How to Tackle RCEs With Ease

Image courtesy VEO Ophthalmics

A New Approach to Stromal Puncture

VEO Ophthalmics recently introduced PLEXITOME, a new surgical instrument used for the treatment of recurrent corneal erosions (RCEs) and significant corneal abrasions. Essentially, the product is a 6.2-mm diameter disc array made of approximately 675 individual spikes. This creates an estimated 3,375 points of epithelial attachment over the entire treated corneal surface when used with “5 imprints.” This “controlled and uniform puncture depth” is used to puncture only through the Bowman layer of the cornea and is designed to reduce long-term recurrence of RCEs in patients.

Notably, it is approved for treatment in the optical axis and has not been found to create optically evident anterior stromal scarring post-treatment.

My Two Cents

Okay, I know, that sounds like an infomercial (and you know I’m not here to do that with this newsletter), but how cool is this?? I did a little digging, and there is some compelling literature behind it. See here.

I’m shocked I haven’t come across this product in the very high-volume cataract and refractive surgery center where I practice (and head the dry eye clinic). I deal with RCEs daily, and this has the potential to help so many of my patients. It seems far more intuitive than stromal puncture (which is my third line of treatment for most patients), and patients would likely find it a lot more tolerable than jabbing their cornea with a high-gauge needle multiple times. By the way, before I get those emails asking what my first- and second-line treatments for RCE are, they are typically as follows:

First-line: fluorometholone acetate ophthalmic suspension 0.1% (Flarex, Harrow) or your loteprednol flavor of choice TID for at least 2 weeks, sodium chloride 5% (Muro128, Bausch + Lomb) QHS for 1 month, and doxycycline 50 mg BID for 1 month
Second-line: Consider debriding and adding a Prokera amniotic membrane (BioTissue)
Third-line: stromal puncture

Keep in mind that your state laws may vary, but I practice in Louisiana, where we have full scope laws. If you’re considering bringing the PLEXITOME into your clinic, check with your state boards to ensure it is within scope.

OUTSIDE THE LANE

Adding to the Hypertension Armamentarium

Baxdrostat (AstraZeneca), an experimental hypertension medication, has shown promising results in treating patients with uncontrolled or treatment-resistant high blood pressure. The findings were published in the New England Journal of Medicine. In the phase 3 BaxHTN trial, involving approximately 800 adults whose systolic blood pressure remained between 140 and 170 mm Hg despite being on at least two antihypertensive medications for a minimum of 4 weeks, baxdrostat—when added to existing therapy—demonstrated notable efficacy. Patients assigned to 1 mg or 2 mg doses of baxdrostat once daily experienced systolic blood pressure reductions of approximately 9 to 10 mm Hg more than those given a placebo. Additionally, about 40% of those on baxdrostat achieved healthy blood pressure levels, compared with fewer than 20% in the placebo group.

The drug works by selectively inhibiting aldosterone synthase, thereby reducing the production of aldosterone—a hormone that promotes salt and water retention—unlike older medications that block its receptors indirectly. The researchers emphasized that such a reduction can meaningfully lower the risk of cardiovascular events, including heart attack, stroke, kidney disease, and dementia.

Safety data were encouraging, showing that baxdrostat was generally well tolerated with no unexpected adverse events, although rare abnormalities in potassium and sodium levels were noted. The company plans to submit regulatory filings before the end of 2025, with potential market approval and launch anticipated in 2026.

Overall, baxdrostat represents a potentially transformative therapeutic option for the millions of patients whose hypertension remains stubbornly uncontrolled despite current drug regimens.

My Two Cents

As optometrists, it’s our job to stay on top of all health care, especially for common ailments such as hypertension. You can impress your patients by spitting out this fact about the future developments in primary care/cardiology. Heck, you could even throw out the random fact that using the phone while you poop greatly raises hemorrhoid risk and either wow them or horrify them. Come to think about it, I’d probably stick to the hypertension stuff.

CAN YOU RELATE

I know I mentioned that I don’t like to sound like an infomercial earlier in this newsletter; however, I do have some big news to share. By the time you *hopefully* read this newsletter, I and quite a few other ODs (and MDs) will have gone live with our newest company, Eyederm Cosmetics. Check out www.eyedermcosmetics.com to see what we’re up to. At launch, we will have one product available (the rest are undergoing final quality control), which is our under-eye patches. Essentially, they are pieces of hydrogel that you stick under your eyes for 15 to 30 minutes. The ingredients hydrate and smooth the skin, giving you a nice, glowing, and healthy appearance!

The idea for the company emerged as it became apparent that many of our patients were using damaging products around their eyes and on their faces. No one assesses these products touted on TikTok and other social medial platforms, and they often contain numerous ingredients that are illegal in many European countries. The United States is an anomaly, however, in that we have only about 10 ingredients that are illegal for use in cosmetics, compared with well over 1,500 in Europe. So, we created a whole line of cosmetic products designed to be the safest and most efficacious on the market. We use those Eurocentric restrictions, along with the Tear Film and Ocular Surface Society’s (TFOS) guidelines, to ensure the ingredients are truly clean. They are also designed to be sold in eye doctors’ offices to provide convenience and confidence for your patients while also adding to your bottom line in these days of declining vision plan reimbursements.