PURPOSE: The kalifilcon A daily disposable toric CL (INFUSE for Astigmatism [IfA]) is designed to provide clear, stable vision and support ocular surface homeostasis for comfortable wear. This real-world evaluation assessed patient satisfaction and experience with the IfA CL.

METHODS: Astigmatic patients aged ≥18 years (whether new or existing CL wearers) were invited by their eye care practitioners (ECPs) to be fitted with IfA CLs and trial them for a 5-day period. Participants then completed an online survey about their experience, with at least 60% of responses validated through follow-up phone calls. A two-sided asymptotic binomial test assessed whether more than 50% of respondents provided favorable ratings for key attributes.

RESULTS: A total of 208 participants completed the survey (71.2% female, mean age 38.5 years). Of these, 57.2% were current contact lens wearers, 40.9% primarily wore eyeglasses, and 1.9% used no prior vision correction. Most participants (84.1%) reported wearing the IfA lens for the full 5-day trial period. The majority agreed that IfA lenses delivered consistently clear vision throughout the day (82.1%), including during physical activities (85.7%) and digital device use (87.0%). Additionally, 77.6% reported reduced halos and glare, even in low-light conditions. Ease of handling was rated favorably by 92.8%, and 91.8% gave a positive overall opinion of the lens. Many indicated they would continue wearing IfA lenses after the study (84.6%) and would recommend them to friends or family who wear contact lenses (93.8%). Participants also expressed interest in learning about new contact lens technologies, with 92.8% valuing ECP education and 86.5% wanting updates on comfort-enhancing innovations. Favorable responses exceeded 50% for all key measures (p<0.001).>

CONCLUSIONS: The present study provides patient perspectives on the real-world performance of the IfA CL. Patients agreed it delivered consistently clear vision and reported a highly positive opinion of it overall; they were likely to continue wear after the trial and were likely to recommend to other CL wearers. Patients are also very open to education and discussion regarding new advancements.

PURPOSE: Tear film changes during contact lens (CL) wear can drive CL dryness and discomfort, a key reason for discontinuation. Digital device use can worsen this through altered blinking and eye strain. CL care solutions may improve wear experience by addressing mechanisms of discomfort; although satisfaction with available solutions is high, many wearers still experience dryness. Biotrue Hydration Plus (BHP) is a multi-purpose solution (MPS) developed to improve comfort. This report describes results of a real-world evaluation of BHP MPS among habitual soft CL wearers who are heavy digital device users experiencing CL-related dryness.

METHODS: Eligible adults (≥18 years) who were habitual soft CL users with an eye exam within 2 years were recruited to the study. The cohort of interest included heavy digital device users (≥10 weekday hours using a computer, smartphone/tablet, or gaming) who reported CL-related dryness at baseline. Participants used BHP MPS for 7 days with a new pair of CLs before completing an online survey (7-point Likert scale). A two-sided asymptotic binomial test assessed whether >50% of responses indicated agreement.

RESULTS: Of a total of 194 participants who were heavy digital device users experiencing CL-related dryness (47.9% female, mean age 41.9 years), a majority (58.8%) had been wearing CLs for >10 years, and 60.3% wore their CLs for 7 days/week. At the end of the trial period, 99.5% of participants were satisfied with how CLs felt after using BHP MPS; 95.4% agreed that BHP MPS helped CLs stay comfortable throughout the day, and 93.3% agreed that BHP MPS helped keep CLs comfortable even when using screens for hours. In addition, 93.8% agreed that BHP MPS helps keep CLs comfortable so they do not feel like their eyes are tired. Agreement rates were 97.9% for gentleness on eyes, 97.4% for keeping lenses feeling clean, and 93.8% for helping to prevent CL dryness. Within-group agreement responses were statistically significantly greater than 50% for all performance attributes (p<0.001).>

CONCLUSIONS: This MPS demonstrated strong satisfaction and performance in this population. CL care solution choice can support a positive real-world wear experience, including for those with extensive digital device use, which commonly contributes to CL dryness.

PURPOSE: While silicone hydrogel contact lenses (CLs) have gained favor among eye care practitioners (ECPs) in recent years, conventional hydrogel CLs continue to represent a meaningful proportion of CLs used in real-world practice. The nesofilcon A daily disposable CL (Biotrue ONEday, BTOD) consists of a unique hydrogel material with a highly hydrophilic polymer (polyvinylpyrrolidone) yielding a CL with the same water content as the human cornea (78%) and a patented dehydration barrier (poloxamer 407) to retain moisture for up to 16 hours and mimic the tear film lipid layer for a smooth optical surface. This meta-analysis evaluated results, including key safety assessments, across key registrational trials that included the BTOD lens which, together, span nearly a decade.

METHODS: This meta-analysis included three 3-month randomized multicenter registrational clinical trials (all in ClinicalTrials.gov) that have evaluated the safety and effectiveness of BTOD, including the first ever registrational study of BTOD as well as 2 subsequent studies of BTOD and BTOD for astigmatism, respectively. Here we report on key results for BTOD in these studies: participant demographics, as well as safety outcomes including slit lamp findings and adverse events. Descriptive data (n [%]) are reported.

RESULTS: A total of 338 participants (676 eyes) who wore BTOD CLs were analyzed across the three studies (N=87 [174 eyes], N=128 [256 eyes], N=123 [246 eyes] in each study individually; intent-to-treat population). Participants were between 18–59 years of age (18–40, 18–55, and 19–59 years) with the majority being female (64.4%, 74.2%, and 63.4%). Over 3 months of follow-up across all studies, BTOD demonstrated robust safety: across all study visits and accounting for a total of over 2,000 documented eye assessments, no significant changes in ocular condition or slit lamp findings >Grade 2 were reported. Incidence of treatment-emergent ocular adverse events was also low across studies (none serious or resulting in discontinuation).

CONCLUSIONS: The present findings in a large population derived from key registrational studies with BTOD, which were conducted over the course of nearly a decade, demonstrate the robust and consistent safety of BTOD when used daily by soft CL wearers. Such insights are valuable to affirm the benefits that a hydrogel daily disposable CL such as BTOD can offer to both patients and ECPs.

PURPOSE: Geographic atrophy (GA), an advanced form of age-related macular degeneration (AMD), is characterized by progressive loss of photoreceptor cells and retinal pigment epithelium (RPE) leading to vision loss. Drugs that protect photoreceptors and RPE may offer significant structural and functional benefits. Alpha-2 adrenergic receptor agonists have shown efficacy in multiple experimental models of retinal disease and slowed GA lesion growth in human clinical trials, suggesting they may be beneficial as novel GA therapeutics. Herein, we used a blue light retinal degeneration model to investigate the effects of a novel alpha-2 adrenergic receptor agonist, BL1106, on outer retinal structure and electrophysiological function.

METHODS: An alpha-2 adrenergic receptor agonist, BL1106, vehicle, or brimonidine was prophylactically administered to male Sprague–Dawley rats either via daily intraperitoneal (i.p.) injections starting 1 hour prior to blue light exposure or by subcutaneous (s.c.) osmotic mini-pumps starting 2 days prior to blue light exposure at 1 mg/kg/day. Treatments continued until day 7 or 14 post blue light exposure. Retinal thickness was measured by optical coherence tomography (OCT) on day 7 or 11. Electroretinography (ERG; scotopic and photopic a- and b-wave) function was evaluated on day 14 in the osmotic mini-pump cohort.

RESULTS: Mean retinal thickness was significantly greater in animals that received BL1106 or brimonidine daily i.p. injections compared to vehicle controls on day 11 post-exposure (p<0.0001), demonstrating a protective effect of alpha2-adrenergic agonist treatment. animals treated with bl1106 via osmotic mini-pump showed a significantly greater mean retinal thickness compared to those animals that received osmotic mini-pump delivery of vehicle p="0.0003)" or brimonidine p><0.0086) on day 7 post-exposure suggesting improved structural effects with bl1106 treatment. these findings corresponded with improved erg function in animals receiving bl1106 but not brimonidine on day 14 post-exposure compared to vehicle controls.>

CONCLUSIONS: A novel alpha-2 adrenergic agonist, BL1106, preserves retinal thickness and ERG function in a blue light model of retinal degeneration, suggesting its potential as a promising future therapeutic for AMD.

PURPOSE: A Phase 2 trial evaluated the safety and efficacy of BL1107 (formerly WB007), a potent, targeted alpha2 agonist in development, to lower intraocular pressure (IOP) and acutely improve vision in patients with glaucoma.

METHODS: 59 patients with glaucoma were enrolled in a 14-day randomized controlled trial comparing BL1107 (0.15% and 0.4%) to timolol (Tim) 0.5% each administered topically twice daily. Mean change from baseline IOP at Day 14 Hour 2 was the primary efficacy endpoint. Endpoints also included mean deviation in decibels (dB) on Humphrey visual fields (HVF) and best refracted low-luminance visual acuity (LLVA). Safety data including adverse events were collected at all study visits. A sample size of 24 per group had >90% power to detect a within-group mean change from baseline of at least 3 mmHg assuming a standard deviation of 2.5 and a two-sided alpha of 0.05, and 91% power to detect between group treatment differences of at least 3 mmHg.

RESULTS: Baseline demographics and IOP were well balanced among groups. Subjects receiving BL1107 were slightly older and baseline IOP was slightly lower compared to subjects receiving Tim. Both doses of BL1107 met the primary endpoint. Within-group mean change from baseline IOP was -4.9, -5.1, and -6.0 mmHg for BL1107 0.15%, BL1107 0.4%, and Tim 0.5%, respectively (p<0.001 for each. between group differences were not statistically significant. bl1107 demonstrated statistically significant improvements in mean deviation on hvf in study eyes 1.4 db bl1107 0.15 vs. tim p="0.046)" and in treated non-study eyes 2.4 db bl1107 0.15 vs. tim p="0.002" and 1.8 db bl1107 0.4 vs. tim p="0.012)." more patients receiving bl1107 had a>15-letter improvement in LLVA in study eyes compared to timolol: 8.7% for BL1107 0.15%, 16.7% for BL1107 0.4%, and 0% for Tim (p>0.05) although the study was not powered for this endpoint. BL1107 was well tolerated. There were no clinically meaningful changes in vital signs, laboratory values, or pupil size with any treatment. Adverse events with BL1107 were mostly mild, transient, and did not lead to discontinuation.

CONCLUSIONS: BL1107 significantly lowered intraocular pressure and demonstrated improvements in visual function compared to timolol. The acute improvements in vision are being investigated in a larger clinical trial.

PURPOSE: To evaluate the analgesic efficacy of topical ocular BL1312 (formerly SAF312/Libvatrep) for postoperative pain following photorefractive keratectomy (PRK) using the Sum of Pain Intensity Differences method over 0–24 hours (SPID24), aligned with FDA guidance on development of non-opioid analgesics for acute pain. The original coprimary endpoints, mean VAS difference at 6 hours (−11.1 mm; p=0.005) and average VAS difference over 0–12 hours (−8.6 mm; p=0.017), were statistically significant.

METHODS: In a Phase 2a randomized, double-masked, vehicle-controlled, bilateral crossover study (NCT02961062), 40 participants undergoing bilateral PRK were randomized 1:1 to two treatment sequences: BL1312 in period 1 after PRK in the nondominant eye followed by vehicle in period 2 after PRK in the fellow eye, or the reverse sequence of study treatment ordering. BL1312 2.5% and vehicle were administered as single drops four times daily (every 6 hours) for 72 hours postoperatively. Pain was assessed using a visual analog scale (VAS) at multiple time points. Data were reanalyzed using SPID24, calculated by the trapezoidal rule. Additional analyses using SPID over 0–12 hours was also performed. Statistical tests used a linear mixed model fit by REML using 0.95% 2-sided confidence level and Kenward-Roger degrees-of-freedom method.

RESULTS: BL1312 demonstrated statistically significantly greater pain reduction in terms of cumulative change in pain compared with vehicle over 0–24 hours (SPID24: −184; p=0.0131). Significant benefit was also observed over 0–12 hours (SPID12: −89.8; p=0.0266) These findings corroborate the original primary analyses and demonstrate consistent pain reduction with BL1312 across the 24-hour postoperative period.

CONCLUSIONS: Use of the cumulative SPID24 endpoint confirms the clinical efficacy of topical BL1312 in delivering significant postoperative pain relief over 24 hours following PRK. This reanalysis provides robust and clinically relevant support for BL1312 as a non-opioid option for management of acute post-PRK pain.

PURPOSE: Transient receptor potential subfamily V member 1 (TRPV1) is a non-selective cation channel that acts as a polymodal receptor and is highly expressed in corneal sensory neurons and corneal epithelial cells. TRPV1 responds to mechanical, thermal, and chemical stimuli and plays a key role in nociception and pain signaling. In this study, we tested the hypothesis that BL1332, a novel TRPV1 antagonist, suppresses acute pain behavior in a rat model of capsaicin-induced ocular pain in order to assess in vivo TRPV1 target engagement.

METHODS: Sprague Dawley rats received a corneal epithelial injury in the right eye (OD) using an Algerbrush. Capsaicin, a potent TRPV1 agonist, was then applied topically OD, and the number of eye wipes was recorded for 60 seconds. Thirty minutes after topical capsaicin application, rats received a topical dose of vehicle, 0.5% proparacaine, or BL1332 at one of four doses: 0.02%, 0.06%, 0.15%, or 0.3%. At 15 minutes, 30 minutes, or 6 hours post-treatment, rats received a second topical application of capsaicin OD, and the number of eye wipes was recorded for 60 seconds to assess pain suppression and duration of observed effect.

RESULTS: Across all BL1332 concentrations tested, a single instillation significantly suppressed capsaicin-induced pain behavior (number of eye wipes) at 30 minutes post-administration compared with vehicle (p<0.01). in contrast 0.5 proparacaine produced a significant reduction only at 15 minutes post-administration p><0.001). notably 0.3 bl1332 demonstrated pain suppression for 6 hours p="0.0004)," whereas 0.02 did not indicating a dose-dependent duration of action.>

CONCLUSIONS: Our study demonstrates that BL1332 robustly inhibits acute capsaicin-induced ocular pain response, with efficacy lasting at least 6 hours at sufficient concentration. These findings help confirm pharmacological activity and in vivo TRPV1 target engagement of BL1332 and support its development for ocular surface pain indications.

PURPOSE: Non-arteritic anterior ischemic optic neuropathy (NAION) is the most common acute optic neuropathy in adults older than 50 years, with contralateral eye involvement occurring in 15–25% of patients within 5 years. However, risk factors predicting contralateral involvement remain incompletely characterized in large, real-world populations. This retrospective cohort study used electronic health record (EHR) data to assess 25 unique clinical conditions, plus diagnostic subtypes and groupings of these risk factors by clinical category, that are potentially associated with development of contralateral NAION.

METHODS: Risk factors previously reported to be associated with initial NAION incidence were identified through literature review, with medication risk factor analysis requiring ≥3 instances of documentation for inclusion. Using TriNetX, separate cohorts of patients with isolated left-eye or right-eye NAION were assembled. Within each cohort, Cox proportional hazards models were used to estimate the effect of each risk factor on developing contralateral NAION within 1 or 5 years, controlling for age at index, sex, essential(primary) hypertension, diabetes mellitus, lipid disorders, sleep apnea, overweight/obesity, and disorders of the lens. Hazard ratios (HRs) were pooled across right- and left-eye cohorts using inverse-variance weighting and reported with 95% confidence intervals (CI).

RESULTS: In the pooled 1- and 5-year analyses, none of the evaluated risk factors demonstrated a statistically significant association with contralateral NAION. Risk factors showing nonsignificant trends toward increased risk and HR >1.5 included (HR; 95% CI): primary thrombophilia at 5 years (2.10; 0.28–15.95), amiodarone at 1 year (2.04; 0.69–5.99) and 5 years (1.68; 0.65–4.32), optic disc drusen at 1 year (1.65; 0.32–8.43) and 5 years (1.57; 0.39–6.42), and semaglutide at 1 year (1.57; 0.28–8.83).

CONCLUSIONS: Risk factors previously associated with first-eye NAION were not confirmed as predictors of contralateral involvement in this large EHR-based analysis. The low incidence of contralateral NAION in this dataset limited statistical power to detect associations. A dataset with higher incidence of contralateral NAION or evaluation of alternative or additional risk factors may be required to better characterize predictors of contralateral NAION.

PURPOSE: Transient receptor potential vanilloid 1 (TRPV1) is an ionotropic receptor expressed in corneal epithelial cells and polymodal sensory neurons. Activation of polymodal nociceptors contributes to both physiological and pathological processes of the ocular surface, including pain sensation and wound healing. BL1332, a novel topical TRPV1 antagonist under development by Bausch + Lomb, is being evaluated as a potential therapeutic for ocular surface pain. In this study, we assessed the effect of 0.3% BL1332 on wound healing rate following central corneal keratectomy and evaluated its impact on corneal sensitivity in the intact contralateral eye.

METHODS: New Zealand White rabbits underwent partial keratectomy (8mm diameter, 100µm depth) on the left eye (OS). BL1332 0.3% was administered to both eyes four times daily (QID) for 9 days. Wound size was assessed once daily by fluorescein staining. Central corneal thickness was measured using optical coherence tomography (OCT). Corneal sensitivity in the intact contralateral eye (OD) was evaluated with a Cochet–Bonnet esthesiometer 10 minutes after the fourth daily dose.

RESULTS: Eyes treated with 0.3% BL1332 healed at a rate comparable to those treated with buffered saline solution (BSS) and faster (p<0.01 at day 6 post-keratectomy than eyes treated with 0.1 dexamethasone a corticosteroid known to delay wound healing but often prescribed post-surgery. after 9 days of 0.3 bl1332 qid administration os corneal thickness returned to baseline pre-surgery levels. lastly 0.3 bl1332 did not alter mechanical corneal sensitivity in the intact contralateral eye when compared with the anesthetic proparacaine p><0.01).>

CONCLUSIONS: Our results show that topical BL1332 administered QID did not impact wound healing rate and did not affect central corneal thickness after healing. In addition, BL1332 did not reduce corneal sensitivity, supporting an analgesic, rather than anesthetic, mechanism of action.

PURPOSE: This study evaluated the concentration-dependent effects of glycerin on cellular metabolic activity in transformed human conjunctival and corneal epithelial cells exposed to desiccation stress.

METHODS: Human corneal epithelial cells from American Type Culture Collection (ATCC-HCEC) and the Riken Cell Bank (Riken-HCEC), as well as human conjunctival epithelial cells (HConjEC), were cultured until confluent. Six concentrations of glycerin (0.1%, 0.2%, 0.5%, 1.0%, 1.2%, and 1.5%) were tested against 50% Hank's balanced salt solution (HBSS) as a negative (no protection) control for each experiment. Cells were pre-exposed to test articles for one hour, after which solutions were removed from cells and the plates were left uncovered in a tissue culture hood with air-flow exposure for 0, 15, 30 or 45 minutes to induce air desiccation. Metabolic activity of the cells was determined by alamarBlue assay and measured in relative fluorescent units (RFUs). Integrated responses of the change in normalized RFUs were analyzed by calculating the areas under the curve (AUC) for each test well over the time course.

RESULTS: Minimal differences were observed between glycerin-pretreated cells and the HBSS control at the 0-minute time point across all three cell lines. Across the desiccation exposure periods, all six concentrations of glycerin produced significantly higher AUC values of normalized metabolic activity compared with the HBSS control in all cell lines tested.

CONCLUSIONS: Glycerin concentrations ranging from 0.1% to 1.5% demonstrated protective effects against air-induced desiccation in conjunctival and corneal epithelial cells. These findings indicate that glycerin may contribute to protection from desiccation stress and support ocular surface homeostasis.

PURPOSE: Inflammation associated with the ocular surface is multifactorial, with environmental, lifestyle, and physiological factors all contributing to ocular surface health. Preservative-free (PF) lubricating eye drops offer a tolerable, accessible option for symptomatic relief. This real-world study evaluated patient experiences with a novel PF lubricating eye drop (Blink Boost PF) containing hyaluronic acid (HA) and polyethylene glycol (PEG) in adults with dry eye symptoms.

METHODS: Adults (≥18 years) with self-reported dry eye symptoms and current users of over-the-counter (OTC) lubricating eye drops participated in a multicenter, prospective, open-label, real-world study. Participants used Blink Boost PF as needed for 4 weeks. Patient-reported outcomes including dry eye symptom severity, comfort, and satisfaction were collected via validated questionnaires at baseline and at follow-up visits.

RESULTS: Participants reported significant improvements in dry eye symptoms after using Blink Boost PF, with statistically significant reductions in symptom severity and improvements in comfort versus baseline. The majority of participants reported satisfaction with the product, citing benefits such as ease of use, fast-acting symptom relief, and tolerability. No serious adverse events were reported during the study.

CONCLUSIONS: In this real-world evaluation, Blink Boost PF demonstrated meaningful improvements in dry eye symptoms and patient-reported satisfaction in adults with dry eye. These findings support the use of PF lubricating eye drops with HA and PEG as an effective option for managing dry eye symptoms.

PURPOSE: This study examined the concentration-dependent effects of hyaluronic acid (HA) on cellular metabolic activity in transformed human conjunctival and corneal epithelial cells exposed to desiccation stress.

METHODS: Human corneal epithelial cells from the American Type Culture Collection (ATCC-HCEC) and the Riken Cell Bank (Riken-HCEC), as well as human conjunctival epithelial cells (HConjEC), were cultured until confluent. Five concentrations of HA were tested against 50% Hank's Balanced Salt Solution (HBSS) as a negative (no-protection) control. Cells were pre-exposed to test articles for one hour, after which the solutions were removed. Plates were left uncovered in a tissue culture hood with airflow exposure for 0, 15, 30, or 45 minutes to induce air desiccation. Metabolic activity was assessed using the alamarBlue assay and measured in relative fluorescence units (RFUs). Integrated responses of normalized RFUs (NR) were quantified by calculating area under the curve (AUC) for each well over the time course.

RESULTS: Minimal differences were observed between HA-pretreated cells and the HBSS control at the 0-minute time point across all cell lines. Under desiccation exposure, HConjEC (0.02–0.1% HA), Riken-HCEC (0.05–0.1% HA), and ATCC-HCEC (0.1% HA) demonstrated significantly higher AUC values of normalized metabolic activity with HA compared with the HBSS control.

CONCLUSIONS: Across the three cell lines, HA concentrations ranging from 0.02% to 0.1% exhibited protective effects against air-induced desiccation. These findings suggest that HA may contribute to protection from desiccation stress in topical ophthalmic formulations and support ocular surface homeostasis.

PURPOSE: Dry eye disease (DED), resulting from tear film dysfunction, is associated with ocular irritation and inflammation. The use of nutritional supplements may contribute to the management of DED. This study aimed to assess patient satisfaction, effectiveness, and ease of use of the Blink NutriTears (NT) supplement among adults with dry eye symptoms in an in-home usage test.

METHODS: The study protocol was reviewed and approved by an independent IRB (WIRB/WCG). Adults (≥18 years, US residents) with a healthcare professional diagnosis of dry eye and an OSDI12 score of 12–50 were enrolled by contacting clinicians who treat patients with DED. Exclusion criteria included pregnancy and a prior allergic reaction to nutritional supplements. Thirteen clinicians distributed 100 days of NT to 167 patients. Surveys assessed patient experiences, satisfaction, and perceived efficacy. Data were collected June–September 2025 and analyzed for changes from baseline to Day 56.

RESULTS: 135 patients (78% female, mean age 48 years, mean dry eye diagnosis duration 4 years) completed all four surveys (days 0, 14, 28, and 56). At baseline, 73% agreed supplements were important to their daily routine, but only 40% believed oral supplements could manage dry eyes and 32% preferred oral supplements over topical drops. By Day 56, 77% agreed that supplements were important to their routine (+4%), 75% believed supplements can be effective in managing dry eye (+35%), and 63% preferred oral supplements over drops (+31%). Screen comfort improved: participants reported 1.5 more hours/day of comfortable screen use after 56 days, and 60% (+32% from baseline) said dry eyes rarely or never limited screen time. More respondents reported that dry eyes were no longer disrupting their lives following the 56-day trial: disagreement about quality-of-life impact rose from 11% to 42%, and disagreement about work disruption rose from 14% to 45% (both +31% vs. baseline). By Day 56, 53% agreed their eyes felt comfortable all day (vs. 4% at baseline), and 32% agreed their eyes never felt stressed (vs. 4%). Fewer participants used OTC eye drops by study end, and those who did used them less frequently.

CONCLUSIONS: NT was associated with improved patient-reported outcomes in dry eye symptoms, quality of life, and work productivity. The supplement was well tolerated, easy to use, and led to reduced reliance on OTC eye drops.

PURPOSE: This work aims to evaluate the halo patterns produced in far vision by two extended range of vision (ERV) intraocular lenses (IOLs), focusing on their spatial extent and intensity. The objective quantification of halos aids in the understanding of dysphotopsia, a condition that can significantly impact visual performance.

METHODS: Halo formation in distance vision with the ERV IOLs B+L enVista Beyond and Alcon Vivity was evaluated objectively using an optical bench. Both lenses had a nominal power of 20 D. The Beyond model is a free spherical aberration (SA) IOL, whereas the Vivity incorporates SA = -0.20 microns for a 5.15-mm pupil at the IOL plane (IOL-pupil). The experimental setup employed an artificial eye model compliant with ANSI Z80.35-2018, featuring an artificial cornea with SA = +0.27 µm (5.15-mm IOL-pupil). Illumination of a 3.44-arcmin pinhole target was provided by a warm-white high-intensity LED combined with a V(λ) photopic filter to simulate the human visual sensitivity.

RESULTS: Images at the far focus plane for both IOLs using IOL-pupils of 3.0 and 4.5 mm are shown in Figure 1. The larger, 4.5-mm pupil corresponds to mesopic distance-vision conditions, such as nighttime driving. All images were processed applying a gamma correction of 0.4 to enhance the visibility of the surrounding halo structures. For the 4.5-mm pupil, the two lenses exhibited halos of comparable extent and intensity, whereas at 3.0 mm the Beyond IOL generated a slightly smaller and more compact halo pattern (Figure 2).

CONCLUSIONS: Halo formation with two ERV IOLs was assessed using an ANSI Z80.35-2018 compliant model eye on an optical bench under white-light conditions. Both lenses exhibited halo patterns of similar size and intensity, with minimal dependence on pupil diameter at 3.0 and 4.5 mm. A modest reduction of the halo was noted for the enVista Beyond lens at 3.0 mm. These findings provide preclinical evidence that may help guide clinicians in selecting the most appropriate IOL for patients undergoing cataract surgery.

PURPOSE: Dissatisfaction with the implanted IOL due to undesirable photic phenomena, contrast sensitivity issues, or inadequate visual performance, etc, may necessitate IOL exchange surgery with another IOL. enVista Envy is a full visual range (FVR) IOL designed to enhance the range of vision, maintain good contrast, and induce minimal dysphotopsia. The purpose of this retrospective study was to evaluate visual performance and patient-reported outcomes following IOL exchange surgery with a FVR IOL.

METHODS: Case records of 23 patients (32 eyes) who were dissatisfied with previously implanted IOLs, such as Clearview 3, Tecnis Odyssey, Alcon PanOptix, Light Adjustable Lens (LAL), or other monofocal IOLs, and underwent IOL exchange with the enVista Envy FVR IOL were reviewed. Outcome measures included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected near visual acuity (UNVA), manifest refraction spherical equivalent (MRSE), and subjective patient experience at 1-month follow-up following the IOL exchange.

RESULTS: Following IOL exchange with the FVR IOL, the mean UDVA was 0.12 ± 0.15 logMAR, with 84.4% of eyes achieving 20/30 or better. The mean CDVA was 0.05 ± 0.12 logMAR, with 93.8% of eyes achieving 20/30 or better. The mean UNVA was -0.05 ± 0.08 logMAR, and all (100%) eyes achieved 20/30 or better. Mean MRSE was -0.08 ± 0.43 D. Patients exchanged from ClearView 3 to Envy reported resolution of halos and haziness, fewer artifacts, and less shadowing, and improvement in overall vision, especially near vision, postoperatively. Patients exchanged from Odyssey experienced fewer halos, better intermediate vision, and improved peripheral vision. Patients exchanged from LAL, or other monofocal IOL reported improvement with reading and computer work. One PanOptix IOL-implanted eye that experienced constant halos also reported improvement in subjective vision following exchange.

CONCLUSIONS: IOL exchange to enVista Envy FVR IOL yielded good distance and near vision outcomes along with high patient satisfaction. Visual disturbances such as halos, starbursts, glare, hazy vision, and peripheral vision blur, reported with previously implanted IOLs, resolved/reduced following IOL exchange to enVista Envy IOL.

PURPOSE: To evaluate the effect of partial corneal spherical aberration (SA) correction in an intraocular lens (pIOL) compared with a neutral SA monofocal IOL (B+L enVista, EE) on the simulated defocus curves using a physiological model eye.

METHODS: A 20.0 D enVista EE monofocal IOL was modified by optimizing the posterior surface aspheric coefficients in Ansys Zemax to partially compensate an ISO2 cornea with +0.20 µm of spherical aberration (pIOL design). Through-focus performance was evaluated using a modified Liou-Brennan model eye by placing a paraxial surface 12 mm anterior to the corneal vertex to simulate defocus. Three levels of physiological corneal spherical aberration—0.00 µm, 0.27 µm, and 0.55 µm at a 5.15-mm IOL pupil—representative of the normal population were modeled by adjusting the anterior corneal conic constant. Simulated visual acuity (VA) was derived from the area under the modulation transfer function (aMTF) curve using a previously published method. All VA simulations were performed for a 3.0-mm IOL pupil aperture.

RESULTS: Peak predicted visual acuity remained similar across all spherical aberration conditions for both the EE and pIOL design. The overall through-focus profiles of the two lenses were likewise comparable, with only subtle differences between them. In eyes modeled with average and high physiological corneal SA, the EE lens exhibited a modest enhancement in intermediate-near performance; however, the magnitude of this effect fell within the standard deviation of the clinical data and is unlikely to be clinically meaningful. Additionally, the peak simulated VA varied across the different corneal SA conditions, suggesting that physiological spherical aberration may contribute to variability in refractive outcomes among patients.

CONCLUSIONS: Under physiological conditions, altering the level of induced corneal spherical aberration did not confer an intermediate-vision advantage for the partially compensating IOL and, if anything, favored the neutral SA design. The observed shifts in best-focus position across corneal SA conditions highlight the importance of accounting for individual corneal spherical aberration when determining IOL power for both designs.

PURPOSE: To conduct an experimental comparison of three multifocal intraocular lenses (MIOLs) based on the evaluation of halo formed by an on-bench model eye.

METHODS: The MIOLs were enVista Envy™ (B+L), AcrySof™ PanOptix™ (Alcon) and Tecnis Odyssey™ (J&J). For halo imaging, 20.0 D lenses using 3.0- and 4.5-mm apertures at the IOL plane (IOL-pupils) were employed. Furthermore, the optical bench incorporates an ISO 2 model eye (ISO 11979-2:2014) with a cornea with spherical aberration of +0.27 µm for a 5.15 mm IOL-pupil and a white light source per ANSI Z80.35-2018 guidelines. The test object was a pinhole placed optically at infinite of 3.44 arcmin angular size. Overall, the set up simulated viewing a car headlight (20 cm) at 200 meters.

RESULTS: Figure 1 illustrates the halos obtained with 3.0 and 4.5 mm IOL pupils from the three multifocal IOLs. All images are shown with gamma correction to meet ANSI requirements, while the intensity profile is displayed on a logarithmic scale. With the smallest pupil, the three MIOLs show similar halos (size and intensity). With the 4.5 mm pupil, however, Envy presents the smallest halo (20.6 ± 0.5 arcmin) followed by Odyssey (24.5 ± 0.5 arcmin) and PanOptix (30.5 ± 0.5 arcmin). Table 1 summarizes the results.

CONCLUSIONS: The halo size stability observed in the Envy, attributable to its distinctive diffractive profile—specifically its apodization and customized step-manufacturing process—indicates a reduced sensitivity to pupil diameter. In contrast, PanOptix and Odyssey exhibit larger halo variations with increasing pupil size, which may be disadvantageous for patients with naturally large pupils. Clinical evaluation is necessary to determine the impact of the halos on the visual quality of the patients implanted with these MIOLs.

PURPOSE: While many full visual range (FVR) intraocular lenses that provide vision at multiple distances are available, they are not generally recommended for post-corneal refractive surgery eyes due to the increased risk of contrast sensitivity reduction and a higher incidence of postoperative visual disturbances. enVista Envy IOL is a FVR IOL designed to enhance the patient's range of vision while being tolerant to visual phenomena. In this retrospective chart review, we evaluated the visual outcomes of this FVR IOL in patients with a history of corneal refractive surgery who underwent cataract surgery.

METHODS: This chart review included patients who had undergone previous laser in situ keratomileusis (LASIK) and subsequently underwent cataract surgery with the implantation of enVista Envy FVR IOL. Outcome measures included uncorrected and corrected distance visual acuity (UDVA, CDVA) and uncorrected near visual acuity (UNVA), manifest refraction spherical equivalent at 1-month follow-up.

RESULTS: Data from 86 eyes of 53 patients were analyzed. The mean postoperative UDVA was 0.11 ± 0.11 logMAR, with 87.2% of eyes achieving UDVA 20/30 or better. The mean postoperative CDVA was 0.05 ± 0.08 logMAR, with 97.7% of eyes achieving CDVA 20/30 or better. The mean UNVA was 0.00 ± 0.11 logMAR with 96.5% of eyes achieving UNVA 20/30 or better, postoperatively. With a slightly mean myopic MRSE (-0.18 ± 0.42 D), 82.6% eyes achieved MRSE within 0.50 D.

CONCLUSIONS: In eyes with prior LASIK, implantation of the enVista Envy FVR IOL resulted in excellent visual outcomes. These results indicate that the enVista Envy IOL is a good option for patients who have had corneal refractive surgery and desire a full range of vision.

PURPOSE: This study evaluated the efficacy and safety of a novel brimonidine tartrate ophthalmic solution 0.025% formulated with sodium hyaluronate (BTOS-HA) against the original brimonidine tartrate ophthalmic solution 0.025% (BTOS) in the treatment of ocular redness.

METHODS: In this multicenter, double-masked, Phase 3 trial, adults with baseline ocular redness >1 (0–4 scale) in both eyes were randomized 1:1 to BTOS-HA or BTOS. Both were dosed QID for 4 weeks. The primary endpoint was investigator-graded ocular redness during Day 1 over 8 timepoints (5–240 minutes) after instillation. Noninferiority required the upper bound of the 95% CI for the mean difference between treatments to remain ≤0.22 units at all 8 timepoints. Key secondary endpoints included mean changes in pre-instillation ocular redness score at 1 and 480 minutes. Safety assessments included TEAEs, BCVA, slit-lamp findings, IOP, dilated fundus exam, and rebound redness assessed out to Day 36.

RESULTS: A total of 578 subjects were randomized (289 in each group). BTOS-HA was statistically noninferior to BTOS at all 8 primary post-instillation time points (5–240 minutes), with all upper confidence limits ≤0.22. At the pre-specified secondary time points, BTOS-HA was noninferior at 1 minute, 360 minutes, and 480 minutes. Additionally, rapid onset within 30 seconds and redness reduction through 10 hours relative to baseline was demonstrated. Safety outcomes were comparable. TEAEs were infrequent and similar between groups. In the BTOS-HA group, only instillation-site irritation (1.7%) and urinary tract infection (1.0%) occurred in ≥1% of subjects; all ocular TEAEs were mild or moderate. Serious TEAEs were rare (BTOS-HA n=1; BTOS n=2), and not related to treatment. Rebound redness was low (BTOS-HA 2.2%; BTOS 1.1%). No clinically meaningful differences were observed in BCVA, IOP, slit-lamp biomicroscopy, or dilated fundus exam in either group.

CONCLUSIONS: BTOS-HA demonstrated noninferiority to original BTOS across all primary and key secondary time points. Relative to baseline, BTOS-HA demonstrated rapid onset within 30 seconds and sustained redness reduction up to 10 hours. The novel BTOS-HA formulation was well tolerated with a safety profile comparable to the well-established safety of BTOS and low rates of rebound redness. These findings support BTOS-HA as an effective redness-relief formulation.

PURPOSE: To compare the optical quality of two Refractive Full Range of Vision (R-FRoV) intraocular lenses (IOLs) in presence of tilt and decentration, a common situation after uneventful IOL implantation.

METHODS: Robustness against misalignment of Bausch & Lomb LuxLife™ (refractive trifocal, RT-FRoV) and Rayner RaynerOne Galaxy™ (refractive spiral, RS-FRoV) was compared on a model eye (ISO 2, corneal spherical aberration of +0.27 µm for 5.15 mm IOL-plane aperture) using green light (550 ±5 nm). The modulation transfer function (MTF) and area under the MTF (0 to 50 cycles/mm, MTFa) were assessed at far with 3.0 mm pupil in centered, decentered (0.25, 0.50 mm) and tilted (3.0°, 5.0°) conditions.

RESULTS: The RT-FRoV showed consistent higher MTF than the RS-FRoV in all conditions (Figure 1). In distance vision and centered, the RT-FRoV had larger MTFa (28.71 versus 23.84). When tilted, both designs exhibited similar mild reduction of the MTFa (7.7% RT-FRoV, 6.0% RS-FRoV). However, the RT-FRoV showed significant greater robustness against decentration than the RS-FRoV IOL, with MTFa decrease of only 0.5% versus 15.8% respectively (Figure 2, Table).

CONCLUSIONS: On-bench comparison of new IOL designs under controlled tilt and decentration conditions is relevant because they pose significant challenges for accurate clinical assessment. For far vision, the RT-FRoV LuxLife™ demonstrated superior MTF than RS-FRoV Galaxy™ in centered and misaligned conditions. While tilt induced similar mild optical quality reduction on both IOLs, the RT-FRoV design proved significant greater robustness against decentration. The impact of these findings on visual outcomes has yet to be studied and deserves further clinical investigation. The limitations of this study stems from the use of narrowband green light, a single average corneal spherical aberration, which may not capture clinical variability, and the restricted analysis to far vision with a 3.0 mm pupil.

PURPOSE: A new dual-disinfectant investigational multi-purpose solution (MPS) and 6 currently marketed MPSs were tested for disinfection efficacy against Acanthamoeba trophozoites per ISO 19045-2:2024 methodology.

METHODS: A. castellanii (A.c, ATCC 50370) and A. polyphaga (A.p, ATCC 30461) trophozoites were tested per new ISO 19045-2:2024 methodology. The new investigational MPS (MPS-1, 0.00015% polyquarternium-1 [PQ-1], 0.0003% alexidine dihydrochloride) and 6 marketed products were tested: MPS-2 (polyhexanide hydrochloride 0.0001%); MPS-3 (polyhexanide hydrochloride 0.00011%, alexidine hydrochloride 0.0004%); MPS-4 (0.0006% myristamidopropyl dimethylamine, 0.001% PQ-1); MPS-5 (0.0005% myristamidopropyl dimethylamine, 0.001% PQ-1); MPS-6 (0.0005% myristamidopropyl dimethylamine, 0.001% PQ-1); MPS-7 (0.00016% alexidine dihydrochloride, 0.0003% PQ-1). Per instructions for use, disinfection by MPSs 1-3 was assessed 4 hours post-inoculation and MPSs 4-7 assessed after 6 hours. Acanthamoeba recovery was determined via Spearman-Karber method; log10 reduction values (LRVs) were analyzed by unpaired t-test using Graphpad Prism.

RESULTS: All MPSs tested had efficacy against A. castellanii and A. polyphaga trophozoites. MPS-1 (LRV 3.9) was significantly greater than MPS-2 (LRV 2.7, p=0.006), 4 (LRV 2.6, p=0.007), 5 (LRV 2.8, p=0.04), and 6 (LRV 3.0, p=0.01) at disinfection of A. castellanii ATCC 50370 trophozoites. All MPS tested were not significantly different at disinfection of A. polyphaga ATCC 30461 trophozoites.

CONCLUSIONS: All MPSs demonstrated efficacy against the Acanthamoeba trophozoites tested per ISO 19045-2:2024, but MPS-1 demonstrated greater disinfection against A. castellanii ATCC 50370 compared to 4 currently marketed MPS products. ISO 19045-2:2024 testing confirms MPS-1 effectively disinfects Acanthamoeba trophozoites.

PURPOSE: Dry eye disease (DED) is common in patients undergoing cataract surgery. Perfluorohexyloctane ophthalmic solution (PFHO) forms an anti-evaporative monolayer at the tear-film surface to reduce both signs and symptoms of DED. This study evaluated whether preoperative PFHO treatment affected postoperative refractive accuracy.

METHODS: This prospective, multicenter, open-label, phase 4 study (NCT06346340) enrolled patients with DED who were candidates for phacoemulsification with posterior chamber intraocular lens (IOL) implantation. Patients instilled PFHO in both eyes QID for 30 days preoperatively and received a second 30-day PFHO treatment beginning approximately 1 month after surgery. The 30-day postoperative standard-of-care visit included assessment of refractive outcome (manifest refraction). The primary endpoint was the mean difference between absolute deviations from predicted refractive error in the study eye.

RESULTS: The study enrolled 97 patients (75.3% female; mean age, 68.6 years). The mean difference between absolute deviations in predicted refractive error measured before and after presurgery PFHO treatment was -0.027 ± 0.167 D (P=0.1385). The difference in the baseline predicted refractive error and the predicted refractive error post-PFHO treatment was within 0.3 D for 94.2% of study eyes. The percentage of patients with calculated IOL power within +0.50 D of the correct IOL power was 72.1% before and 83.7% after PFHO treatment. Two adverse events were considered related to treatment (mild eye pruritus and mild noninfective conjunctivitis).

CONCLUSION: In patients with DED undergoing cataract surgery, PFHO did not alter the accuracy of preoperative biometry and keratometry measurements or impact the predicted refractive error. The accuracy of IOL power determination was increased after preoperative PFHO treatment. PFHO was well tolerated in this patient population.

PURPOSE: Dry eye disease (DED) is common in patients needing cataract surgery and can be further exacerbated in the postoperative period. Perfluorohexyloctane ophthalmic solution (PFHO) is approved for treatment of signs and symptoms of DED. This study evaluated the effects of PFHO treatment before and after cataract surgery in patients with DED.

METHODS: This prospective, multicenter, open-label, phase 4 study (NCT06346340) enrolled patients with DED who were candidates for phacoemulsification with posterior chamber intraocular lens (IOL) implantation. Patients instilled PFHO in both eyes QID for 30 days preoperatively and received a second 30-day PFHO treatment beginning approximately 1 month after surgery. Total corneal fluorescein staining (tCFS), rated on a 0-15 scale; eye dryness, rated on a 100-mm visual analog scale (VAS); Ocular Surface Disease Index (OSDI); root mean square (RMS) higher-order aberrations (HOA) in the central 6.0 mm of the cornea; and visual acuity were assessed before and after each PFHO treatment period.

RESULTS: The study enrolled 97 patients. Mean (SD) tCFS score improved from 5.0 (2.7) to 2.1 (2.2) and 1.3 (1.8) after the first and second 30-day PFHO treatments, respectively (P<0.001 for both. reductions from baseline in eye dryness vas score from 62.3 19.0 to 37.5 23.1 and 25.9 23.3 respectively were observed while osdi score improved from 51.9 16.9 to 30.1 17.6 and 11.9 10.9 p><0.001 for all. most patients experienced stable or improved rms hoas after pfho treatment. the percentage of patients with best-corrected visual acuity bcva of 20 20 or better was 86.0 at the first postsurgical assessment and 91.8 after 30 days of subsequent pfho treatment.>

CONCLUSIONS: Presurgical PFHO treatment resulted in statistically significant reductions in signs and symptoms of DED with further improvement after postoperative treatment, including more patients with BCVA of 20/20 or better. These findings support a role for PFHO in pre- and postoperative management of DED in patients undergoing cataract surgery.

PURPOSE: To evaluate the clinical effectiveness and safety of a new dual-disinfectant investigational multi-purpose solution (MPS) for contact lens care compared to a commercially available MPS when used by habitual planned replacement soft contact lens (CL) wearers to clean and disinfect their CLs.

PURPOSE: Age-related macular degeneration (AMD) is driven in part by oxidative damage and inflammation, which contribute to progressive dysfunction of the retinal pigment epithelium (RPE) and neurosensory retina. The AREDS and AREDS2 formulations provide antioxidant and micronutrient support to slow disease progression; however, the potential additive benefits of B vitamins on RPE protection have not been evaluated. B vitamins regulate mitochondrial metabolism, homocysteine balance, and oxidative stress, suggesting a possible complementary and additive effect alongside current AREDS2 nutrients. This study compared the effects of AREDS2 components, B vitamins, or their combination on cytoprotection and gene expression in an iPSC-derived RPE AMD model.

METHODS: Human iPSC-derived RPE cells from donors carrying high-risk AMD alleles (ARMS2/HTRA1) were treated with N-retinyl-N-retinylidene ethanolamine (A2E) and blue light to model AMD after pretreatment with AREDS2 components, B vitamins, or their combination. Cell viability was evaluated using CellROX assays. Transcriptomic changes were assessed by bulk RNA sequencing, and differential gene expression (DESeq2) was analyzed for Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment.

RESULTS: Exposure to either AREDS2 components alone or the combination of AREDS2 components and B vitamins significantly improved cell viability in this iPSC-RPE AMD model. Distinct gene expression profiles were observed following exposure to AREDS2 components versus the combined treatment, including additional pathways associated with antioxidant defense and overall RPE health, suggesting enhanced stress adaptation and cellular recovery capacity.

CONCLUSIONS: Although exposure to B vitamins alone did not significantly improve cell viability or drive notable changes in gene expression, their combination with AREDS2 components was protective in this in vitro AMD model. The combined treatment also elicited additional gene expression changes related to oxidative stress and RPE survival pathways compared with exposure to AREDS2 components alone, suggesting a potential additive or synergistic effect.

PURPOSE: Currently marketed RGP disinfection products were tested for disinfection efficacy against Acanthamoeba trophozoites per ISO 19045-2:2024 methodology.

METHODS: A. castellanii (A.c, ATCC 50370) and A. polyphaga (A.p, ATCC 30461) trophozoites were tested per new ISO 19045-2:2024 methodology. Nine marketed products with RGP disinfection indications were tested: RGP-1 (chlorhexidine gluconate 0.003%, polyaminopropyl biguanide [PAPB] 0.0005%); RGP-2 (chlorhexidine gluconate 0.003%, PAPB 0.0005%); RGP-3 (polyhexamethylene biguanide 0.0005%); RGP-4 (ε-Polylysine 0.01%); RGP-5 (polyquaternium-1 0.0011%); RGP-6 (povidone-iodine 0.05%); RGP-7 (none); RGP-8 (polyhexanide 0.0002%); RGP-9 (Polyhexanide 0.0001%). Per instructions for use, disinfection by RGP-1,2,5,6,7, and 8 were assessed 4 hours post-inoculation; RGP-3 at 5 minutes, RGP-4 at 30 minutes, and RGP-9 assessed after 6 hours. Acanthamoeba recovery was determined via Spearman-Karber method. Log10 reduction values (LRVs) were analyzed with an unpaired t-test using Graphpad Prism.

RESULTS: Products tested varied in their disinfection efficacy against A.c and A.p trophozoites. RGP-1 (LRV 3.9) demonstrated greater disinfection of A. castellanii trophozoites versus RGP-3 (LRV 1.7, p=0.0005), RGP-4 (LRV 2.2, p=0.0002), RGP-5 (LRV 3.1, p=0.03), RGP-6 (LRV 2.7, p<0.0001), RGP-7 (LRV 2.4, p=0.0005), RGP-8 (LRV 1.9, p=0.0002), and RGP-9 (LRV 0.0, p<0.0001). RGP-2 (LRV 4.0) demonstrated greater disinfection of A. castellanii trophozoites versus RGP-3 (LRV 1.7, p=0.0005), RGP-4 (LRV 2.2, p=0.0002), RGP-5 (LRV 3.1, p=0.02), RGP-6 (LRV 2.7, p=0.0001), RGP-7 (LRV 2.4, p=0.0005), RGP-8 (LRV 1.9, p=0.0002), and RGP-9 (LRV 0.0, p<0.0001). RGP-1 (LRV 4.0) demonstrated greater disinfection of A. polyphaga trophozoites versus RGP-3 (LRV 0.7, p=0.003), RGP-8 (LRV 3.0, p=0.03), and RGP-9 (LRV 1.0, p=0.003). RGP-2 (LRV 4.0) demonstrated greater disinfection of A. polyphaga trophozoites versus RGP-3 (LRV 0.7, p=0.003), RGP-8 (LRV 3.0, p=0.03), and RGP-9 (LRV 1.0, p=0.003).

CONCLUSIONS: RGP-1 demonstrated greater disinfection than seven RGP products against A. castellanii and three products against A. polyphaga. RGP-2 demonstrated greater disinfection than seven RGP products for A. castellanii and three for A. polyphaga. Results confirm that RGP-1 (Boston Advanced Conditioning) and RGP-2 (Boston Simplus) products effectively disinfect Acanthamoeba trophozoites.

PURPOSE: To compare corneal incision temperature changes and heat-generation patterns between two phacoemulsification systems with different operating frequencies and modes, using an ex vivo porcine eye model.

METHODS: Three ex vivo porcine eyes were used. A 2.4-mm clear corneal incision was created with a keratome. Stellaris Elite with the Attune handpiece (Bausch + Lomb; 28.5 kHz, up to 150 µm stroke) and a 1.8-mm MICS needle and sleeve was compared to Centurion (Alcon) with the Ozil handpiece and Balanced Tip needle and sleeve (44.5 kHz, up to 90 µm longitudinal stroke; 32 kHz torsional). For each system, phaco power was activated using room-temperature BSS under 450 mmHg vacuum and 50 mmHg infusion pressure at 25%, 50%, and 100% power. For each power level, three repetitions were performed. Corneal incision temperature was recorded from baseline using a FLIR A325sc thermal imager focused on the incision. Temperature rise (ΔT) was calculated as the average increase from baseline. System comparisons were performed using two-sample t-tests (α=0.05).

RESULTS: Stellaris Elite/Attune produced consistently lower corneal incision temperature increases than Centurion/Ozil. Mean ΔT (°C) at 25%, 50%, and 100% power was 1.4, 2.6, and 2.5 °C for Stellaris Elite/Attune, versus 2.8, 5.5, and 9.1 °C for Centurion longitudinal mode (all p<0.01), and 3.2 p><0.01), 4.4 p><0.05), and 3.2 c p="0.065)" for centurion torsional mode. stellaris elite attune was 50-73 lower than centurion longitudinal and 22-56 lower than centurion torsional across 25-100 power. temperature distribution along the sleeve also differed: stellaris elite attune showed maximal heating further from the incision whereas centurion ozil exhibited higher temperatures near the corneal incision and around the sleeve hub.>

CONCLUSIONS: In this ex vivo model, the lower-frequency longitudinal phacoemulsification system (Stellaris Elite/Attune) produced smaller corneal incision temperature increases than the higher-frequency longitudinal and torsional modes of Centurion/Ozil. Differences in needle design, including the shorter MICS needle versus the Balanced Tip needle, likely contributed to both the magnitude and location of the thermal load. These findings suggest that operating frequency, mode of energy delivery, and needle geometry all influence thermal distribution at the corneal incision and may affect thermal safety margins during phacoemulsification.

PURPOSE: Topical prostaglandin analogs such as latanoprostene bunod (LBN) are indicated for the reduction of intraocular pressure (IOP). This study aims to document real-world outcomes, utilization patterns, and eyecare practitioner (ECP) satisfaction with LBN in patients with open-angle glaucoma or ocular hypertension.

METHODS: This retrospective, multicenter, cross-sectional case review and survey study included licensed ophthalmologists/optometrists with ≥3 years' experience who had prescribed LBN ophthalmic solution 0.024% in ≥10 patients in the last 12 months. ECPs submitted deidentified cases via a standardized case report form and completed a prescriber's experience survey. Outcomes included IOP and safety. The protocol received central institutional review board exemption.

RESULTS: This interim analysis included 85 eyes (56 patients; 55% female; mean±SD age, 68±15 years) from five sites in the USA. Overall, 71% (39/55; n=1 unknown) had ocular comorbidities. At baseline, the mean±SD IOP (n=83) and target IOP (n=78) were 19.9±6.5 and 14.5±2.4 mmHg, respectively. At most recent follow-up, 89% (48/54; n=2 unknown) of patients remained on LBN treatment. The median (interquartile range) time since treatment initiation was 28 (12–51) weeks. At most recent follow-up, mean±SD IOP was 14.3±5.6 mmHg, representing a 28% decrease from baseline (N=85 eyes). Eleven adverse events were reported in nine patients; the most common was a decrease in visual acuity. Of five ECPs surveyed, four were from a medium-sized practice (11–50 ECPs); all ECPs had ≥11 years' experience. ECPs rated LBN effectiveness (mean±SD) as 9.2±0.5 and 8.0±1.9 for eyes with no prior treatment and with previous failed IOP-lowering drops, respectively (on a scale from 0, very poor effectiveness, to 10, very good effectiveness). ECPs ranked their overall satisfaction with LBN as a mean±SD of 9.2±0.5 (on a scale from 0, very dissatisfied, to 10, very satisfied).

CONCLUSIONS: LBN 0.024% ophthalmic solution was clinically effective in this real-world study, with patients showing decreased IOP. ECPs reported high clinical effectiveness and satisfaction with this treatment.

PURPOSE: Dry eye disease (DED) causes substantial discomfort and functional impairment, but its real-world burden and unmet needs vary globally. This analysis compares findings from two complementary surveys: (1) a study of U.S. adults and (2) a five-country study conducted in the UK, France, Germany, Poland, and Saudi Arabia. Both surveys involved both the general population and self-identified DED sufferers. The goal was to identify universal themes and to highlight region-specific differences in symptom burden, care pathways, and patient understanding.

METHODS: Both studies used online, cross-sectional surveys administered to adults ≥18 years. The U.S. study (N=2,003; 461 sufferers) assessed symptom burden, knowledge, treatment use, and interactions with eye care professionals (ECPs). The ex-U.S. multinational study was conducted in two phases: the general population (Phase I, N=2,580) and individuals with regular symptoms of DED (Phase II, N=2,572) to characterize prevalence, symptom severity, self-care, and professional care. All results were weighted to reflect national demographics.

RESULTS: Across both studies, dryness and ocular fatigue emerged as highly prevalent, bothersome symptoms. In the overall U.S. population, approximately 50% reported suffering eye dryness, with 15% experiencing symptoms regularly. This is consistent with the multinational finding that ~25% of adults experienced regular symptoms, nearly half of whom reported them daily. Three unmet needs were consistent across all countries: (1) limited awareness of DED causes, consequences, and treatment options; (2) delayed or infrequent ECP engagement; and (3) dissatisfaction with current management and uncertainty regarding long-term care. Certain country differences were notable: ECP visits at least once a year for DED sufferers ranged from 40% in France to over 70% in the U.S. and Saudi Arabia, paralleling differences in professional diagnosis of DED.

CONCLUSIONS: Despite geographic and healthcare differences, DED sufferers across all surveyed regions share a substantial and under-recognized symptom burden, low disease awareness, and limited satisfaction with current care. Variation in ECP engagement suggests opportunities for region-specific strategies, while the universal trends highlight a global need for earlier recognition, improved patient education, and more proactive management of DED.

PURPOSE: Lifitegrast ophthalmic solution 5.0% has demonstrated efficacy in patients with dry eye disease (DED), with a subset of patients experiencing rapid and sustained symptomatic response. This study aimed to characterize the clinical and demographic features of "robust responders" to lifitegrast through eye care professional (ECP) qualitative interviews and retrospective chart review.

METHODS: This study combined two complementary methods. First, structured qualitative interviews were conducted with experienced ECPs across the U.S. who routinely prescribe lifitegrast for DED. ECPs were asked to describe the clinical profile of patients who achieved rapid (within 4 weeks) and sustained (≥3 months) symptomatic response. Second, a retrospective chart review was performed on patients identified by participating ECPs as robust responders. Data collected included demographics, DED severity, comorbidities, prior treatments, time to symptom relief, and treatment persistence.

RESULTS: ECPs consistently described robust responders as patients with moderate-to-severe DED with predominantly inflammatory features (e.g., elevated MMP-9, lid margin disease, conjunctival hyperemia) and a history of incomplete response to artificial tears alone. Chart review data supported these clinical impressions: robust responders tended to be female, with mean age in the 50s-60s, and had clinically documented signs of ocular surface inflammation at baseline. The majority reported meaningful symptom improvement within the first 4 weeks of treatment, with sustained response over follow-up. Patient adherence and persistence were high among this subgroup.

CONCLUSIONS: Robust responders to lifitegrast are characterized by inflammatory DED features and a history of inadequate response to lubricants. Identifying these clinical signals early may help guide treatment selection and improve outcomes. These findings support a proactive approach to recognizing patients most likely to benefit from anti-inflammatory therapy.

PURPOSE: Lifitegrast ophthalmic solution, 5.0%, is an anti-inflammatory agent indicated for the treatment of signs and symptoms of dry eye disease. This post hoc analysis of phase 3 pivotal data identified patients with rapid and pronounced reduction in dry eye symptoms with lifitegrast treatment and evaluated defining characteristics.

METHODS: This was an exploratory analysis of data from the OPUS-2 and OPUS-3 studies (NCT01743729, NCT02284516): 12-week, prospective, double-masked, multicenter, placebo-controlled, randomized, parallel-arm clinical trials. Pooled data in the lifitegrast treatment arm were analyzed using a cluster analysis to identify homogenous populations of patient response types based on percent change from baseline in eye dryness score (EDS; as evaluated on a VAS 0-100 scale) at Days 14, 42, and 84. Patients with Sjögren's syndrome or incomplete data were excluded from the analysis. Patient demographics and baseline characteristics among the defined subgroups were evaluated.

RESULTS: The analysis population included 638 patients in the lifitegrast treatment arm. Mean (SD) age was 58.4 (14.1) years; 77.4% were female; 80.1% were White, 10.3% Black, and 6.0% Asian. At baseline, mean (SD) EDS score was 69.4 (16.9), overall. Five patient subgroups were identified in the lifitegrast treatment arm: early sustained responders with ≥60% EDS reduction at all time points (n=113; 17.7%); steady responders with ≥20%, ≥40%, and ≥60% reduction at Days 14, 42, and 85 (n=113; 17.7%); Day 84 response of ≥60% (n=127; 19.9%); Day 84 response of ≤30% to <60% n="119;" 18.7 day 84 response of><30% n="166;" 26.0. there were significant differences in mean symptom scores across the 5 patient subgroups p><0.001), with numerically lower mean symptom scores for eye pain burning stinging foreign body sensation and photophobia in the patients demonstrating an early sustained response.>

CONCLUSION: The majority (353 of 638, 55.3%) of patients treated with lifitegrast had ≥60% reduction in EDS by Day 84. The group with rapid and sustained EDS reductions by week 2 tended to have lower symptom scores than the other subgroups, suggesting that early treatment may be beneficial for maximal response. Further studies to corroborate these findings are warranted.

PURPOSE: Perfluorohexyloctane ophthalmic solution (PFHO) and lifitegrast ophthalmic solution 5% (LIF) address distinct mechanisms of dry eye disease (DED), targeting excessive tear evaporation and ocular surface inflammation, respectively. Understanding eyecare providers' (ECPs) experience managing DED with concomitant (CON) PFHO/LIF can inform patient care and future therapeutic strategies. This provider survey evaluated real-world utility and outcomes of CON PFHO/LIF in patients with DED.

METHODS: A geographically diverse sample of ECPs managing DED with CON PFHO/LIF were invited to complete a survey that included items regarding reasons for concomitant therapy, patient types, time to improvement, and duration of therapy. Provider satisfaction for overall management, sign/symptom improvement, and tolerability was rated on a 5-point scale (from not at all satisfied to extremely satisfied).

RESULTS: A total of 83 ECPs (30 ophthalmologists and 53 optometrists) completed the survey. ECPs treated a mean of 221 (range, 16-600) DED patients per month with 90% reporting using CON PFHO/LIF in ≤30% of their patients. ECPs reported that they would be very/extremely likely to prescribe CON PFHO/LIF in 10%, 40%, and 83% of patients with mild, moderate, and severe DED, respectively. CON PFHO/LIF was commonly prescribed in patients with mixed mechanisms of DED and in patients with ocular surface inflammation. Most clinicians initiated PFHO or LIF and then added on the other therapy. Primary rationale for CON PFHO/LIF was rapid symptom relief and complementary mechanism of action, over long-term relief, sign relief, or safety/tolerability profile. Symptom improvement was typically observed within 2 to 3 weeks, and most clinicians anticipated indefinite duration of combination therapy. Satisfaction ratings (mean [SD], 0-5 scale) for overall management of DED, improving symptoms, improving signs, and tolerability were 4.16 (0.69), 4.12 (0.73), 4.10 (0.70), and 3.67 (0.90), respectively.

CONCLUSION: Findings from this real-world survey of ECPs highlight the utility of concomitant use of PFHO and LIF for the treatment of DED in a broad spectrum of patients with DED. Physicians reported a high level of satisfaction with the efficacy and tolerability of concomitant therapy.

PURPOSE: Autoimmune diseases such as systemic lupus erythematosus (SLE), Sjögren's syndrome (SS), and rheumatoid arthritis (RA) are strongly associated with dry eye disease (DED), often driven by ocular surface inflammation. Lifitegrast ophthalmic solution 5% (Xiidra®), a lymphocyte function-associated antigen-1 (LFA-1) antagonist, targets T-cell–mediated inflammation, a key mechanism in autoimmune-related DED. This analysis describes real-world characteristics in autoimmune patients initiating lifitegrast.

METHODS: A retrospective cohort study using the American Academy of Ophthalmology IRIS® Registry linked to pharmacy claims identified adults with DED who initiated lifitegrast between January 1, 2017, and December 31, 2024. Subgroups included patients with comorbid SLE, SS, or RA diagnosed at or within 12 months prior to lifitegrast initiation. Demographics, comorbidities, and treatment patterns were assessed.

RESULTS: Among 143,005 patients with DED initiating lifitegrast, 2,720 (2%) had SLE, 8,651 (6%) had SS, and 8,249 (6%) had RA. Mean ages were 57, 59, and 62 years, respectively; >90% were female across cohorts. Aqueous tear deficiency predominated (>90% across cohorts). Ocular comorbidities included cataract (37–45%) and glaucoma (6–9%). Nonocular comorbidities were common, including hypertension (44–57%) and other autoimmune conditions (eg, SS in SLE cohort: 38%; RA in SS cohort: 23%). Prior DED therapy included topical cyclosporine (14–19%) and punctal plugs (10–11%). Mean lifitegrast treatment duration ranged from 140 to 150 days.

CONCLUSIONS: Autoimmune patients with DED initiating lifitegrast in routine practice exhibited high inflammatory burden and frequent ocular comorbidities. These findings support lifitegrast as a targeted therapy for autoimmune-related DED in real-world settings.

PURPOSE: Lifitegrast ophthalmic solution 5.0% (Xiidra®) is approved for the treatment of signs and symptoms of dry eye disease (DED). This study reports the real-world safety and tolerability experience of lifitegrast in patients with DED.

METHODS: This was a multicenter, retrospective chart review and provider survey conducted across U.S. eye care practices. Eligible patients were adults (≥18 years) with a clinical diagnosis of DED who had initiated treatment with lifitegrast for ≥30 days. Providers documented patient demographics, baseline DED severity, prior therapies, and treatment-emergent adverse events (TEAEs). Safety outcomes included incidence of ocular and systemic TEAEs, severity, time to onset, and treatment discontinuation due to AEs.

RESULTS: Data were collected from a total of providers and patients across U.S. sites. The majority of patients were female with a mean age in the 50s-60s. Most commonly reported TEAEs were ocular and mild-to-moderate in severity, including instillation-site reactions (burning, irritation), dysgeusia (altered taste), and transient blurred vision. The majority of TEAEs occurred within the first 2 weeks of treatment and resolved without intervention. The discontinuation rate due to AEs was low. No serious treatment-related adverse events were reported. The overall safety profile in this real-world setting was consistent with that observed in pivotal clinical trials.

CONCLUSIONS: This real-world analysis confirms the favorable safety and tolerability profile of lifitegrast ophthalmic solution 5.0% in patients with DED. The most common adverse events were mild and transient, supporting the use of lifitegrast as a well-tolerated long-term treatment option for inflammatory DED in routine clinical practice.