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In this Q&A, John D. Gelles, OD, and Steven Greenstein, MD, chat about what inspired them to launch the symposium, what makes this year’s agenda especially exciting, and why the future of refractive care depends on stronger collaboration between ODs and MDs.

Bridging disciplines and elevating care: A Q&A with John Gelles, OD, and Steven Greenstein, MD

Videos

Bridgitte Shen Lee, OD, FAAO, FBCLA, FEAOO, details the key takeaways from a poster presentation she participated in during ARVO 2025.

ARVO 2025: Miebo demonstrates favorable tolerability in prescription refill rates

deepeye TPS is designed to close the gap between real-world outcomes and trial data by reducing patient dropout.

AI therapy planning support assistant launched by deepeye Medical receives CE mark

Bridgitte Shen Lee, OD, FAAO, FBCLA, FEAOO, discussed research that utilized IQVIA longitudinal prescription claims data from September through November 2023, coinciding with Miebo's FDA approval in September.

ARVO 2025: The early adoption and utilization of perfluorohexoloctane (Miebo)

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Steven Greenstein, MD, one of the cochairs of the Collaborative Care Symposium gave some insight into the upcoming conference and what attendees can expect. 

A sneak peek into the Collaborative Care Symposium 2025 with Steven Greenstein, MD

Charting the path to optimal  eye emergency care at CRU 2023

John D. Gelles, OD, and Steven A. Greenstein, MD, share some insights into the new data on corneal cross-linking presented at IKA Keratoconus Symposium.

IKA Keratoconus Symposium 2023: New data presented for epi-on cross-linking

A recent study has shown the potential role artificial intelligence (AI) systems could play in diabetic retinopathy (DR) screenings. Study authors, led by Hasan Nawaz Tahir, MS, of the Department of Community Medicine at both the College of Medicine, Dwadimi, Shaqra University in Shaqra, Saudi Arabia, and the Khyber Medical College Peshawar in Peshawar, Pakistan, found in their systematic review and meta-analysis that the systems were able to achieve high sensitivity and specificity values, particularly in undilated eye screenings.

“These results highlight that AI systems, especially in undilated eye conditions, show promise for clinical use with reliable sensitivity and specificity, but variations exist depending on the system and clinical setting,” the study authors stated.

Researchers conducted a literature search for AI and manual screening methods of DR using PubMed and Google Scholar in order to identify relevant studies to include in the research that was published between January 2015 and September 2024. A second search was then done on February 2025, in which 13 additional studies were added to make a total of 25 included studies. Those that were included were categorized by whether they were observational or validation. Studies that were included evaluated AI algorithms or manual screenings for DR in patients from 15 to 90 years old that were diagnosed with DR and reported sensitivity and specificity outcomes for either dilated or undilated eye conditions, according to researchers. Risk of bias was assessed using the QUADAS-2 tool for validation studies, the AXIS tool for cross-sectional studies, and the Newcastle-Ottawa Scale for cohort studies. They were also assessed for quality by 2 independent reviewers to evaluation selection bias, outcome/exposure assessment bias, follow-up bias, measurement bias, sample representativeness, reporting bias, index test bias, reference standard bias, flow and timing bias, and ethical considerations bias. Studies that were excluded were those that did not report the outcomes of interest, if the author of the studies did not respond to interest queries, or if the full text was not available to the study authors.

In total, 613,690 images used for screening were included in the study. For undilated eyes, AI screening had a pooled sensitivity of 0.90 [95% CI: 0.85-0.94] and pooled specificity of 0.94 [95% CI: 0.91-0.96]. Manual screening images had a pooled sensitivity of 0.79 [95% CI: 0.60-0.91] and pooled specificity of 0.99 [95% CI: 0.98-0.99]. As for dilated eyes, the pooled sensitivity of AI screening is 0.95 [95% CI: 0.91-0.97] and pooled specificity is 0.87 [95% CI: 0.79-0.92]; dilated eyes with manual screening sensitivity is 0.90 [95% CI: 0.87-0.92] and specificity is 0.99 [95% CI: 0.99-1.00].

“AI-assisted screening for diabetic retinopathy shows comparable sensitivity and specificity compared to manual screening,” the study authors stated. “These results suggest that AI can be a reliable alternative in clinical settings, with increased early detection rates and reducing the burden on ophthalmologists.”

The study authors also made note of the heterogeneity in the studies included in terms of study settings, photographic protocols, and reference standards, with reference standards for manual grading differing across studies, among other limitations. The researchers also concluded that since some of the studies had a moderate risk of bias, which could lead to overestimation or underestimation of accuracy.

 “To ensure that AI systems are safe and effective for real-world use, evaluations need to be conducted in representative clinical settings. Systems should be tested on a wide range of image qualities, and medical settings,” the study authors noted.

Tahir HN, Ullah N, Tahir M, et al. Artificial intelligence versus manual screening for the detection of diabetic retinopathy: a comparative systematic review and meta-analysis. 

https://doi.org/10.3389/fmed.2025.1519768

In total, 613,690 images used for screening were included in the study.

AI systems demonstrate promising potential for DR screening, study finds

Susana Marcos, PhD, outlines a presentation she gave at ARVO 2025 on a unique utilization of optical coherence tomography.

ARVO 2025: OCT-based marker for accommodative effort in presbyopes

to discuss research that she presented at ARVO 2025 focusing on optical coherence tomography (OCT) markers for accommodative effort in presbyopes. The study utilized a custom-developed OCT technology specifically designed for high-speed, 3-dimensional imaging of the anterior segment of the eye. The research examined 3 groups of presbyopes: early, middle, and advanced, further subdivided into emmetropes and myopes. The primary goal was to identify how different parameters of the eye change during accommodative effort across these groups. Key findings revealed 3 primary parameters that change significantly during accommodation: lens thickness, anterior chamber depth, and pupil size.

"Over more than 100 years, scientists have been trying to understand the onset of presbyopia, how it progresses all the time, but also to learn more about accommodation," said Percy Lazon de la Jara, director of Research Programs for CooperVision and the paper's coauthor. "There have been hundreds of papers published around this topic. However, Dr Marcos' system gives us an additional hint because of this high technology that she's using to try to understand what previous studies couldn't find because of not having enough resolution to image the eye or to get images from OCT. So Susana's work is really interesting because she has OCT equipment that can image the front of the eye and the crystalline lens, and we can detect changes on the crystalline lens, movement, how it changed its shape, how it changed the radius, what happened to the pupil and to the anterior chamber of people suffering from presbyopia at different stages of life. So that makes it a really interesting area of research, and it can give us new hints about how the accommodative effort works and how it deteriorates over time."

Notably, the researchers discovered some unexpected results, such as a paradoxical increase in pupil diameter during accommodation. Due to this and other factors like illumination, they concluded that pupil size might not be the most reliable marker for accommodative effort. Lens thickness emerged as the most consistent and reliable marker across all presbyope groups. Even as presbyopia advanced, lens thickness demonstrated systematic changes during accommodative demands. Interestingly, myopes showed more pronounced changes compared with emmetropes, with higher slopes of lens thickness change and faster reaction times in dynamic measurements.

The researchers highlighted potential future applications of their findings, such as developing accommodating lenses or devices that could be triggered by measuring lens thickness. The custom OCT technology allows for unprecedented three-dimensional quantification of the crystalline lens, enabling measurements beyond traditional methods. Beyond this specific study, the OCT technology developed by Marcos has broader potential applications, including:

Studying lens changes in myopia development

The study represents a significant advancement in understanding accommodative effort and demonstrates the powerful diagnostic capabilities of advanced OCT imaging technologies.

For the fifth year in a row, VSP Vision has been selected as the 2025 US Best Managed Company Gold Standard award winner.

 The program, sponsored by Deloitte Private and The Wall Street Journal, works to recognize outstanding private companies in the US, according to a news release.

VSP was selected as the winner of the award by a panel of external judges.

“Receiving this award, with Gold Standard honors again, is a testament to our ongoing commitment to deliver purposeful growth and impact for our clients, members and network doctors,” said VSP Vision President and CEO Michael Guyette in the release. “As we also celebrate our 70

 anniversary this year, we’re reminded that achievements like these are the direct result of VSP’s unmatched culture of care, driven by our dedicated employees around the world.”

Additionally, VSP has received Gold Standard status for the second consecutive year through the program. This status is for companies that have received recognition through the program 4 or more times.

Additionally, VSP recently announced the release of “The Future of Oculomics,” a Futurist Report from the VSP Global Innovation Center. The report examines how the eye’s connection to the rest of the human body elevates eye care in the health care continuum outside of the specialty, according to a news release.

 Particularly, oculomics assess the association between ophthalmic biomarkers and systemic health and diseases states.

“The eye has long served as a window into full-body health. During a comprehensive eye exam, an optometrist can detect signs of more than 270 chronic conditions and diseases,” said Ruth Yomtoubian, vice president and head of the VSP Global Innovation Center, in the release. “Thanks to recent advancements in artificial intelligence, imaging technologies, and big data, the role of the eye and eye doctors in overall health is becoming even more significant.”

The report found that 87% of eye care providers were not familiar with the term “oculomics,” therefore classified as a new term in the field; however, 57% did report that they were already providing health insights beyond eye health. A majority (70%) of providers either strongly agreed or agreed that providing health insights that touch on health outside the eye can significantly enhance patient care.

However, eye care providers surveyed remain divided on the role of artificial intelligence (AI) in the field, with 33% either very comfortable or comfortable with AI assistance, 29% uncomfortable or very uncomfortable, and 28% neutral.

Additionally, a large majority (92%) of VSP Vision Care members surveyed either strongly agreed or agreed that eye examinations have the potential to provide valuable health insights beyond eye health. Of members surveyed, 82% reported that they were either comfortable or very comfortable with receiving this information from their optometrist.

Of note, 29% of patients surveyed reported their neurological and cognitive health as the top choice for receiving health information about from their optometrist, with cardiovascular health at 23%.

Additionally, the report highlighted 15 early-stage companies that are utilizing AI-enabled diagnostic solutions to reveal insights into systemic health conditions and diseases. Some of these diagnostic solutions include handheld fundus cameras and smart glasses.

“Oculomics is an emerging field that is still developing. As a leader in health-focused vision care, VSP is excited to explore the potential that oculomics offers for the future of eye care and overall health care,” Yomtoubian said in the release.

VSP Vision receives prestigious 2025 US Best Managed Company Gold Standard award. News release. VSP Vision. May 14, 2025. Accessed May 19, 2025. 

https://vspvision.com/newsroom/company-news/company-announcements/VSP-Vision-Receives-Prestigious-2025-US-Best-Managed-Company-Gold-Standard-Award-

VSP Vision. The Eye as a Window into the Body: The Future of Oculomics. 2025:9. 

https://s.tiled.co/2HcUlf5/futurist-report-oculomics

The VSP Global Innovation Center releases new report on The Future of Oculomics: The study of the eye as a window into overall health.

The award marks the company's fifth consecutive recognition from the program.

VSP Vision selected as 2025 US Best Managed Company Gold Standard award winner

Ophthalmic technologies company Intalight has announced that its DREAM OCT platform received a CE Mark through the European Union.

 The new version of optical coherence tomography (OCT) “provides the highest quality OCT images currently on the market,” according to a news release.

"Intalight is incredibly proud to receive CE mark approval in Europe for our DREAM OCT," said Intalight Chairman and Founder Shawn Peng in the release. "This achievement allows us to provide ophthalmologists in Europe with state-of-the-art technology that delivers improved results for their patients."

DREAM is an acronym for deep imaging depth, rapid sweeping speed, extensive scan range, accurate results, and multimodal imaging capabilities. The device has the capability of covering an ultrawide single scan, delivering a 130-degree optical coherence tomography angiography (OCTA) image. With swept-source 12 mm super-depth scanning, the DREAM OCT is able to image a large portion of the vitreous space, in addition to providing quality imaging of the choroid and retina. The super-depth anterior scanning achieves 16.2 mm (in air), which allows for the complete anterior segment, from the cornea to the anterior part of the vitreous, to be scanned in a single scan.

 The device’s capabilities for longer wavelength allow for the penetration through opacities in either the lens or vitreous, the release stated.

"Over the past few years, we've heard from eye care professionals that they need a solution that gets them over the imaging finish line with speed, accuracy, and depth," said Intalight CEO and Cofounder Bing Li in the release. "DREAM OCT delivers a full set of imaging modalities for the most challenging clinical and research applications for the retina and outperforms everything else health care providers know."

Intalight also noted that more than 160 peer-reviewed papers have utilized findings from DREAM OCT devices thus far.

 One of the most recent studies, published in 

examined the macular sensitivity using microperimetry in patients with proliferative diabetic retinopathy following vitrectomy. The relationship between the sensitivity and foveal microstructures with OCT/OCTA was also assessed. A total of 84 patients (84 eyes) with proliferative diabetic retinopathy indicated for vitrectomy were included in the study, among other inclusion criteria. LogMAR best-corrected visual acuity, macular sensitivity of microperimetry, macular retinal thickness, and macular vessel perfusion using OCT/OCTA were all examined at 1 week, 1 month, and 3 months postoperatively.

“Postoperative mean macular sensitivity was significantly correlated with outer retinal thickness and deep capillary plexus perfusion for patients with proliferative diabetic retinopathy,” the study authors stated. The authors were led by first author Manqiao Wang, MD, PhD, of Tiangin Key Laboratory of Retinal Function and Diseases, the Tiangin Branch of National Clinical Research Center for Ocular Disease, the Eye Institute and School of Optometry, and the Tianjin Medical University Eye Hospital, all in Tianjin, Chian.

DREAM OCT devices are currently being utilized in retina academic institutions and retina private practices in the US, Europe, and Asia, according to Intalight.

"This is such exciting news for Intalight that there's no more waiting in Europe, and we look forward to being able to provide this innovative solution in the US," said Intalight Chief Commercial Officer Joe Garibaldi in the release. "We look forward to continuing to grow our prestigious network of global institutions and ophthalmologists with our recent CE approval and eventually our FDA approval."

Intalight receives CE Mark for its progressive DREAM OCT swept source imaging. News release. PR Newswire. May 15, 2025. Accessed May 19, 2025. 

https://www.prnewswire.com/news-releases/intalight-receives-ce-mark-for-its-progressive-dream-oct-swept-source-imaging-302454390.html

Wang M, Shao Y, Gong Y, et al. Association of macular structure with microperimetry sensitivity following vitrectomy for proliferate diabetic retinopathy. 

DREAM is an acronym for deep imaging depth, rapid sweeping speed, extensive scan range, accurate results, and multimodal imaging capabilities. 

Intalight's DREAM OCT platform receives CE Mark

Neda Shamie, MD; Selina McGee, OD, FAAO, Dipl ABO; and Jacob Lang, OD, FAAO; provided their insights during CIME 2025 on May 4.

CIME 2025: What you missed in presbyopia tips, tricks, and updates

A plethora of topics were discussed from a collaborative care perspective at this year's annual Controversies in Modern Eye Care (CIME) conference in Los Angeles, California. From lenses to eye drops, presbyopia was a particularly hot topic on May 4. Neda Shamie, MD; Selina McGee, OD, FAAO, Dipl ABO; and Jacob Lang, OD, FAAO, detail key takeaways on presbyopia from CIME 2025.

Pharmacological presbyopia treatment is definitely something that we've been thinking about for a long time. It is a kind of a holy grail of eye care. Everyone over the age of 45 develops presbyopia, so to have a solution to bridge those patients until they develop cataracts or significant symptomatic changes of their vision, it's really important to think about solutions for our patients and eye drops. Presbyopia drops are a fantastic option for the right patient. It's ideal for that niche patient, the one who's between 45 and about 55 who is starting to have presbyopia. 

An ideal patient would be an emmetrope who's really enjoyed excellent vision for a long time and is starting to have difficulty with their near vision. There's really no surgical grade option for them. Definitely, spectacles are great. Contact lenses with mono vision are great, but then drops offer an additive, or kind of a complementary option for these patients. What's exciting are all the improvements in the presbyopia drop kind of options that we have available. Thus far, we have had the 1.25% pilocarpine, which has been great and some patients really respond nicely to it. But because of the higher concentration of the pilocarpine, there are [adverse] effects associated with it. 

So now recently, there was a new eye drop the pilocarpine 0.4% that has been FDA approved and available to us. Really exciting, lower concentration of pilocarpine, less [adverse] effect profile and yet equal response. The vehicle of this drop is soothing to the ocular surface. And really it's 2-in-1 in a sense. And many of these patients really have ocular surface disease that contributes to their visual problems. And so the new 0.4% pilocarpine offers ocular surface soothing effect with a vehicle together with a lower dose of pilocarpine.

Presbyopia is one of those really frustrating conditions for patients, and they don't understand all their options. They don't even understand that they can have multiple options. And I think that's the biggest key, is we want to prescribe for specific situations, and that might be a pair of spectacles and a therapeutic drop, it might be contact lenses and spectacles and a therapeutic drop, it might be a surgical option and a therapeutic drop. So I think we have to get out of this mindset. And our patients certainly don't understand this, that there's more than one option, and they're allowed to have more than one option, and so I think it's just really important that we give patients all of the available therapies and all the available technologies we have great candidates for therapeutic interventions with presbyopia are patients that are motivated.

Ultimately, it's not finding the right exact prescription or the right exact pupil size. It's more about is the patient motivated to try something different and be less dependent on their current technology. When you are examining your patient and you're talking about pharmaceutical options for presbyopia, you're going to do everything that you already do. It's going to make sure that the patient is a good candidate for the prescription therapy, and that means looking at their retina, whether it's a wild field photo or it's a dilated eye exam, as long as you can look and make sure they don't have any retinal pathology or anything else that would preclude them from being able to use it. It's the things that you and I already do. So just make sure that patient's had a comprehensive eye exam and then move forward with your therapies from there.

What excites me most about pharmacological correction for presbyopia is really a new option. The flexibility that pharmacological options give our patients to use it when they need it, and be able to give them some freedom, flexibility and lifestyle options for their busy lives and busy careers through these busy presbyopic years is really what excites me most. 

Some of the barriers that patients run into with regard to pharmacologic correction and presbyopia, I think one of the biggest ones is their providers. [It] is actually the doctors not knowing what options are out there with regards to pharmacologic correction and how those pharmacologic options might benefit their patients in their chairs. So furthering their education, embracing new things. I think that's the biggest thing and the biggest barrier to patients getting access to these options. When we're thinking about our patients and taking care of our patients, if we're prescribing any sort of treatment option, we want to do the best for our patients first, right? Do no harm. So we've got to take care of our patients from tee to green, from ocular surface to retina, optic nerve, we've got to take care of the entire patient. And that's why it's so important that we're the doctor, that this is really, you know, we're talking about presbyopia correction with pharmaceuticals. This is an eye drop in an eye drug. And so eye doctors need to take the role there and be the doctor. Take care of the entirety of the globe, the entirety of their ocular health from front to back.

Neda Shamie, MD; Selina McGee, OD, FAAO, Dipl ABO; and Jacob Lang, OD, FAAO, provided their insights during CIME 2025 on May 4.

Conference

A recent study has further underscored the potential of retinal imaging as a noninvasive and accessible screening tool for Alzheimer disease in a multimodal model that utilizes retinal and blood-based biomarkers that have been used to detect the disease.

 The study, led by first author Swetha Ravichandran, PhD student at the University of Alabama at Birmingham, found that combining retinal and blood-based biomarkers significantly improved diagnostic accuracy, particularly when using threonine-217 (p-tau 217) and plasma amyloidogenic beta residue 42/40 ratio (Aβ42/Aβ40 ratio).

“This could revolutionize early AD detection, facilitating earlier intervention, and improved disease management,” the study authors stated.

The study authors also noted that while previous studies have shown that blood-based and retinal biomarkers have shown potential to identify patients that may be at risk for Alzheimer disease, integrating the 2 types of biomarkers has not been adequately assessed in preclinical Alzheimer disease.

 “This concept introduces a novel and synergistic approach to improve screening accuracy and predictive capability for early AD detection,” the researchers stated.

By using a multimodal receiver operating characteristic model based on retinal biomarkers (gliosis area, inner inferior retinal nerve fiber layer [RNFL] thickness) and plasma biomarkers (p-tau217 and Aβ42/Aβ40 ratio), researchers observed an area under the curve (AUC) of 0.97 (95% CI = 0.93–1.01) when compared to unimodal models of retinal and plasma biomarkers. Researchers also evaluated the diagnostic value of neurofilament light (NfL) and threonine-181 (p-tau181).

“A single retinal biomarker may not be sensitive or specific to AD. This is because these retinal biomarkers are also affected by other retinal diseases. Even though we clinically excluded comorbid retinal conditions, it is difficult to distinguish preclinical manifestations of these comorbid retinal conditions from retinal changes that occur in preclinical AD,” the study authors stated. “For example, putative retinal gliosis is indicated in other retinal conditions that have neuroinflammatory components such as glaucoma, diabetic retinopathy, and [epiretinal membrane]. While the above retinal diseases were clinically excluded from our study, it is possible that some of the retinal changes observed could be preclinical manifestations of these conditions.”

A total of 82 cognitively unimpaired participants, and 141 eyes, who were previously involved in the Atlas of Retinal Imaging in Alzheimer’s Study (ARIAS), were included in the study. Inclusion criteria for the study included the absence of or controlled hypertension (blood pressure < 140/90), hyperlipidemia (total cholesterol ≤ 240 mg/dL), and systemic diabetes (HbA1c ≤ 7). All eyes in the study had a best corrected visual acuity of ≥ 20/40 (~ Log MAR 0.30) and refractive errors ≤ ± 3.00 DS (spherical equivalent) or equivalent axial lengths (range: 22–24 mm) in order to prevent any significant differences in the retinal magnification, per the Bennett formula.

Participants also underwent comprehensive neuropsychological assessment using the MoCA and the RBANS-U. Spectral domain optical coherence tomography images were obtained, and plasma sampling and analysis were conducted for the study. With 32 participants having received recent Aβ PET neuroimaging, the results were also made available to the ARIAS study team.

A significant correlation was also found between putative retinal gliosis and p-tau217 in the univariate mixed model (

 = .007) but not for the other plasma biomarkers evaluated (

 > .05). Additionally, a sensitivity of 93.8% and a specificity of 92% was observed in the Aβ42/Aβ40 ratio.

Study authors noted that future research should work to validate the findings of the study in larger, more diverse populations, in addition to evaluating the longitudinal impact of retinal changes in Alzheimer disease progression. Biological mechanisms linking the disease pathology to putative retinal gliosis could also provide an opportunity to understand more about said pathology and therapeutic targets.

Ravichandran S, Snyder PJ, Alber J. Association and multimodal model of retinal and blood-based biomarkers for detection of preclinical Alzheimer’s disease. 

2025;17:19. https://doi.org/10.1186/s13195-024-01668-5

The recent study details the diagnostic value of a multimodal model utilizing both types of biomarkers when compared with unimodal models.

Steven A. Greenstein, MD

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