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A survey collected demographic data, ocular and medical history, and responses assessing knowledge of glaucoma and cataracts in the Qassim region of Saudi Arabia.

Saudi Arabian study finds knowledge gaps in public understanding of glaucoma and cataracts

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Rachelle Lin, OD, MS, FAAO, details her presentation on inherited retinal diseases at CRU 2025.

Emerging opportunities in inherited retinal diseases

One of Rachelle Lin's, OD, MS, FAAO, presentations at CRU 2025 focuses on the evolving landscape of inherited retinal diseases (IRDs) in optometry, highlighting significant advancements in genetic understanding and treatment. In 2017, a groundbreaking moment occurred with the first FDA-approved gene therapy for a specific genetic mutation associated with Leber's congenital amaurosis, marking a transformative period in IRD management. Genetic testing has become a crucial tool in patient care, providing unprecedented insights into disease characteristics. By identifying specific gene mutations, healthcare providers can now offer patients comprehensive information about their condition, including inheritance patterns, potential progression, and risks of passing the disease to future generations. This knowledge extends to understanding whether a condition is autosomal dominant, recessive, or X-linked. 

Lin stated that at the Ketchum Health University Eye Center, nearly 20% of low vision clinic patients have IRDs. These patients are typically younger - in their 20s, 30s, and 40s - and are seeking early intervention. The clinic provides in-house genetic testing and counseling, which attracts patients looking for comprehensive care. The speaker emphasized the importance of early detection, particularly for children with family histories of IRDs. By diagnosing these conditions earlier, healthcare providers can potentially implement more effective management strategies and explore emerging treatments. Two key resources were highlighted: the American Academy of Ophthalmology's updated guidelines for IRD diagnosis and the American Optometric Association's 2024 publication report. These documents provide healthcare professionals with current, comprehensive information on diagnosing and managing inherited retinal diseases. The lecture underscores a significant shift in IRD management - from a condition with limited understanding to a field with genetic insights, potential therapies, and personalized patient care. The ability to provide patients with detailed genetic information not only aids in their current treatment but also helps them understand their long-term prognosis and potential family implications.

Conference

Jennifer Li, MD, details a talk she gave alongside Melissa Barnett, OD, FAAO, FSLS, FBCLA, at CRU 2025 in Napa, California.

Neurotrophic keratitis: Multidisciplinary approaches to enhance patient outcomes

Jennifer Li, MD, a professor of ophthalmology at UC Davis Eye Center, provides an in-depth overview of neurotrophic keratitis (NK), emphasizing its critical yet often overlooked nature in eye care. NK is a condition characterized by reduced corneal sensation that frequently goes undiagnosed. Li stresses the importance of healthcare providers keeping this condition in mind, especially when patients present with dry eye symptoms. The key to early detection is a simple corneal sensation test, which can be performed using a cotton wisp, comparing sensation between both eyes. The diagnostic approach involves checking corneal sensation in all quadrants, starting with the unaffected eye. Li advises against applying eye drops before testing, as this can interfere with accurate sensation assessment. She recommends testing with a small cotton wisp, not the entire cotton swab, to get precise results. Management of NK is multifaceted and patient-specific. Initial steps include:

Surgical interventions like neuronization

Li emphasizes a collaborative approach, working closely with optometrists and oculoplastic surgeons to provide comprehensive care. Each patient requires a tailored strategy, considering their unique underlying causes and symptoms. The overarching message is early detection and proactive management. By maintaining a high index of suspicion for NK, checking corneal sensation systematically, and adopting a stepwise treatment approach, healthcare providers can significantly improve patient outcomes. Key takeaways include the simplicity of diagnosis, the importance of thorough examination, and the need for personalized, collaborative treatment strategies in managing NK.

CRU 2025: Neurotrophic keratitis and multidisciplinary approaches to enhance patient outcomes

Melissa Tawa, OD, FAAO, provides insights to take glaucoma management from reactive to proactive in presentations given at CRU 2025 in Napa, California.

CRU 2025: Exploring minimally invasive glaucoma surgeries

Melissa Tawa, OD, FAAO, from Marshall B Ketchum University's Southern California College of Optometry discusses the evolving landscape of glaucoma management, focusing on a proactive and comprehensive approach to patient care. In collaboration with Deborah Ristvedt, DO, she delivered 3 lectures on glaucoma, specifically exploring minimally invasive glaucoma surgeries (MIGS). The lectures delved into the various devices available, their mechanisms, and patient selection criteria. Key considerations include whether procedures bypass the trabecular meshwork, their invasiveness, and whether they can be standalone or combined with cataract surgery. Tawa emphasizes a shift from reactive to proactive glaucoma management. Modern technologies like optical coherence tomography (OCT) now enable early glaucoma detection before visual field defects occur. New medications, drug delivery systems, and surgical procedures allow clinicians to control intraocular pressure (IOP) more effectively and prevent progressive vision loss. She stresses the importance of communication with ophthalmological specialists, recognizing that access and comfort levels with glaucoma management vary among practitioners. When making referrals, Tawa recommends creating comprehensive patient history packets that provide a holistic view of the patient's condition. These packets typically include:

Previous discussions about potential interventions

The goal is to make the referral process seamless, giving receiving ophthalmologists immediate insight into the patient's background. By understanding patient preferences and previous conversations, specialists can approach treatment discussions more effectively. Tawa's approach underscores the importance of personalized, proactive glaucoma management, leveraging technological advancements and fostering collaborative communication between optometrists and ophthalmologists to optimize patient outcomes.

CRU 2025: Exploring minimally invasive glaucoma surgeries 

Deb Ristvedt, DO, details a handful of presentations on glaucoma she gave during CRU 2025 in Napa, California.

CRU 2025: Interventional glaucoma as a proactive approach to glaucoma management

Deborah Ristvedt, DO, from Vance Thompson Vision discusses the significant evolution of glaucoma treatment over the past decade. The presentation focuses on moving beyond traditional eye drop treatments to more proactive and patient-friendly interventional approaches. The key shift in glaucoma care is transitioning from a reactive to a preventative model. Ristvedt emphasizes that drops are no longer the only or best solution, highlighting several misconceptions in current glaucoma treatment. While medications can be effective, patient compliance and side effects remain significant challenges. Modern glaucoma management now includes multiple innovative techniques, including selective laser trabeculoplasty (SLT) for consistent 24/7 pressure control, procedural pharmaceuticals that directly target eye pressure, minimally invasive glaucoma surgeries (MIGS) focusing on the trabecular meshwork, and novel devices addressing aqueous fluid production and flow.

The ultimate goals are comprehensive 24/7 pressure control and preventing vision loss. Ristvedt notes that currently, 13% of patients still risk losing vision in one eye, making early intervention crucial. A critical aspect of improved glaucoma care is patient education and early detection. Ristvedt stresses the importance of collaboration between ophthalmology and optometry to help patients understand glaucoma and overcome fears about treatment. Emerging technologies like ocular perfusion goggles for treating normal tension glaucoma represent exciting advancements. The focus is on individualizing care, reducing patient burden, and intervening earlier in the disease progression. The future of glaucoma treatment looks promising, with an increasing number of techniques and devices that allow more personalized, less invasive, and more effective management strategies. By educating patients and implementing these advanced treatments, healthcare professionals can help patients maintain long-term vision and quality of life.

Alongside Rachelle Lin, OD, MS, FAAO, Nguyễn, MD, MSc, detailed what treatments are currently available for retinal vascular diseases, including neovascular age-related macular degeneration and diabetic retinopathy.

A retinal roundup with Dr. Quan Đông Nguyễn

At the 2025 CRU meeting in Napa, California, Quan Đông Nguyễn, MD, MSc discussed recent developments in retinal diseases, focusing on diabetic retinopathy, macular edema, geographic atrophy, and neovascular age-related macular degeneration (nAMD). He highlighted the availability of new medical therapies and the benefits and risks of anti-complement therapies for geographic atrophy. The discussion also covered the ineffectiveness of adding VEGF-C and -D blockers in neovascular AMD treatments. The session emphasized early treatment, the importance of collaboration between ophthalmology and optometry, and the potential of growth factor therapies like ciliary neurotrophic factor for macular telangiectasia.

Editor's note: The below transcript has been lightly edited for clarity.

Hi, I'm Quan Đông Nguyễn, currently professor of ophthalmology, Medicine and Pediatrics at the Byers Eye Institute and at Stanford University School of Medicine in Palo Alto. Certainly, it's great pleasure to be back here at the 2025 CRU meeting here in Napa. Yesterday, we were discussing about the various developments and investments in the field of retina, especially medical retina aspect as well as inherited retinal disease. So I had a wonderful time sharing with our colleagues some of the developments we have. The session covered 4 different parts, starting out with diabetic retinopathy, diabetic macular edema, then followed by geographic atrophy, and followed by neovascular AMD, and finished up with a session on treatment of different aspect of the disease and the treatment, the last aspect we covered, was macular telangiectasia. So during that 1-hour discussion, we went over many different aspects. Certainly, we talked about some of the latest developments, availability of medical therapy in medical retina, for example, with the availability of flotetuzumab, with the availability of the high dose of aflibercept, 8 milligram. Then we talked about how we can use them, when to apply them, when to switch, when to do certain things. 

Subsequently, we talked about geographic atrophy. Currently we have 2 different availability drug that we use for treatment of geographic atrophy: anti-complement 3 and anti-commitment 5. And so we discussed about the potential goods and benefits of both of them, knowing that even though they do not stop the growth of the disease, of the geographic atrophy, but they certainly can slow down. And so we talk about the risk and benefit for that. 

Then we move over to neovascular AMD, where we were able to look at different regimen, different study. Again, based on the development of that, we learned that it is very important to treat, certainly using anti-VEGF therapy, but also perhaps to consider other aspects. We learned that the addition of blockage of VEGF-C and D may not make a difference, given the result of the recent costudy that failed to show that addition of anti-VEGF-C and D make any difference for that in that aspect. So we learned about upcoming trials that may be helping to reset the goal for our patient with retinal vascular diseases like diabetic retinopathy and macular degeneration. 

Then we all finished the session about treatment for macular telangiectasia, showing that how the ciliary growth factor has been able to improve of that concept. So the CNTF treatment, ciliary neurotrophic factor, have been very helpful, and the trial positive, and it's recently been approved. So we look forward on perhaps consider managing outpatient with that condition with the latest treatment. So overall, the session was quite exciting. I was very pleased to be able to share our knowledge with our colleagues in both ophthalmology, as well teaching, educating some our colleague in optometry as well, some of the latest development we have.

One of the concepts that come out recently is that disease should be treated early and not waiting for end stages. So I think the collaboration between the 2 fields of ophthalmology and optometry is extremely important. Certainly, there's limited number of ophthalmologists, especially retina specialists, so therefore, many of our patients are being evaluated locally in different small cities, for example, by our colleagues in optometry. It would be very good to alert the patient, alert yourself also too, that disease can come or can reoccur unexpectedly. And we have learned from many of these trials that it is better to treat early and treat appropriately. So delay treatment may not be good, so it's very good that we could detect early and perhaps the optometrists can then send to the appropriate colleagues in retina, for example, to help out.

Alongside Rachelle Lin, OD, MS, FAAO; Nguyễn, MD, MSc, detailed what treatments are currently available for retinal vascular diseases, including neovascular age-related macular degeneration and diabetic retinopathy.

CRU 2025: A retinal roundup with Dr. Quan Đông Nguyễn

Cecelia Koetting, OD, FAAO, DiplABO, details a talk she gave among optometrists and ophthalmologists at CRU 2025.

The importance of comanagement and thorough examination in neurotrophic keratitis cases

Neurotrophic keratitis (NK) is a critical eye condition that is often misdiagnosed and misunderstood, according to Cecelia Koetting, OD, FAAO, DipABO. In her presentation "Neurotrophic Keratitis: Multidisciplinary Approaches to Enhance Patient Outcomes," presented alongside Melissa Barnett, OD, FAAO, FSLS, FBCLA; Jennifer Li, MD; and Quan Đông Nguyễn, MD, MSc; an overview of what to look out for in diagnosing neurotrophic keratitis was given.

Unlike typical dry eye, NK can progress to serious complications such as persistent epithelial defects, corneal ulcers, and potentially requiring a corneal transplant. The key to effective management lies in early detection through careful corneal sensitivity testing. 

Practitioners can use various tools to check corneal sensitivity, including cotton tip applicators, crochet bins, or even dental floss. The primary challenge is recognizing that what appears to be standard ocular surface disease may actually be NK. Misdiagnosis can lead to ineffective treatments, making accurate identification crucial. 

The approach to NK management is multifaceted and collaborative. Successful treatment often involves co-management across different medical specialties. For instance, oncology patients experiencing side effects from cancer medications frequently present with NK symptoms. Similarly, rheumatology patients with conditions like lupus, sarcoidosis, or Sjogren's syndrome may also develop NK. 

Each patient's NK management is unique. Some practitioners may take a more aggressive approach, treating the condition comprehensively, while others might refer to specialists for specific interventions. The goal is to create an approachable and flexible treatment strategy that addresses the individual patient's needs. 

Referral to a cornea specialist becomes necessary when surgical interventions are required. However, many stages of NK can be effectively managed through careful monitoring, appropriate treatments, and interdisciplinary collaboration. The most critical takeaway is the importance of thorough examination and corneal sensitivity testing. By recognizing NK early and understanding its potential progression, healthcare providers can prevent more severe complications and provide targeted, effective care for patients experiencing this complex eye condition.

Cecelia Koetting, OD, FAAO, DipABO, details a talk she gave among optometrists and ophthalmologists at CRU 2025.

Jennifer Stevens, OD

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