Year in review of optometric advancements

Exploring how technological and pharmaceutical advancements will change the field, four ODs discussed primary areas to watch in this year during a rapid-fire lecture at the American Academy of Optometry 2019 meeting in Orlando. Participants were:
Jacob Lang, OD, FAAO, of Stillwater, MN
Jaclyn Garlich, OD, FAAO, of Boston
Mark Buboltz, OD, FAAO, of Bloomington, MN
Roya Habibi, OD, FAAO, FSLS, of Seattle
Myopia control contact lenses
Historically, ODs have looked at orthokeratology as the gold standard for myopia control but now, soft lens technology is catching up.
Daily-wear soft contact lenses have been approved for myopia control, featuring dual-focus, distance-centered lenses with low refractive error and axial length.

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Low-dose atropine is a known solution for slowing myopia progression, but a new drug called micropine has entered the scene.
“This is testing 0.01 % and 0.1 % atropine,” Dr. Garlich says, noting that research indicates that myopia progression can be slowed by as much as 60 to 70 percent.
Presbyopia treatment drops
Multiple companies are working on presbyopia drops. Different modes of action involve miosis to increase depth of focus or addressing lens elasticity directly.
“The average result is around two lines of near vision improvement,” Dr. Garlich says.
Presbyopic surgical option
The latest presbyopic surgical options include corneal inlays such as Kamra (SightLife), which offers a 1.6-mm aperture to create a slight pinhole effect with a modified monovision approach.
Raindrop, another corneal inlay option, has been recalled by the U.S. Food and Drug Administration (FDA) due to the risk of corneal haze.
Premium IOLs
Trifocal and light-adjustable intraocular lenses (IOL) are emerging with options available from Alcon (AcySof IQ PanOptix), (Johnson & Johnson Vision (Tecnis Symfony), and RxSight (Light Adjustable Lens).
In particular, options like extended range of vision lenses are designed for elongating focus and offering continuous vision with high contrast. Light-adjusted IOLs bring new ways to help eyecare practitioners lock in the correct prescription for patient comfort by featuring lens optics that can be adjusted up to three times each, three to five days apart.
Postop inflammation
ODs may be interested in new intracameral medications such as Dexycu (EyePoint). This is dexamethasone intraocular suspension 9 percent that dissolves within a month.
“We can see that, when compared to the placebo in about 60 percent of patients, their anterior chamber cleared,” Dr. Lang says.

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Dexamethasone plugs
Dextenza (Ocular Therapeutix) is a dexamethasone insert that delivers medication to the ocular surface for up to 30 days. This punctal plug is FDA approved for managing postoperative pain and inflammation and is preservative-free. As a plus, ODs don’t need to worry about sizing when applying the insert.
“Once the plug is placed, it is activated by moisture and will swell to fit,” Dr. Garlich says.
Rho-k inhibitors
Two new glaucoma medications that target rho-kinase inhibitors include Rhopressa (netarsudil ophthalmic solution 0.02%, Aerie) as well as Rocklatan (netarsudil/latanoprost ophthalmic solution 0.02%/0.005%, Aerie), which was approved in 2019.
Glaucoma
For managing glaucoma and dry eye, ODs may be interested in Xelpros (latanaprost, Sun Pharma), the first commercially available latanaprost formulation that is benzalkonium chloride (BAK) free.
“Another way to get around this whole dilemma of glaucoma and dry eye is to microdose it, such as through the microdosing Eyenovia Optejet eye dropper,” Dr. Buboltz says.
New minimally invasive glaucoma surgeries (MIGS) give ourglaucoma patients more opportunity to decrease their glaucoma drops after being combined with cataract surgery. The Hydrus implant (Ivantis) and iStent Inject (Glaukos) are notably two new MIGS devices which have proven some benefits over the original iStent (Glaukos).
Also on the horizon is Allergan’s Bimatroprost SR (Sustained-Release) Implant. The drug can be injected into the eye and has shown a 30 percent reduction in intraocular pressure (IOP) over 12 months. Allergan submitted a New Drug Application (NDA) to the FDA in July 2019.
In terms of minimally-invasive glaucoma surgery (MIGS) options, ODs can expect to see the Hydrus Microstent (Ivantis), iStent Inject (Glaukos), and iStent Supra (Glaukos). There will also be new, valveless tube shunts entering the market, such as Ahmed ClearPath (New World Medical).

Related: AI testing is almost here, and it doesn’t care if ODs are readyArtificial tears
New artificial tear options include Refresh Relieva by Allergan, designed to work on hyperosmotic tears, and Systane Complete, which works on all layers of the tear film at once. 
“This is unique in that it has these nanodroplets that help minimize blur when you put the drop in,” Dr. Garlich says.
Dry eye nasal spray
An innovative new drug for dry eye is a nasal spray OC-01 (Oyster Point), which targets the trigeminal nerve inside of the nose to stimulate tear production. This drug is currently undergoing two Phase IIb clinical trials.
Intense pulsed light
Intense pulsed light (IPL, Lumenis) solutions for managing dry eye are gaining ground in optometry, with treatment research showing statistically significant improvements for refractory dry eye and meibomian gland function.
Neurotrophic keratitis
Oxervate (cenegermin, Dompé) is a newly approved drug for managing neurotrophic keratitis. This approach leverages a nerve growth protein that occurs naturally in the human body to heal nerves, stimulating immature neurons to grow and survive.
Cutting-edge contact lenses
One of the newest technologies is Oasys with Transitions (senofilcon A, Johnson & Johson Vision). This lens is innovative because of its 30-second activation time and a partial filter for indoor light. 
Another new option is Precision1 (verofilcon A, Alcon), featuring a microthin layer of moisture on the lens surface with a total composition of over 80 percent water.
New monitoring technology
New technologies in optometry include IDx-DR (IDx Technologies), an FDA-approved monitoring tool that uses artificial intelligence to assess fundus photos for signs of diabetic retinopathy.
“It is pretty accurate,” Dr. Garlich says.
Another exciting tool is EyeBOX (Oculogica), an FDA-approved device for concussion diagnosis. A simple test with eye-tracking software allows ODs to better diagnose concussions and monitor patient conditions over time.

More by Greg Hill: Know what common glaucoma mistakes to avoid