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Prevent Blindness names April as Women’s Eye Health and Safety Month 

Videos

Melissa Barnett, OD, FAAO, FSLS, FBCLA, discusses keratoconus management, diagnosis, and other key insights at CRU 2025.

CRU 2025: Prioritizing early diagnosis of keratoconus

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

CRU 2025: The importance of comanagement and thorough examination in neurotrophic keratitis cases

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

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Rebecca Alexander, LCSW-R, MPH, has been gradually losing both her vision and hearing since she was a teenager due to Usher syndrome type 3. She discusses the importance of making practice accessible for those with vision loss in an exclusive interview.

Vision loss's role in accessibility advocacy with Rebecca Alexander

This poll is for optometrists and eyecare professionals, only. It will close on Friday, March 25, 2022.

E. Poor understanding of optometry by others

Poll: What is your biggest frustration with optometry as a whole?

Bausch + Lomb has announced the US launch of Arise, a lens fitting system that uses intelligent, cloud-based technology to aid in the orthokeratology lens design process. Arise is capable of syncing directly with topographers to create precise lens designs for the treatment of myopia in the matter of seconds. The system also utilizes the first orthokeratology lens design with toric peripheral curves approved by the US Food and Drug Administration to treat myopia overnight, according to a news release.

“Traditional orthokeratology lens fitting methods can be complex and time-consuming,” said Yang Yang, president of Global Vision Care at Bausch + Lomb, in the release. “The Arise platform’s streamlined fitting process will reduce chair time and increase efficiency for eye care professionals.”

Arise works by utilizing advanced algorithms to interpret corneal topography images and recommends lens designs without a fitting set required. The system evaluates lens centration and patient progress by using an overnight outcome map library and recommends any adjustments needed following overnight wear. Arise’s cloud-based platform also allows secure access to patient data and provides direct support from the Bausch + Lomb expert consultation team. The system is designed for lens fitters of all experience levels.

“Arise combines all aspects of the orthokeratology process—from topography capture to lens design and more—into one seamless, user-friendly technology,” said Brooke Messer, OD, FAAO, FSLS, of Vance Thompson Vision in West Fargo, North Dakota, in the release. “The ease and precision of Arise will be a welcome addition to my practice.”

Arise is now commercially available in the US, the UK, and Europe.

The Boston orthokeratology (oprifocon A) shaping lenses for overnight wear available with Arise are indicated for use in reduction of myopic refractive error in non-diseased eyes. The lenses can be used in part of the Bausch + Lomb Vision Shaping Treatment VST process for the temporary reduction of myopia up to 5.00 diopters with eyes having astigmatism up to 1.50 diopters.

Bausch + Lomb launches Arise orthokeratology lens system in the United States. News release. Bausch + Lomb. March 17, 2025. Accessed March 17, 2025.

The system aids in the orthokeratology lens design process by syncing directly with topographers to create precise lens designs for the treatment of myopia in the matter of seconds.

Bausch + Lomb launches new Arise lens fitting system

Okyo Pharma has filed an application for Fast Track designation with the US Food and Drug Administration (FDA) for urcosimod (formerly known as OK-101) for the treatment of neuropathic corneal pain (NCP).

Gary S. Jacob, PhD, CEO of Okyo Pharma commented on the application in a press release from the company.

“Fast track was first introduced by FDA to expedite development and review of drugs to treat serious conditions lacking any FDA-approved drug,” said Jacob. “Notably, neuropathic corneal pain falls into this category, and our application for Fast Track designation marks a significant milestone in our commitment to addressing the urgent needs of patients suffering from this type of pain. It is our belief that urcosimod has the potential to redefine the treatment paradigm for individuals grappling with this challenging condition.”

Fast track designation allows for the company to have more frequent meetings with the FDA to discuss the drug’s development plan, ensure collection of appropriate data needed to support drug approval, as well as the use of a rolling FDA review to expedite its regulatory path

NCP is a condition that causes severe pain and sensitivity of the eyes, face, or head, and the exact cause is unknown, but is thought to result from nerve damage to the cornea combined with inflammation. There is currently no FDA-approved drug to treat NCP.

Urcosmod is a lipid conjugated chemerin peptide agonist of the ChemR23 G-protein coupled receptor, typically found on immune cells of the eye responsible for the inflammatory response. Urcosimod showed clear statistical significance in multiple endpoints in a 

recently completed Phase 2, multi-center, double-masked, placebo-controlled trial to treat dry eye disease

presently being evaluated in a randomized, placebo-controlled, double-masked Phase 2 trial

 to treat 48 neuropathic corneal pain patients.

announced the United States Adopted Name (USAN) of urcosmid, formally OK-101.

 According to the company, the suffix “-mod” in urcosimod denotes its classification as a modulator of key inflammatory and neuropathic pathways, critical to addressing ocular conditions such as neuropathic corneal pain and dry eye disease.

OKYO Pharma files for Fast Track Designation with FDA for urcosimod to treat neuropathic corneal pain. Published March 10, 2025. Accessed March 10, 2025.

https://ir.4dmoleculartherapeutics.com/news-releases/news-release-details/4dmt-announces-first-patients-enrolled-4front-1-phase-3-clinical

Urcosmod is a lipid conjugated chemerin peptide agonist of the ChemR23 G-protein coupled receptor, typically found on immune cells of the eye responsible for the inflammatory response.

Canonical

OKYO Pharma files Fast Track designation application with the FDA for urcosimod for the treatment of NCP

Ocugen, Inc. completed dosing ahead of schedule in the Phase 2 portion of the Phase 1/2 ArMaDa clinical trial for OCU410. This candidate is a novel multifunctional modifier gene therapy candidate in development for the treatment of 

. OCU410 targets multiple pathways associated with GA.

Shankar Musunuri, PhD, MBA, Chairman, CEO, and Co-founder of Ocugen spoke to this milestone in the company’s press release, saying, “Dosing completion is a major accomplishment for our OCU410 program. Based on the multifunctional effect of our modifier gene therapy, the profound unmet medical need, limited treatment options, and the fact that it is designed as a one and done treatment, we believe OCU410 can be a potential blockbuster therapy and the gold standard for treating GA worldwide. The data from this trial will help us design a future pivotal Phase 3 study planned for 2026 and enable our commercial strategy for Biologics License Application (BLA) and Marketing Authorization Application (MAA) filings as soon as 2028.”

Huma Qamar, MD, MPH, CMI, is the Chief Medical Officer of Ocugen. In the press release he shared, “Given the safety concerns associated with currently approved GA treatments, the encouraging safety and tolerability profile of OCU410 offers a promising treatment option. With Phase 2 enrollment now complete, OCU410 has the potential to be a one-time treatment, reducing the burden of frequent injections, improving patient compliance, and ultimately enhancing quality of life.”

In the Phase 2 study, the safety and efficacy of OCU410 in patients with GA secondary to dAMD will be assessed. Fifty-one patients were randomized 1:1:1 into either of 2 treatment groups (medium or high dose) or a control group. In the treatment groups, subjects received a single subretinal 200-µL administration of 5 x 1010 vector genomes (vg)/mL (medium dose) or 1.5 x 1011 vg/mL (high dose), while the control group remained untreated.

The ArMaDa clinical trial for OCU410 is being performed at 14 retinal surgery centers across the US.

1. Ocugen, inc. Announces dosing completion in the phase 2 armada clinical trial for ocu410—a multifunctional modifier gene therapy for the treatment of geographic atrophy secondary to dry age-related macular degeneration. Ocugen, Inc. February 12, 2025. Accessed February 13, 2025. https://ir.ocugen.com/news-releases/news-release-details/ocugen-inc-announces-dosing-completion-phase-2-armada-clinical

OCU410 is a novel multifunctional modifier gene therapy candidate that targets multiple pathways associated with GA.

Pipeline

Ocugen, Inc. completes dosing in Phase 2 portion of ArMaDa clinical trial for OCU410

Unless you’ve been practicing under a rock for the past 15 years, you’ve likely heard of the “20- 20-20 rule" for computer eye strain. It has been recommended by almost every major state association and eyecare industry outlet, including the American Optometric Association (AOA), the American Academy of Ophthalmology (AAOpt), The Vision Council and many more. But have you ever wondered where it came from or what was the rationale for the practice?

I graduated from Illinois College of Optometry in 1975. After my 2-year active duty service for the US Navy in San Diego and a few years in private practice, I started working at an office near a local university. It was here where I started seeing patients who had vision problems that didn’t fit “the mold” for their age. For instance, patients in their 20s were just starting to become myopic; others were having headaches, but only during the weekdays and at the end of the day. When I began to ask questions about their lifestyle and activities, I found that most of these people were in the computer sciences division at the university. Since I completed my optometric education during the 70s, we never studied the effects that screens had on the vision of a student or office worker. This area of “display viewing” was new and there were few, if any, studies on the interaction of the computer display and vision. I decided then that this was an area of eye care that was underserved and needed to be addressed.

Fortunately, I was able to contact the renowned James Sheedy, OD, PhD, then professor at the UC Berkeley School of Optometry, who was conducting studies of computer-related eye strain. I followed up with him to see the results of his studies and decided to form a consulting business to go directly to corporations and other businesses where workers were using computers on a regular basis. I would go to their corporate offices and perform on-site evaluations, giving lectures and making recommendations based on my findings. In addition, I started offering presentations to ergonomic conferences due to the fact that many of these professional never had any background on the workings of the visual system.

 in 1998. Soon after this publication, I was invited to give interviews with media outlets (radio and TV), which looked at this new concern for vision stress as another effect—in addition to carpal tunnel syndrome—of computer use. Given time limitations, they all asked for a “nutshell” approach to resolving this issue. This is when I came up with the “3-B” approach, which was to “Blink, Breathe, and Break.”

Around this same time, I came across a research study on carpal tunnel syndrome that noted that shorter, more frequent breaks from computer use were more beneficial than one break every two hours, which was previously recommended. I realized that the same held true for the visual system, so to simplify the discovery, I created the “20-20-20” rule for display users. The rule states, “Every 20 minutes, take 20 seconds and look 20 feet away.” As I mentioned, this rule has now been adopted by the AOA, AAOpt, the Vision Council, and many more organizations and independent eyecare professionals.

I once attended a conference where a speaker was discussing myopia. I found it a bit disconcerting when, toward the end of the lecture, the speaker announced, “The 20-20-20 rule doesn’t work.” I was taken aback at this statement but quickly realized that the speaker was referring to myopia and not eye strain. After the presentation, I met the speaker in the lobby and mentioned that I developed the rule to relieve eye strain and not as a myopia control technique. I had hoped that I got the point across but recently, I’ve seen more recommendations from a variety of sources that promote the rule for myopia control.

I never did trademark the rule but am gratified to have a few organizations and colleagues acknowledge where it originated. One day in 2018, I received a call from an optometrist in San Diego who was writing an article on the source of the 20-20-20 rule. He asked me if I knew where it came from. I said, “as a matter of fact, I do!” He interviewed me, and in February of 2018, Dr. Brian Chou published his article, “

Deconstructing the 20-20-20 rule for digital eye strain

Again, the rule was not trademarked, but I take great pride in the fact that I have not only helped patients, but I have also helped my profession. It was gratifying to have attendees from my early ergonomic lectures return the following year and exclaim, “Hey, you’re that 20-20-20 guy!”

It's funny the way things work out. And to all my colleagues who quote the rule to media outlets and patients: You’re welcome!

The 20-20-20 rule has taken on a life of its own, but it remains a useful trick to reduce digital eye strain.

Behind the creation of the 20-20-20 rule for digital eye strain

Glaucoma is a deceptive and dangerous disease as most patients have few or no symptoms. Glaucomatous optic neuropathy is the leading cause of irreversible blindness worldwide and the second-leading cause of overall blindness (8%). Approximately 79 million persons worldwide have glaucoma, and approximately 2 million patients in the United States and more than 11 million worldwide are bilaterally blind from glaucoma.

The leading theory of the main cause of damage to the optic nerve is excessive fluid pressure within the eye, which can be caused by increased aqueous production, blockage of drainage ducts, and narrowing or closure of the iris angle. Because most cases of glaucoma report an increase in intraocular pressure, the goal of treatment is only to lower the eye pressure. Even in cases of normal-tension glaucoma (NTG), no other treatment modality exists but to lower eye pressure. Treatment that reduces intraocular pressure has been shown to improve outcomes in randomized clinical trials.

 Yet even here, there is no cure but only slowing of the progression of the disease.

The traditional approach to diagnosing the disease is to measure intraocular pressure, evaluate the optic disc for signs of degeneration (cupping, pallor, etc.), and evaluate the peripheral visual field, where the primary vision loss occurs.

Control of intraocular pressure in glaucoma may require multiple drugs of different classes (

). Use of glaucoma medications delays visual field loss by lowering intraocular pressure and reduces the absolute risk of progression by 17% in patients with early glaucoma.

 The United Kingdom Glaucoma Treatment Study, a multicenter, randomized, placebo-controlled trial, published results in 2015 showing longer visual field preservation in patients with primary open-angle glaucoma (POAG) taking latanoprost (Xalatan).

Although no studies prove a connection between specific foods or supplements and glaucoma, it’s safe to assume that diet and overall health can affect the disease. The eyes are part of the body so what supports overall health can support ocular structures as well. For people living with glaucoma and even those not at high risk for glaucoma, following nutritional advice on diet and lifestyle choices may help protect eyesight.

One theory on the incidence of glaucoma is related to stress. Prolonged stress leads to adrenal exhaustion, and exhausted adrenals are no longer able to produce aldosterone, which stabilizes the salt balance in the body. When too much salt is lost from the body, the tissue fluids build up and often will push into the eye, increasing the IOP and forcing the lens forward, as well as damage the optic nerve.

Foods rich in antioxidants and phytochemicals (natural compounds found in plants)—whole grains, berries, leafy greens, and nuts—may help protect against damage from free radicals, which have been linked to an increased risk of eye diseases like glaucoma. However, researchers say further studies are needed to determine whether these foods protect against retinal degeneration related to glaucoma.

Whole grains are rich in fiber, vitamins, and antioxidants. Fiber is essential for good health because it helps maintain a healthy digestive system, while vitamins and antioxidants help strengthen the immune system and protect the body from disease. All of these things can also help improve eye health.

Nuts are a good source of vitamin E, magnesium, and arginine, all of which are protective against glaucoma. Nuts are also rich in healthy fats, fiber, and antioxidants that fight oxidative stress, which can lead to cell damage. Increasing intake of these nutrients may reduce the risk of developing glaucoma.

Pycnogenol is a compound of natural chemicals that come from the bark of a European pine tree. It is thought to be an antioxidant that helps protect cells from damage. The active ingredients in pycnogenol can also be extracted from other sources, including peanut skin, grape seed, and witch hazel bark.

Mirtogenol is a combination tablet containing 40 mg of pycnogenol and 80 mg of Mirtoselect, standardized bilberry extract. A study in 2008 indicated that Mirtogenol may represent a safe preventive intervention for lowering the risk of developing symptomatic glaucoma by controlling IOP and improving ocular blood flow.

 A follow-up study using Mirtogenol with latanoprost showed improvements in retinal microcirculation that were statistically significant for all management groups.

In a recent study, Wistar albino rats were treated with capsanthin 50% (CapsiClear) at low, mid, and high doses and IOP levels were compared to control and disease groups. In this study, IOP was induced by intravitreal injection of carbomer, which elevated levels. IOP was confirmed, the formula was administered for 28 days, and IOP was recorded weekly. The results showed that 28-day repeated administration of capsanthin 50% at dose levels of 20, 40 and 80 mg/kg reduced IOP from day 8 onward. The IOP returned to a level almost equal to that of the untreated groups.

Capsanthin 50% did not result in clinical signs of toxicity, mortality, changes in body weight, or feed consumption. There were no treatment-related changes in hematology and clinical chemistry parameters. Based on the available results, it was concluded that daily oral administration of CapsiClear up to 80 mg/kg reduced the IOP in male Wistar rats.

Nitric oxide (NO) is involved in the vasodilation of smooth muscle in the cardiovascular, urogenital, respiratory, gastrointestinal, and immune systems. It also has a role in angiogenesis, platelet aggregation, and the musculoskeletal system with regulating bone formation. The mechanism of action is through direct and/or indirect means. NO has a dual role in the inflammatory process, with both excessively low or high concentrations leading to pathology. At high concentrations, NO can be proinflammatory and pathologic while also having desired antimicrobial effects.

Foods that can increase production of NO include beets, root vegetables, garlic, dark chocolate (in moderation), leafy greens,
nuts and seeds, citrus fruits, pomegranates, and watermelon.

Nicotinamide adenine dinucleotide (NAD) is a coenzyme that is essential to life and is found in every cell of all living things. NAD is required to catalyze reactions for more than 400 enzymes, more than any other vitamin-derived coenzyme. It is one of the top essential molecules for life because it is involved in many physiological and pathological functions including adenosine triphosphate (ATP) production in the mitochondria and oxidation of fatty acids and amino acids, DNA damage repair, oxidative stress, inflammation, cellular senescence, and others.

Several studies have shown that mitochondrial function may underlie both susceptibility and resistance to developing glaucoma. Mitochondria meet high energy demand, in the form of ATP, which is required for the maintenance of optimum retinal ganglion cell (RGC) function. Reduced NAD levels have been closely correlated to mitochondrial dysfunction and have been implicated in several neurodegenerative diseases including glaucoma. NAD provides neuroprotective effects by increasing oxidative phosphorylation, buffering and preventing metabolic stress, and increasing mitochondrial size and motility.

 Supplements that decrease inflammation like glutathione, berberine, or curcumin can help increase NAD levels. Likewise, a supplement to decrease senescent cells such as quercetin may also help increase systemic NAD levels.

IOP-independent mechanisms contributing to the development of glaucomatous neurodegeneration include oxidative stress, excitotoxicity, mitochondrial dysfunction (as described above), and impaired ocular blood flow. In the concept of oxidative stress in POAG, the leading role is given to ischemia-reperfusion processes as the main reasons for the formation of reactive oxygen species (ROS). An increase in IOP levels provokes a spasm of the retinal blood vessels, leading to a reduction of the blood circulation of the retina. Subsequent natural reperfusion also contributes to the development of oxidative species. The resumption of oxygen supply to tissues is accompanied by a higher concentration of ROS, which causes the formation of free radicals and massive damage to cellular structures.

Berries are rich in antioxidants, which can help prevent oxidative stress that contributes to glaucoma. A study published in 

 found that eating plenty of berries could lower the risk of developing the disease by as much as a quarter. Berries such as raspberries, blackberries, and strawberries contain resveratrol, a compound found in red wine that has been linked to lower rates of glaucoma. In addition, blueberries are packed with anthocyanins—pigments responsible for their deep color and antioxidant properties.

Astaxanthin (AST) is another powerful antioxidant that has been studied for its effect on IOP. One study investigated the cytoprotective effect of AST on RGC degeneration using an NTG mouse model. The results revealed that the antioxidative stress effects of AST inhibit RGC degeneration in the retina and may be useful in the treatment of NTG.

A recent meta-analysis was conducted to clarify the relationship between vitamin intake and glaucoma risk.

 The study performed 5 meta-analyses of existing studies to summarize the evidence on the association between vitamin intake and glaucoma risk. The initial search identified 689 studies, 8 of which (262,189 patients) met the eligibility criteria for the meta-analysis. The results of this study demonstrated that high-dose intake of vitamins A and B, but not vitamins C, D, or E, was associated with a low prevalence of glaucoma.

The eyes are extensions of the brain and are nourished as much as any other part of the body. Nerve tissue is some of the most highly metabolically active tissue and needs an abundance of proper nutrients to function properly. Given the state of dietary options that are offered by the standard American diet, it is increasingly critical that we pay more attention to our diets as we age. Unfortunately, this is not a priority for the general public and many are overwhelmed with conflicting information about proper nutrition. Thus, it behooves the eye care practitioner to study the role of food and nutrients for proper healthy functioning, not just to resolve chronic disease but also to prevent these diseases from occurring at all.

1. Quigley HA, Broman AT. The number of people with glaucoma worldwide in 2010 and 2020. 

. 2006;90(3):262-267. doi:10.1136/bjo.2005.081224

2. Kass MA, Heuer DK, Higginbotham EJ, et al. The Ocular Hypertension Treatment Study: a randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma. 

. 2002;120(6): 701-830. doi:10.1001/archopht.120.6.701

3. Heijl A, Leske MC, Bengtsson B, et al; Early Manifest Glaucoma Trial Group. Reduction of intraocular pressure and glaucoma progression: results from the Early Manifest Glaucoma Trial. 

. 2002;120(10):1268-1279. doi:10.1001/archopht.120.10.1268

4. The AGIS Investigators. The Advanced Glaucoma Intervention Study (AGIS): 7. The relationship between control of intraocular pressure and visual field deterioration. 

 2000;130(4):429-440. doi:10.1016/s0002-9394(00)00538-9

5. Vass C, Hirn C, Sycha T, Findl O, Bauer P, Schmetterer L. Medical interventions for primary open angle glaucoma and ocular hypertension. 

. 2007;2007(4):CD003167. doi:10.1002/14651858.CD003167.pub3

6. Heijl A, Leske MC, Bengtsson B, et al; Early Manifest Glaucoma Trial Group. Reduction of intraocular pressure and glaucoma progression: results from the Early Manifest Glaucoma Trial. 

7. Garway-Heath DF, Crabb DP, Bunce C, et al. Latanoprost for open-angle glaucoma (UKGTS): a randomised, multicentre, placebo-controlled trial. 

 2015;385(9975):1295-1304. doi:10.1016/S0140-6736(14)62111-5

8. Steigerwalt RD, Gianni B, Paolo M, Bombardelli E, Burki C, Schönlau F. Effects of Mirtogenol on ocular blood flow and intraocular hypertension in asymptomatic subjects. 

9. Gizzi C, Torino-Rodriguez P, Belcaro G, Hu S, Hosoi M, Feragalli B. Mirtogenol supplementation in association with dorzolamide-timolol or latanoprost improves the retinal microcirculation in asymptomatic patients with increased ocular pressure. 

10. Shanmugham, V, Subban R. Capsanthin from capsicum annum fruits exerts anti-glaucoma, antioxidant, anti-inflammatory activity, and corneal pro-inflammatory cytokine gene expression in a benzalkonium chloride-induced rat dry eye model. 

. 2022;46(10):e14352. doi:10.1111/jfbc.14352

11. Tribble JR, Otmani A, Sun S, et al. Nicotinamide provides neuroprotection in glaucoma by protecting against mitochondrial and metabolic dysfunction. 

. 2021;43:101988. doi:10.1016/j.redox.2021.101988

12. Karpilova M.A., Poluyanova A.D. [Antioxidant nutraceuticals for glaucoma.] 

. 2020;136(4. Vyp. 2):317-323. doi:10.17116/oftalma2020136042317

13. Kikuchi K, Dong Z, Shinmei Y, et al. Cytoprotective effect of astaxanthin in a model of normal intraocular pressure glaucoma. 

. 2020;2020:9539681. doi:10.1155/2020/9539681

14. Han FF, Fu XX. Vitamin intake and glaucoma risk: a systematic review and meta-analysis. 

. 2022;45(5):519-528. doi:10.1016/j.jfo.2021.10.010.

Supplementing vision care with nutrition may protect ocular tissues.

Rebecca Alexander, LCSW-R, MPH

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