted to be able to have a functional assessment of the retina comparing the right eye to the left eye. Also, because the patient has a macular pathology (drusen), we want to be ultra protective of the vision in the right eye. We had recently instituted a drusen protocol that prompted the technician to proceed with a Flicker 16 test. Although this was not the most useful protocol (PhNR is preferred in this case), it helped provide clarification given the difficulty we were having capturing actionable detail using other tests.

) show the right eye implicit time and amplitude are within normal limits. The left eye implicit time is significantly outside normal limits and the amplitude is reduced. These results indicate the presence of cellular stress due to a retinal pathology.

We are now seeing this patient more frequently to monitor drusen and optic neuritis recurrence. She is scheduled back in 6 months, at which time we will perform the PhNR test. We also advised the patient to use an AREDS supplement. We also encouraged the patient to continue to see neurology, but if she does not, at least we are doing what we can to fill that void.

Volpe NJ. The optic neuritis treatment trial: a definitive answer and profound impact with unexpected results. 

 2008;126(7):996-999. doi:10.1001/archopht.126.7.996

Pirko I, Blauwet LA, Lesnick TG, Weinshenker BG. The natural history of recurrent optic neuritis. 

. 2004;61(9):1401-1405. doi:10.1001/archneur.61.9.1401

Graves J, Balcer LJ. Eye disorders in patients with multiple sclerosis: natural history and management. 

. 2010;4:1409-1422. doi:10.2147/OPTH.S6383

Routine electroretinography use supports patient management

UK-based NHS eye patient servicer SpaMedica has announced a partnership with Vision Express to offer preregistration training placements for 150 aspiring optometrists.

 Trainees chosen for a placement will be able to shadow SpaMedica’s clinical teams and in-house optometrists as they treat patients with a variety of eye conditions, including cataracts and wet age-related macular degeneration, according to a news release.

“We know hospital placements for pre-reg optometrists can be difficult to secure due to limited availability, so we’re delighted to be working with Vision Express and The College of Optometrists to facilitate wider access to professional development and training opportunities,” said Tom Critchley, SpaMedica’s principal optometrist, in the release. “During their placements, our pre-reg trainees will gain a variety of practical skills, underpinned by theoretical modules that will help them throughout their careers.”

SpaMedica’s pre-reg training program will be run across its nationwide network of hospitals, with trainees taking part in the cataract pre- and postoperative clinics in addition to medical retina services. Trainees will also see the company’s theatre teams perform procedures including cataract removal and vitreo-retinal surgery. Placements will last for 2 and a half days with the opportunity to attend virtual clinics with patients.

After inspection conducted by the Care Quality Commission, SpaMedica’s hospitals have been rated as “good” or “outstanding,” with 98% of patients who have reviewed the provider on the NHS website has given SpaMedica a 5-star rating.

“SpaMedica has an excellent reputation in the optical sector and our partnership will ensure pre-reg optometrists are able to access high quality training and superivison in both community and hospital settings, meeting many of the competencies outlined in the Scheme for Registration,” said Dan McGhee, director of Professional Services for EssilorLuxottica Optical Retail UK and Ireland / Vision Express UK and Ireland, in the release.

Rafeh Rehman, the first pre-reg optometrist from Vision Express, recalls the welcome he received when he started his hospital placements at SpaMedica Manchester on February 4, 2025. “It was lovely to receive such a warm welcome and I’m looking forward to gaining valuable experience and expanding my skill set,” Rehman said in the release. “It will be really interesting to get an insight into hospital optometry and I’m grateful to both Vision Express and SpaMedica for helping me on my journey to becoming a registered optometrist, ensuring I’m able to deliver the highest standard of care to my patients.”

SpaMedica plans to welcome more pre-reg optometrists in the future.

SpaMedica launches pre-reg training program to support future generations of optometrists. News release. SpaMedica. February 11, 2025. Accessed February 12, 2025.

A total of 150 placements are for aspiring optometrists to shadow SpaMedica’s clinical teams and in-house optometrists as they treat patients.

SpaMedica partners with Vision Express, offering preregistration training placements

Envision Summit 2025: Jessica Steen on co-management

Jessica Steen, OD, FAAO, Nova Southeastern University College of Optometry, discussed the importance of co-managing glaucoma patients throughout their lifetime – emphasizing the selection of therapeutics based on mechanism of action, efficacy, and tolerability, and the strategic use of interventional therapies and surgical decision-making. Steen highlighted the necessity of collaboration between optometrists and ophthalmologists for effective patient care. She also expressed excitement about new therapeutics in clinical trials, including those for neurodegeneration and neuroprotection, which extend beyond intraocular pressure (IOP) reduction.

At the Envision Summit 2025 in San Juan, Puerto Rico, Jessica Steen, OD, FAAO talked with glaucoma surgeons on the importance of comanaging patients throughout their lifetime. 

Envision Summit 2025: Importance of comanagement in glaucoma treatment

Clinical stage biotechnology company Qlaris Bio announced positive topline results from 2 of its US Phase 2 clinical trials investigating QLS-111 in patients with primary open angle glaucoma (POAG) and ocular hypertension (OHT).

 Osprey and Apteryx, the masked, randomized Phase 2 trials, successfully met all primary and secondary endpoints, according to a news release.

“We are pleased with QLS-111’s performance in our Phase 2 Osprey and Apteryx trials,” said Thurein Htoo, CEO of Qlaris Bio, in the release. “These results with our novel preservative free formulation give us confidence that the selective targeting of episcleral venous pressure with QLS-111 has the potential to be a first-in-class therapeutic.”

The Osprey study (NCT06016972) assessed the safety, tolerability, and intraocular pressure (IOP)-lowering activity of QLS-111 in a range of doses compared to vehicle in 62 adult patients with POAG or OHT. The study found that the 0.015% concentration dosed once daily in the evening drove the greatest decrease in IOP, as seen in the mean reductions of 3.7 mmHg from mean diurnal baseline IOP of 23.0 mmHg.

As for the Apteryx study, safety, tolerability, and additive IOP-lowering efficacy of QLS-11 was assessed when dosed in addition to latanoprost compared to latanoprost alone. The study involved 32 patients 12 years old or older with POAG or OHT who were stable on latanoprost monotherapy. The patients’ mean diurnal baseline IOP with latanoprost monotherapy was 19.8 mmHg. QLS-111 0.015% dosed with latanoprost demonstrated additive mean IOP reductions when compared to latanoprost monotherapy, and achieved a 3.2 mmHg greater reduction for QLS-111 QPM dosing and 3.6 mmHg greater reduction for QLS-111 twice daily dosing.

“The data show QLS-111’s synergistic ability to provide significant IOP lowering in patients already on latanoprost,” said Barbara Wirostko, MD, FARVO, chief medical officer at Qlaris Bio, in the release. “This substantial additive effect demonstrates the potential to significantly benefit patients who do not achieve IOP lowering goals with current therapies. Additionally, we believe the promising tolerability profile of QLS-111 will further enhance the value to our patients by driving improved treatment compliance and adherence. This is supported by the absence of clinically relevant hyperemia, with no corneal changes and no clinically relevant ocular or systemic findings thus far in our studies.”

Additionally, all QLS-11 concentrations and dose regimens in both studies “demonstrated excellent safety and tolerability,” according to Qlaris Bio. No serious adverse events were reported, with investigators also not finding any other ocular or systemic adverse events. Additionally, no incremental hyperemia was observed when QLS-111 0.015% was added to latanoprost.

“The QLS-111 Phase 2 data are quite promising and indicative of an innovative therapy,” said Ike Ahmed, MD, FRCSC, director of the Alan S. Crandall Center for Glaucoma Innovation at the Moran Eye Center, University of Utah, in the release. “Along with its attractive safety profile, the potential of QLS-111 to surpass the additive efficacy of other glaucoma medications when used with latanoprost, means patients can remain on a drug that can achieve better IOP control. The robust results of the Osprey and Apteryx trials give me confidence that our patients may soon have an important new treatment option that targets this clear unmet need. Furthermore, the possibility of combining QLS-111 with trabecular meshwork MIGS procedures to address downstream resistance may unlock potential of these procedures.”

Qlaris Bio will be presenting a corporate update at the Glaucoma 360 New Horizons Forum 2025 on February 7 in San Francisco, California.

Qlaris Bio announces positive topline data from 2 Phase 2 trials of QLS-111 in patients with primary open angle glaucoma and ocular hypertension. News release. Qlaris Bio. February 5, 2025. Accessed February 5, 2025. 

https://qlaris.bio/qlaris-bio-announces-positive-topline-data-from-two-phase-ii-trials-of-qls-111-in-patients-with-primary-open-angle-glaucoma-and-ocular-hypertension/

All QLS-111 concentrations and dose regimens in both Osprey and Apteryx trials “demonstrated excellent safety and tolerability,” according to the company.

Positive topline results from Qlaris Bio Phase 2 clinical trials find QLS-111 demonstrates IOP-lowering activity in patients with POAG, OHT

CooperVision presented new contact lens research in 2 scientific poster presentations at the 2025 Global Contact Len Symposium (GSLS), which ran from January 15-18 in Las Vegas, Nevada.

 The posters presented research conducted on the optical design used in MyDay Energys and Biofinity Energys brands for digital device users, in addition to CooperVision’s Binocular Progressive System for presbyopes utilized in the MyDay and clariti 1 day product families, according to a news release.

“While we conduct and support a sizable range of foundational studies every year, we also prioritize research that helps eye care professionals (ECPs) have a deeper understanding of how the contact lenses they fit everyday work in practice on their patients. This helps support confidence among prescribers, ideal patient experiences, and practice success. It’s the type of practical scientific evidence that the profession has come to expect from a partner like CooperVision,” said Francis Erard, CooperVision’s vice president of Research & Development, in the release.

In the poster “Influence of Pupil Size on Vision Performance and Visual Satisfaction with a Daily Disposable Multifocal Contact Lens System,” 45 participants with varied pupil sizes (2.3 mm at 250cd/m2 to 6.6 mm at 2.5cd/m2) were fit into MyDay daily disposable multifocal contact lenses, also outfitted with the Binocular Progressive System.

 Distance binocular high contrast visual acuity (BHCVA) under high and low illumination, distance binocular low contract visual acuity (BLCVA) measured under high illumination, near BHCVA and near BHLCA under medium illumination, and subjective vision satisfaction scores at distance and near were all measured in the clinical study.

No significant correlations were found between visual acuity and pupil size across varying degrees of distance, contrast, and luminance. Correlations were either weak or very weak between vision metrics, including visual acuity and vision satisfaction, and pupil size, in every environmental condition.

 Thus, the Binocular Progression System effectively corrects for presbyopia independent of pupil size, which supports MyDay multifocal and clariti 1 day multifocal as an option for eye care providers to fit with a wide variety of patients, according to the release.

Additionally, the “Comparison of Axial Eye Growth in Children Undergoing Orthokeratology to Myopic Eye Growth” poster presented analysis of real world retrospective axial length (AL) data from 429 patients 6-19 years old who wore overnight orthokeratology contact lenses (Paragon CRT 100 and Paragon CRT Dual Axis). Data for the study was collected from the Berkeley Myopia Control Clinic between 2008 and 2023.

 Analysis of said data found eye growth among patients was slower than expected if left untreated, with rates approximately half compared to anticipated progression of adolescent eyes (11-18 years old) and slightly greater than 50% in younger eyes (6-10 years old). Lens treatment effects were similar between the Paragon CRT 100 and Paragon CRT Dual Axis.

“The caliber of eye care is constantly increasing around the globe, as are expectations among patients and ECPs alike. CooperVision believes that reinforcing everyday clinical decisions with sound evidence will continue to become more critical, and why we are dedicated to advancing ocular science through the research we conduct and support though our partnerships,” said Erard in the release.

GSLS 2025 posters highlight CooperVision major scientific breakthroughs. News release. CooperVision. January 15, 2025. Accessed January 28, 2025. https://coopervision.com/our-company/news-center/press-release/gsls-2025-posters-highlight-coopervision-major-scientific

Two posters presented research conducted on the optical design used in MyDay Energys and Biofinity Energys.

CooperVision presents new research findings on contact lenses at GSLS 2025

Currently, one-third of children and adolescents worldwide have myopia, with the prevalence expected to dramatically increase by the year 2050.

 Although our profession has made significant strides in progressing myopia management toward standard of care, optometrists still face challenges implementing myopia management into everyday clinical practice. Parents are often skeptical about what they may perceive as a novel approach to myopia, may have cost concerns, or even be fearful of potential adverse effects that contact lenses or eye drops may have on their child. To make the most impact on our concerted fight against myopia, we need a plethora of options to accommodate each type of patient, refractive error, and budget. This article will highlight the future of myopia management and what options are on the horizon.

Currently, the most widely accepted eye drop for myopia management is atropine, a nonselective muscarinic antagonist. Although the exact mechanism of action is unknown, the leading hypothesis is that atropine targets muscarinic and nonmuscarinic receptors in the retina and sclera, limiting their thinning and ultimately retarding axial elongation.

 Clinically, atropine is being used off label, but findings from the LAMP trial have shown 0.05% atropine to be more effective than 0.025% and 0.01% when controlling myopia progression. In addition, all concentrations resulted in minimal adverse effects.

 Despite findings from clinical trials supporting safety and efficacy of atropine, many parents are still leery of using a non–FDA-approved pharmaceutical agent for their child. Thus, there have been significant efforts in our industry to get an FDA-approved formulation to market.

Sydnexis’ SYD-101 is a patented atropine formulation containing a unique ingredient that stabilizes atropine to near physiologic pH. To prevent rapid degradation of atropine, most water-based formulations are dropped below pH 5, which is very acidic and consequently uncomfortable for the user and decreases bioavailability. On the contrary, SYD-101 is specially designed to maximize comfort, stability, and efficacy.

 Currently, SYD-101 (0.01% and 0.03% atropine) is in an ongoing phase 3 clinical trial (STAR; NCT03918915) with more than 850 participants enrolled, with an expected completion date in 2025.

Vyluma’s Childhood Atropine for Myopia Progression (CHAMP; NCT03350620) trial tested the efficacy of NVK002, their preservative-free, low-dose atropine formulation (0.01% and 0.02%). CHAMP was a multicenter, international trial that enrolled 576 children with myopia over a 4-year period. Results showed 0.01% atropine was associated with slower myopic progression and axial elongation when compared with placebo. In addition, it exhibited a strong safety profile and no significant rebound effect, proving NVK002 as a potential treatment for childhood myopia.

 Currently, Vyluma is in discussion with the FDA to address their questions about Vyluma’s trial and their atropine formulation in hopes of forging a path forward.

Eyenovia’s phase 3 CHAPERONE trial (NCT03942419) tested MicroPine low-dose atropine (0.1% and 0.01%) with their proprietary Optejet dispensing platform. This was a US-based, multicenter trial that evaluated 252 children with myopia over 4 years. The drug was well tolerated by the participants; however, the rate of myopic progression was unfortunately not significantly different between the 2 treatment arms and the placebo arm. Because the study did not meet its primary end point of less than 0.5 D of progression over 3 years, Eyenovia decided to terminate the trial as of November 2024.

 However, the company is now more thoroughly reviewing the data and evaluating next possible steps.

iVeena’s IVMED-85 is an experimental topical eye drop containing copper used twice daily to slow myopia progression. Copper is a cofactor for lysyl oxidase (LOX). The proposed mechanism of action is to increase LOX, which is the enzyme that mediates collagen cross-linking in both the sclera and cornea. IVMED-85, theoretically, should increase LOX activity and result in corneal flattening, scleral stiffening, and axial elongation reduction.

 In October 2023, iVeena Delivery Systems was awarded a National Eye Institute Phase 1 Small Business Research Grant for IVMED-85. For now, we are currently awaiting further information on their first human clinical trials.

Likely the most anticipated addition to comprehensive myopia management is an FDA-approved spectacle option. Although several lenses are in the pipeline, none are currently available in the US market.

Essilor’s Stellest lenses employ highly aspherical lenslet target (HALT) technology. The lens consists of 1021 invisible lenslets strategically arranged on 11 rings. This design creates a volume of myopic defocus in the peripheral retina. The clinical trial results reveal the Stellest lenses save 1.75 D of myopia over a 5-year period, providing conclusive evidence in its ability to slow myopia progression.

 Recently, they became available in several sun tints, with expanded parameters on the horizon for non-US markets.

HOYA’s MiYOSMART lenses use “defocus incorporated multiple segments” technology. The lens consists of a clear 9-mm central optic zone surrounded by several segments of +3.50 D arranged in a honeycomb-like pattern, creating peripheral blur. Findings from the 2-year clinical trial concluded that children wearing the MiYOSMART lenses had 60% less myopia progression when compared with children wearing single-vision lenses.

 This study is ongoing and is the longest running myopia control spectacle lens study to date. MiYOSMART lenses are also available in photochromics and polarized sun tints in 30 countries but are not yet available in the US.

SightGlass Vision lenses use the Diffusion Optics Technology (DOT) design, which consists of a clear, central optic zone surrounded by thousands of light-scattering microdots, which mimic natural light settings. These lenses slow myopia progression by scattering the light before it reaches the retina, which, in turn, interrupts the signal for axial elongation. The 2-year pivotal CYPRESS trial (NCT04947735) results showed 59% reduction in myopia progression for participants wearing the DOT lenses full-time vs those wearing single-vision lenses.

 In addition, the 4-year data echoed the 2-year data, showing statistically significant slowing of axial elongation and cycloplegic spherical equivalent refraction.

 In February 2024, SightGlass received Breakthrough Device designation from the FDA, which is reserved for “highly innovative devices that provide more effective treatment or diagnosis of life-threatening or irreversibly debilitating human disease or conditions.”

 This allows for more frequent FDA feedback during the premarket review phase along with prioritized submission review.

Currently, CooperVision’s MiSight 1 Day is the only FDA-approved myopia control option. MiSight is a dual-focus lens consisting of 2 correction zones for the correction of the patient’s refractive error and 2 treatment zones consisting of 2 D of defocus. In findings from their landmark 7-year clinical trial, MiSight slowed myopia progression and axial elongation by an average of 59% and 57%, respectively, in children aged 8 to 12 years at the initiation of treatment. After 6 years, approximately 25% of patients showed minimal to no progression, and after 7 years, there was no rebound effect after lens cessation.

Visioneering Technologies has an ongoing clinical trial, Progressive Myopia Treatment Evaluation for NaturalVue Multifocal Contact Lens Trial (PROTECT; NCT05159765), evaluating the effectiveness of NaturalVue Multifocal in managing myopia progression in children. NaturalVue Multifocal is a daily, disposable, center-distance, extended depth-of-focus design. The 1-year results are promising, with adjusted outcomes of 89% reduction in myopia progression and 58% reduction in axial elongation when compared with single-vision lens wearers. Further insights into the long-term impacts of this lens design will be revealed in the 2- and 3-year data.

Johnson & Johnson Vision’s Abiliti 1-Day Soft Therapeutic Lenses for Myopia Management are silicone hydrogel lenses designed with RingBoost technology. These lenses create a ring of focus that is formed in front of the retina and around the visual axis, theoretically allowing more treatment power to be engineered into the lens design. Their 6-month pilot study comparing ACUVUE OASYS, a dual-focus design on OASYS material, with Abiliti 1-Day resulted in Abiliti 1-Day providing the least amount of axial elongation. More studies are underway as we anticipate more long-term data findings.

Repeated low-level red light (RLRL) therapy has recently gained attention as a potential treatment for myopia progression. The exact mechanism of action is not yet well understood, but the leading hypothesis is that red light can prevent structural changes in both the retina and choroid and reduce scleral hypoxia seen in patients with myopia, both of which could prevent myopia onset and reduce progression.

 RLRL therapy consists of foveal exposure to long-wavelength red light (635-650 nm) for 3 minutes twice daily. Although RLRL appears to be an attractive, simple option for myopia management, serious safety concerns have been raised, including the long-term impacts of red-light exposure. Findings from a recent study found that during the 3-minute sessions, 2 different RLRL devices approached or surpassed their thermal and photochemical maximum permissible exposure, putting the retina at significant risk for irreversible damage.

 Findings from this study highlight the urgent need for further research into the particular area of myopia management before implementing into clinical practice.

Dopavision’s MyopiaX is an innovative smartphone application that provides noninvasive, nonpharmaceutical treatment to the eye to slow myopia progression. Although children are engaging in fun virtual reality or educational content, the app administers patented blue light to the optic nerve head, activating a network of cells in the retina and increasing dopamine release. Dopamine is a neurotransmitter proven to inhibit axial elongation and myopia progression. Dopavision’s MyopiaX-1 randomized, controlled clinical trial (NCT04967287) is being conducted across 6 European countries with 124 children with myopia and is currently ongoing. The 6-month data released in October 2024 showed promising results of positive clinical effects on myopia progression and no ocular safety events.

 Completion of the MyopiaX-1 trial will provide further insights and allow for future clinical trials and further development of MyopiaX.

NovaSight’s TrackSight, an application capable of running on a laptop, tablet, or smartphone, uses the in-device camera to track eye movements. It is intended to be used by both children and young adults. Although the individual is using the app, reduction in myopia progression is achieved by real-time peripheral blur on their screen. Unlike spectacles, which offer static peripheral blur optics, this app tracks eye movements and creates custom-tailored contrast degradation depending on the location of the eyes. This allows for natural eye movements and uninterrupted on-axis acuity during the user’s experience. NovaSight is currently planning a feasibility trial to evaluate the immediate response on choroidal thickness, which would then be followed by a 12-month pilot study.

Because the number of patients with myopia will continue to increase, so should our number of options to help mitigate this worsening issue. As we await the exciting future of myopia management, be diligent about capitalizing on the options we currently have available, both on- and off-label.

Liang J, Pu Y, Chen J, et al. Global prevalence, trend and projection of myopia in children and adolescents from 1990 to 2050: a comprehensive systematic review and meta-analysis. 

. 2024;bjo-2024-325427. doi:10.1136/bjo-2024-325427

Upadhyay A, Beuerman RW. Biological mechanisms of atropine control of myopia. 

. 2020;46(3):129-135. doi:10.1097/ICL.0000000000000677

Yam JC, Zhang XJ, Zhang Y, et al. Three-year clinical trial of Low-Concentration Atropine for Myopia Progression (LAMP) study: continued versus washout: phase 3 report. 

. 2022;129(3):308-321. doi:10.1016/j.ophtha.2021.10.002

Safe and effective low-dose atropine can be stable and comfortable too. Review of Myopia Management

 August 15, 2023. Accessed January 8, 2025. https://reviewofmm.com/sydnexis-low-dose-atropine-formulation-can-be-stable-and-comfortable-too/

The safety and efficacy of SYD-101 in children with myopia (STAR). ClinicalTrials.gov. Updated February 15, 2024. Accessed January 8, 2025. https://clinicaltrials.gov/study/NCT03918915

Zadnik K, Schulman E, Flitcroft I, et al; CHAMP Trial Group Investigators. Efficacy and safety of 0.01% and 0.02% atropine for the treatment of pediatric myopia progression over 3 years: a randomized clinical trial. 

. 2023;141(10):990-999. doi:10.1001/jamaophthalmol.2023.2097

Eyenovia provides update on phase 3 CHAPERONE study. News release. Eyenovia. November 15, 2024. Accessed January 8, 2025. https://eyenoviabio.gcs-web.com/news-releases/news-release-details/eyenovia-provides-update-phase-3-chaperone-study

Ambati B, Molokhia S. Advancing myopia therapy with IVMED-85. Review of Myopia Management

October 15, 2021. Accessed January 8, 2025. https://reviewofmm.com/advancing-myopia-therapy-with-ivmed-85/

iVeena awarded NEI-SBIR grant for progressive myopia drug candidate IVMED-85. News release. iVeena. October 26, 2023. Accessed January 8, 2025. https://iveenamed.com/news/item/84-iveena-awarded-nei-sbir-grant-for-progressive-myopia-drug-candidate-ivmed-85

Li X, Huang Y, Liu C, et al. Myopia control efficacy of spectacle lenses with highly aspherical lenslets: results of a 5-year follow-up study. Presented at: Association for Research in Vision and Ophthalmology Annual Meeting; May 5-9, 2024; Seattle, WA.

Lam CSY, Tang WC, Tse DYY, et al. Defocus incorporated multiple segments (DIMS) spectacle lenses slow myopia progression: a 2-year randomised clinical trial. 

. 2020;104(3):363-368. doi:10.1136/bjophthalmol-2018-313739

From eye drops to novel treatments, it’s time to assess all options for improving patients’ visual acuity.

Janette Pepper, OD, FCOVD

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