There is something special about beginnings. It’s an opportunity to start again, learn from the past and anticipate and even accelerate the future. If you position your practice now for what is likely to come, you can thrive in the new year. Fortunately, there are numerous exciting innovations we can anticipate in 2022 that will allow us to do exactly that.

Prepare for Presbyopia

With Vuity (Allergan) recently hitting the market—the first FDA-approved eye drop to treat presbyopia—and another low-dose pilocarpine that is preservative-free potentially coming in 2022, we have to anticipate the presbyopia opportunity, especially since there are about 32 million patients who have never seen an optometrist and use reading glasses.¹

The first visit requires a comprehensive eye exam, binocular vision testing, a dilated fundus evaluation, assessment of chronic inflammation and advanced pupil testing.

The opportunity is more than just a new therapeutic for reading via pupil constriction, it’s also about educating patients about PALs, presbyopic contact lenses and, in some cases, light-adjusting or multifocal IOLs.

Dilating Drops Replacement

A new microdose (8µL) dispenser known as MydCombi (Eyenovia) may become available this year. Compared with three drops at 30µL to 50µL each (topical anesthetic, phenylephrine and tropicamide), the option of delivering a dilating agent through an easy-to-use dispenser seems appealing for doctors (cost-saving and quicker administration) and patients (minimal burning, reduced tearing, less makeup smearing and only one application). It may also increase efficiency and possibly reduce the duration of dilation after the exam.

MGD/DED Lipid Solubilizing Agent

There is also a good chance we will see a new therapeutic from Bausch + Lomb that can solubilize thickened meibum. It’s the first dry eye drug in the United States that achieved a statistically significant improvement in pre-specified signs and symptoms in only two phase III clinical trials. If you consider the fact that 86% of all DED involves MGD, having a drop that could liquify hardened meibum would be a valuable addition.

With the recent approval of Tyrvaya (Oyster Point) and availability of Parasym Plus Eyes (TJ Nutrition), we can tackle the neurological component of DED. Likewise, the use of these neurological agents results in stimulation of meibum, mucin and aqueous.

Taming Demodex

The first drug for Demodex blepharitis, TP-03 (Tarsus Pharmaceuticals), achieved positive results in trials and may be approved this year. Currently, mechanical blepharoexfoliation (Blephex, Alcon) and a Manuka honey extract/coconut oil cleanser (MyboClean) coupled with a unique silicone brush is showing success in managing Demodex.

It has been shown that 58% of all patients observed in an optometric office show the presence of collarettes (clear sleeves at the base of the lashes that are pathognomonic for Demodex). It’s time to begin the new year by having patients look down while at the slit lamp and scanning across the base of the lashes.

Dry Macular Degeneration

An exciting potential injection to treat dry AMD, which constitutes 90% of all cases in the United States, may see approval. The drug, from Apellis, works on the complement system and was shown to reduce the size of geographic atrophy in patients with dry AMD. But even patients with wet AMD may see a significant advancement with Susvimo (Genentech), which was FDA-approved a few months ago. It’s a port system for delivering anti-VEGF into the vitreous to alleviate the need for frequent injections and office visits. I suggest starting to educate your dry AMD patients now about a potential treatment that may be available soon.

The inevitable future can sometimes be slowed but, as it’s been said, what you resist, persists. So, in the best interest of patients and your practice, the most prudent thing you can do is prepare and accelerate to ensure you thrive as each key development comes to fruition.

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.

^{1. Heath DA, Spangler JS, Wingert TA, et al. 2017 national optometry workforce survey. Accessed December 20, 2021.}