Virginia Eye Consultants

Background Epidermal Growth Factor Receptor (EGFR) inhibitors, while effective in oncology, are associated with under-characterized ocular adverse events (AEs). Prior studies have been limited in scope, lacking a comprehensive, class-wide analysis of the full spectrum of ocular toxicity, particularly for newer agents. Methods We conducted a disproportionality analysis of the FDA Adverse Event Reporting System (FAERS) (2001-2025). Twelve EGFR-targeted agents were evaluated against a pre-specified set of ocular MedDRA Preferred Terms. To ensure robust signal detection, a significant association was defined by ≥3 co-reported cases, a Proportional Reporting Ratio (PRR) ≥2.0, and a false-discovery-rate adjusted p-value <0.05. Results Among 6,976,462 drug-event combinations, 20 met all signal criteria for Eyelash Abnormalities, Ocular Surface Disease, or Vision‑Threatening and Intraocular Events. Trichomegaly demonstrated extreme disproportionality (e.g., panitumumab PRR= 465.3, 95% Confidence Interval [CI], 247.7-874.3). A consistent pattern of ocular surface toxicity (conjunctivitis, keratitis, blepharitis) was observed across multiple tyrosine kinase inhibitors and monoclonal antibodies, indicating a class-wide effect. Signals for serious events included corneal perforation (erlotinib, n= 7, PRR=13.9, 95% CI= 6.6-29.4) and optic neuropathy (erlotinib, n= 6, PRR= 2.9, 95% CI= 1.3-6.4). Conclusion This analysis confirms a strong, class-wide signal for ocular toxicity across the spectrum of EGFR inhibitors, from characteristic eyelid changes to sight-threatening complications. These findings underscore the necessity for proactive ophthalmologic monitoring, including baseline assessment, in patients receiving these therapies to preserve vision and maintain quality of life during cancer treatment.

Micropulse transscleral laser therapy is a clinically beneficial adjunctive treatment option for African American individuals with severe-stage primary open angle glaucoma who have undergone prior glaucoma procedural interventions. To assess the safety and efficacy of micropulse transscleral laser therapy as an adjunctive treatment in reducing intraocular pressure and ocular hypotensive medications in African American patients. We analyzed 44 eyes of 44 African American individuals with severe-stage primary open angle glaucoma who underwent prior procedural interventions and received a subsequent micropulse treatment. Mean intraocular pressure and ocular hypotensive medications were evaluated at all postoperative visits through 12 months. Main outcome measures included within-group reductions in intraocular pressure and ocular hypotensive medications at 12 months compared with baseline. Univariate and multivariable logistic regression models were used to calculate odds ratios to evaluate characteristics associated with the likelihood of success at 12 months. Success was defined as achieving a target intraocular pressure of ≤12mmHg without additional medications and no secondary surgical interventions. Mean intraocular pressure was significantly reduced from 22.9±6.2mmHg at baseline to 13.8±4.8 at 12 months following micropulse, a 40% reduction ( P <0.001). The majority of patients were on 4-6 ocular hypotensive medications at baseline. By 12 months, the proportion of patients requiring ≥3 ocular hypotensive medications was significantly reduced compared with baseline ( P =0.03). Univariate analysis revealed that a history of trabeculectomy before micropulse treatment increased the likelihood of successful surgery at 12 months by nearly 5-fold (OR: 4.67; P =0.03). Micropulse is an effective adjunctive treatment in African Americans with severe-stage primary open angle glaucoma and a history of prior glaucoma procedures.

To describe a technique involving combined endothelialectomy and trypan blue staining to allow for improved visualization and Descemet membrane (DM) removal during endothelial keratoplasty. Endothelialectomy with 2 disposable endothelial irrigating cannulas (Vortex and Sterimedix) and an irrigation-aspiration handpiece are described. Several passes over the desired area are made to ensure adequate endothelialectomy treatment. Trypan blue is instilled into the anterior chamber, and after irrigation, the trypan stains the exposed DM, which enhances visualization. Subsequently, one's standard technique for descemetorhexis can then be performed. Endothelialectomy with trypan blue staining was performed in 9 eyes and was able to successfully enhance visualization of DM in all cases. The technique easily allowed for visualization of the descemetorhexis edge despite the poor view. Although all 3 instruments for endothelialectomy allowed for successful descemetorhexis, the Vortex endothelial cannula provided more complete and consistent endothelialectomy with fewer passes. The descemetorhexis tissue from 1 case using the Sterimedix cannula was sent for histological review and demonstrated a paucity of endothelial cells, intact DM, and blunted guttae. Targeted endothelialectomy and trypan blue staining can be a useful technique to enhance visualization during endothelial keratoplasty. This can allow for a more complete descemetorhexis in areas with marginal visibility.

This study sought to determine the effect of donor preservation time and other donor tissue factors on the clinical outcomes of keratolimbal allograft (KLAL) transplantation. In this retrospective chart review of patients who underwent KLAL transplantation, electronic health records were reviewed for relevant patient ocular and surgical history. Donor tissue factors were collected from donor reports. The primary outcome measure was time to epithelialization. Exclusion criteria included prior ocular surface stem cell transplantation, loss to follow-up, missing data from medical records, indication for surgery other than limbal stem cell deficiency, and early removal of KLAL tissue. Regression analysis was performed to compare time to epithelialization and donor tissue factors. Subgroup analysis was performed using the Student t test to evaluate the impact of donor preservation time on time to epithelialization. A total of 154 eyes were identified of which 122 were included for analysis. The mean time to epithelialization was 55 days and median was 35 days. No donor tissue factors were found to affect total time to corneal epithelialization. Subgroup analysis comparing the effect of different total preservation times on time to epithelialization did not reveal any statistically significant associations. No relationship was found between time to donor tissue preservation and time to epithelialization after KLAL surgery. It appears that limbal stem cells can be safely stored for up to 9 days in corneal storage solution in hypothermic temperatures without clinical consequences.

Patients with Demodex blepharitis have a considerable symptomatic burden that negatively impacts their daily activities and well-being. Despite chronic manifestations of and problems associated with blepharitis that resulted in multiple visits to eye care providers, Demodex blepharitis remained underdiagnosed or misdiagnosed. This study aimed to evaluate the effect of Demodex blepharitis on patients' daily activities and well-being. This prospective, multicenter, observational study recruited 524 patients with Demodex blepharitis from 20 U.S. ophthalmology and optometry practices. Demodex blepharitis was diagnosed based on the presence of the following clinical manifestations in at least one eye: >10 collarettes on the upper lashes, at least mild lid margin erythema of the upper eyelid, and mite density of ≥1.0 mite/lash (upper and lower combined). Patients were asked to complete a questionnaire related to their symptoms, daily activities, and management approaches. The proportion of patients who experienced blepharitis symptoms for ≥2 years was 67.8%, and for ≥4 years, it was 46.5%. The three most bothersome symptoms ranked were "itchy eyes," "dry eyes," and "foreign body sensation." Overall, 77.4% of patients reported that Demodex blepharitis negatively affected their daily life. One-third (32.3%) of patients had visited a doctor for blepharitis at least two times, including 19.6% who visited at least four times. Despite having clinical manifestations of Demodex blepharitis confirmed by an eye care provider, 58.7% had never been diagnosed with blepharitis. Commonly used management approaches were artificial tears, warm compresses, and lid wipes. Among those who discontinued their regimen, 45.9% had discontinued because of either tolerability issues or lack of effectiveness. Among contact lens wearers, 64.3% of the patients either were uncomfortable wearing contact lenses or experienced vision changes "sometimes" or "frequently." Demodex blepharitis results in a significant negative impact on daily activities, creating a psychosocial and symptomatic burden on patients.

There is a clinical necessity for dry eye disease treatments that perform across a broad range of presenting patient severities. Varenicline solution nasal spray (VNS), a unique cholinergic agonist ocular surface-sparing nasal spray therapy, demonstrated significant improvement in both signs and symptoms of dry eye disease in subjects with mild, moderate, and severe symptoms as the clinical studies enrolled a more real-world patient population. This study evaluated efficacy outcomes for VNS in patients with mild-moderate and severe dry eye disease. An analysis of integrated data from two randomized clinical trials, ONSET-1 (NCT03636061) and ONSET-2 (NCT04036292) (vehicle control [VC], n = 294; VNS 0.03 mg, n = 308), was performed. Adults 22 years or older with dry eye disease, Ocular Surface Disease Index score of ≥23, corneal fluorescein staining score of ≥2 in ≥1 regions/≥4 all regions, and Schirmer Test Score (STS) of ≤10 mm (no restrictions on Eye Dryness Score [EDS]) were included in this study. Efficacy was evaluated using analysis of covariance among pre-specified subgroups of mild-moderate and severe baseline disease severity defined by STS (≤5 vs. >5) and EDS (<60 vs. ≥60). Consistency of effect was evaluated by interaction tests. No treatment-subgroup interactions were observed for all end points ( P > .05). The odds of achieving a ≥10-mm improvement in STS for VNS versus VC for patients with baseline STS ≤5 and >5 were 3.4(95% confidence interval, 2.0 to 5.6) and 2.3(1.3 to 4.0) and for EDS of <60 and ≥60 were 3.4(1.9 to 6.1) and 2.5(1.5 to 4.0). Least-squares mean treatment/VC differences in change from baseline in EDS for patients with baseline STS ≤5 or >5 were -7.4(95% confidence interval, -12.5 to -2.4) and -2.8(-8.7 to 3.1); EDS of <60 and ≥60 were -2.9(-8.3 to 2.5) and -8.1(-13.6 to -2.6). Compared with VC, VNS improved tear production and patient-reported symptoms in patients with dry eye disease, demonstrating consistency of effect regardless of initial presenting severity.

PurposeTo evaluate the impact of Demodex blepharitis on patients’ daily activities and quality of life.Patients and MethodsIn this multicenter, observational, prospective, IRB-approved study, 311 Demodex blepharitis patients aged ≥18 years were included. Demodex blepharitis was diagnosed based on the presence of ≥1.0 mite per lash (upper and lower eyelids combined), >10 collarettes on the upper lashes, and at least mild lid margin erythema of the upper eyelid in at least one eye. All patients were asked to complete a questionnaire about their symptoms, daily activities, quality of life, and management approaches, and descriptive statistics were used to analyze the responses.ResultsMore than half the patients had been experiencing symptoms of blepharitis for ≥4 years. The three most frequent and bothersome symptoms experienced by patients were dry eyes, itchiness, and irritation. Nearly half the patients (47%) responded that they were conscious of their eyes all day, and 23% said that they were constantly worrying about their eyes. Other activities that were negatively affected included difficulty driving at night (47%), additional time needed for daily hygiene routine (30%), and difficulty in wearing eye make-up (in 34% of females). While all subjects had objective signs of Demodex blepharitis confirmed by an eye care provider, 58% said they had never previously been diagnosed with blepharitis. The most commonly used management approaches for Demodex blepharitis were artificial tears (47%), warm compresses (32%), and lid wipes (14%).ConclusionDemodex blepharitis has a significant negative impact on daily activities and the mental and physical well-being of afflicted patients.