The Doctor Is in, Case Closed

HOT TOPIC

The Next Generation of CXL Therapy Is on the Horizon

Glaukos Corporation has submitted a new drug application (NDA) to the FDA for Epioxa (Epi-on), a next-generation corneal cross-linking (CXL) iLink therapy designed to treat keratoconus. Epioxa is notable for being noninvasive and not requiring the removal of the corneal epithelium, which is a significant advancement over traditional treatments.

The NDA submission is backed by data from two phase 3 pivotal trials that demonstrated favorable tolerability and safety profiles and achieved primary efficacy endpoints. Epioxa would be the first noninvasive CXL drug therapy, if approved. It could transform the treatment paradigm for patients with keratoconus by reducing procedure times, improving patient comfort, and shortening recovery time.

My Two Cents

This is exciting and would change our treatment protocol at Williamson Eye Center. Also, epi-on would likely be legal for every OD in the country to perform!

I staunchly believe in offering (and encouraging) CXL for every patient with keratoconus or corneal ectasia showing progression. It is now the standard of care to do so. That said, multiple times each week, a new cone sits in my chair who was never sent over for CXL and has unfortunately developed corneal scarring. They inevitably tell me they’ve noticed their vision continuing to worsen and finally wanted a second opinion on their other options. As members of the optometric profession, we need to do a better job of immediately referring out any patient we have with even the slightest suspicion of keratoconus. You will get the patient back from your referring doctor, and your patient will respect you more because of the care and concern you show.

OUTSIDE THE LANE

VA ODs Granted Physician-Level Recognition

Although not quite outside the lane, but maybe outside my lane, the US House and Senate recently approved the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act (S. 141), signed into law by President Joe Biden on January 2, 2025. This legislation provides physician-level recognition for doctors of optometry within the Department of Veterans Affairs (VA), addressing a long-standing issue of recruitment and retention of optometrists in the VA system. The new law adds optometry to the physician pay scale, allowing the VA to offer optometrists increased pay awards, bonuses, and annual evaluations. This change aims to make VA optometry positions more competitive with private-sector opportunities, helping to fill numerous vacant positions and retain experienced providers. Vision and eye health care is the third-most requested service by veterans, and VA optometrists provide roughly 70% of essential primary and medical eye care services. The legislation is expected to significantly improve the quality of eye care available to veterans by ensuring that VA facilities have the necessary staff to meet their needs. (Read more here.)

My Two Cents

Okay, I’m unsure about that last statement about improving the eye care available to veterans with this new law. Nearly every VA optometrist I’ve met could talk circles around me about most topics related to medical eye care. They are indeed the elite of the elite, and many of us in demanding medical eye care positions can trace a good deal of our clinical education back to VA ODs. Kudos to the government for finally making sure these truly world-class clinicians who provide eye care to our veterans get the recognition they so deserve.

CAN YOU RELATE

With the new year comes an opportunity to make brand new plans. In addition to all those New Year’s resolutions that may have already been broken, we need to do our best to plan for the year ahead. By the way, did you know there’s such a thing as “Quitter’s Day,” which falls on the second Friday of January (research shows that most people tend to abandon their resolutions by this day)? Apparently, Quitter’s Day is now a thing.

I’m figuring out what conferences I’ll attend this year. A few staples on my schedule are Optometry’s Meeting, Academy, and MOD Live. Of note, MOD Live will be held in Austin, Texas, November 7-9. From what I’ve heard, it’s a fantastic city that should provide the perfect backdrop to the wonderfully intimate atmosphere that MOD Live has developed over the past few years. I will also be attending Vision Expo West, as last year’s meeting was amazing and one of the highlights of 2024 for me.

A newer conference I’ve heard fantastic things about is the GRT Summit, which takes place in national parks and incorporates hiking and other activities into the schedule. This year, the Dry Eye Institute (DEI), founded by Crystal Brimer, OD, FAAO, is offering a hybrid program at The Oasis in Death Valley on January 31st, just before the GRT Summit. Our clinic is one of the largest dry eye centers in the country, but there is no one better to learn the treatment and business of dry eye from than Dr. Brimer. I won’t be able to attend this year, but I have the meeting marked on my calendar for next year, which brings up an interesting point: As many states (finally) allow online continuing education credits for a reasonable amount of our yearly need, it means the demand for in-person conferences may start to dwindle. Understandably, some meetings have joined with others and taken on partnerships similar to the one that the GRT Summit and Dr. Brimer’s DEI have formed.

In Louisiana, we can earn 6 hours of online continuing education (up from just 1 hour in years past), thus reducing my need to attend in-person conferences quite dramatically. However, I still choose to attend certain conferences, as a great deal of learning and growth occurs outside the lecture halls, in the exhibitor area, and at impromptu events. These are the moments when doctors can share what’s happening in their practices and pick up the most nuanced ways to improve their clinical acumen. There will always be a need for these in-person events, but it will be interesting to see how the conference schedules and industry respond to the continued proliferation of online CE offerings.