In many ways, 2022 was tough for our profession, but a new year brings hope for a major turnaround—and it’s very likely to occur. One reason is that optometry is the top prescribing profession of topical ophthalmic medications, accounting for almost 75% of presbyopia drop prescriptions and almost 70% of dry eye medications.

A Year of Loss

By most standards, 2022 can be epitomized as a year of great loss, including the profession’s leaders to finances and everything in between. Optometry practices showed little to no growth and salaries look to be the same or less compared to the previous year. Loss of staff was a major theme impacting growth in optometric practice, research recruitment and even optical sales.

We lost two icons in the profession, Art Epstein and Stuart Richer. Dr. Epstein, a frequent author and educator, had a great following. His online publication, Optometric Physician, has some of the highest readership of any online product to date. Dr. Richer was known as the “godfather of nutrition” and one of the most intelligent physicians in our profession. Both will be greatly missed for years to come.

Hope on the Horizon

We have many reasons for hope in 2023, including more potential ophthalmic therapeutic approvals than any year in history. There are an unprecedented six new drug applications likely to achieve FDA approval, including two for dry age-related macular degeneration (AMD)/geographic atrophy (GA), three for dry eye disease (DED), one for blepharitis and possibly an additional one for myopia management.

• Dry AMD/GA. Drug candidates for these diseases are showing a significant slowing of progression with hints that long-term treatment could potentially halt further cell loss completely. It’s possible that early and continuous treatment could stop the advancement of any remaining viable cells in the dreaded diagnosis of AMD.

• DED. The first of these promising therapies is NOV03 (Bausch + Lomb), which appears to inhibit evaporation 80 times greater than human meibum, and by mixing with a patient’s existing meibum, it creates an anti-evaporative layer that lasts four to six hours. It also was found to reside in meibomian glands for more than 24 hours.

The second therapeutic is Cycl-A-Sol (Novaliq), a sister product to NOV03. It contains 0.1% cyclosporine, giving the drop a combination of a novel and comfortable vehicle with an effective immunomodulator. It has been shown to provide faster improvement in signs and symptoms, including corneal staining.

• Blepharitis. TP-03 (Tarsus Pharmaceuticals), the first drug specifically for Demodex blepharitis, showed an improvement in clinically meaningful collarette cure rates of almost 90%, compared to 33% for the vehicle after six weeks of BID treatment. It also demonstrated statistically significant mite eradication and lid erythema improvement. Demodex blepharitis may affect over 20 million Americans, giving this therapeutic the potential to serve many patients as a drug for DED.

Later in the year, we may see reproxalap (Aldeyra Pharmaceuticals) with a first-ever RASP (reactive aldehyde species) inhibitor. RASP are reactive molecules that covalently bind to cells, disrupting their function and activating pro-inflammatory mediators. It’s an upstream approach, much like steroids, but without the risks. It seems to affect tear production in addition to multi-level inflammation control, potentially making it one of the fastest-acting dry eye therapeutics.

Finally, although likely in early 2024, it is possible we could see 0.1% atropine commercialized (Vyluma) as a prescription option for myopia management in pediatrics. This is something to keep our eye on.

It’s time to bounce back from 2022 and get ready for all the possibilities that lie ahead for you and your patients. This year may go down as the most prosperous year in eye care history for novel therapeutics, optometry practices and patient success in the areas of dry AMD/GA, DED and Demodex blepharitis. 

Dr. Karpecki is medical director for Keplr Vision and the Dry Eye Institutes of Kentucky and Indiana. He is the Chief Clinical Editor for Review of Optometry and chair of the New Technologies & Treatments conferences. A fixture in optometric clinical education, he consults for a wide array of ophthalmic clients, including ones discussed in this article. Dr. Karpecki's full list of disclosures can be found here.