This Week in Ophthalmology: Week of December 9, 2024

Editor's note: The below transcript has been lightly edited for clarity.

Hello, I am David Hutton of Ophthalmology Times. Welcome to another episode of This Week in Ophthalmology, a program looking at some of the week’s top headlines and videos.

Earlier this year, I attended the 18th Annual Controversies in Modern Eye Care meeting on May 4, 2024, in Los Angeles, California. Today, I will revisit two of my interviews from that meeting.

Dr. Deborah Ristvedt discussed glaucoma treatment developments.

Deborah Ristvedt, DO: Hi, I'm Deb Ristvedt from Alexandria, Minnesota, part of Vance Thompson Vision. I am an anterior segment and glaucoma surgeon. Today at the Controversies in [Modern] Eye Care symposium, I'm talking about the unmet needs in glaucoma treatment and therapy.

We've had our tried-and-true medications and a lot of you may not know that we've only had our first-line therapy prostaglandin analogues since 1997 and then there was kind of a lull when it came to how we treat glaucoma. We know that in the past we've had drops, we've had laser, and then we've had more invasive surgery in the form of trabeculectomies or tube shunts.

But now we're looking at the histology of the trabecular meshwork and what's happening in glaucoma and now we have new mechanism of action medications designed to treat just that, our natural outflow pathway.

This morning we talked about latanoprostene bunod, which releases nitric oxide to relax the trabecular meshwork. We talked about rho kinase inhibitors in the form of netarsudil, which works at the cellular level of the trabecular meshwork, as well as decreases episcleral venous pressure.

So when we're talking about medication therapy, 1 of our main goals nowadays in intervention of glaucoma is to eliminate the need of stacking medications and to use some of these medications to get the biggest bang for our buck when it comes to lowering IOP.

David Hutton: James A Katz, MD, discussed Demodex blepharitis, which remains under-diagnosed and under-treated. To combat these pesky mites, he detailed treatment options in his 2024 Controversies in Modern Eye Care presentation. Let’s check it out.

James A. Katz, MD: Hi I'm Dr Jim Katz. I practice ophthalmology in the Chicago area. Today I had the opportunity to speak on Demodex blepharitis with a colleague of mine, Marc Bloomenstein, and what I spoke about was the different therapies for Demodex blepharitis. And there are a lot of different treatments we've had over the years. The issue with Demodex blepharitis, is we've never had a good treatment, 1 that showed efficacy, 1 that showed safety or really any of them that were FDA approved. I went through treatments such as tea tree oil, and the effects of that, although there can be side effects of irritation. I went through oral medications, ivermectin, methazolamide, and those types of medications. We went through microblepharoexfoliation, treatments to the lid surface itself. All these types of things have been used in the past to allow us to try to treat the irritation of the lids that can be caused by Demodex blepharitis, the redness that could be caused by Demodex blepharitis. Now we have a treatment, the treatment's lotilaner 0.25%, the marketed name is XDEMVY, and this product was FDA approved in July of 2023, and now we have it available. It's used twice a day for 6 weeks, 6 weeks because a lifecycle of this micro organism or mite is approximately 2 to 3 weeks, and we want to get through 2 life cycles.

So the whole idea is to allow this medication to work well. We went through the FDA protocol and how it got approval for the medication through the Phase 3 trial and how it showed efficacy for the eradication of mites in the eyelashes and eyelids and as well how it treated the eyes for redness to reduce the redness in the eyes. So those types of things were done, as well as importantly the primary endpoint of reducing collarettes, or that sleeve on the upper lash that can cause all the irritation and inflammation of the eye and how much reduced those collarettes were after a full course of treatment. So now we have a way that's quite efficacious, shows safety, and most importantly is FDA approved to easily treat Demodex blepharitis. We need to understand how to diagnose this by looking at that upper lid and having the patient look down. It's very easy to spot on the eyelids when we have the patient's look down at the slit lamp. But when we forget to do that it's easy to miss this diagnosis because some patients don't have a lot of symptoms. Some come in with subtle itching of the eyelid margin, subtle redness. So it's our job to look at that upper lid by having the patient look down, diagnose the Demodex blepharitis, and now easily treat it for our patients and improve how they feel.

David Hutton: Thank you for joining me for another episode of This Week in Ophthalmology. Be sure to look for more details on these and other great articles on our website, ophthalmologytimes.com.