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In response to a previously published article, three ophthalmologists present their views on intravitreal pharmacotherapy injections.

Dexamethasone rebuttal: Who should perform intravitreal injections?

Retina World Congress 2025 will take place May 8-11. As researchers prepare for their, presentation, we are highlighting the upcoming sessions that are scheduled for this meeting, which will be held in Fort Lauderdale, Florida.

Note: The following list of presentations are in alphabetical order by company. Updates will be added to this article as new information becomes available.

The company highlight Phase 2 results for migaldendranib (MGB), Ashvattha’s investigational subcutaneous treatment for wet age-related macular degeneration (wet AMD) and diabetic macular edema (DME). The presentation, entitled, "Emerging Data om Anti-angiogenic Nanomedicine (Migaldendranib MGB/D-4517.2) for AMD and DME" will be given by Michael Singer, MD on Sunday, May 11, 2025; 11:11 – 11:16 am ET.

Phase 2 clinical data demonstrated that MGB administration lowered production of subretinal fluid reducing or eliminating the need for intravitreal anti-VEGF treatment in both the study eye and fellow eye in wet AMD and DME subjects with bilateral disease. New data indicates that MGB may be the first safe systemic therapy for the treatment of wet AMD and DME without ocular adverse events.

Huma Qamar, Chief Medical Officer at Ocugen will represent Ocugen at Retina World Congress to share a presentation and join retinal surgeons and industry peers during a panel discussion.

Inherited and Rare Retinal Diseases Session
Moderated by Rishi P. Singh, MD, FASRS and Kourous A. Rezaei, MD on Thursday, May 8, 2025, 10:35 – 11:12 AM ET

Ocular Therapeutix will present information at the meeting in Fort Lauderdale regarding the axitinib intravitreal hydrogel clinical trials, the use of its candidate OTX-TKI for diabetic retinopathy, and the HELIOS clinical trial for diabetic retinopathy.

Axitinib Intravitreal Hydrogel: Update on Clinical Trials

Presented by Carl C. Awh, MD, FASRS, on Friday, May 9, 2025, 4:33 – 4:38 PM ET.

Presented by Dilsher S. Dhoot, MD, FASRS on Saturday, May 10, 2025, 8:44 – 8:49 AM ET

Volumetric Macular Fluid Analysis of the Impact of a Single Axitinib Intravitreal Injection (OTX-TKI) from the HELIOS Clinical Trial for Diabetic Retinopathy

Presented by Carl J. Danzig, MD on Saturday, May 10, 2025, 8:52 – 8:57 AM ET

The company will present further insights from Stage 1 of the Phase 3 DIAMOND program reinforcing the efficacy and safety profile of OCS-01 eye drops for DME will also be shared. OCS-01 is being developed to be the first non-invasive treatment for DME, addressing key unmet needs for earlier treatment intervention and for inadequate responders to the current standard of care.

Ashvattha Therapeutics to Present at ARVO, Retina World Congress, and AOS Annual Meeting. Ashvattha Therapeutics. April 15, 2025. Accessed April 16, 2025. https://www.globenewswire.com/news-release/2025/04/15/3061682/0/en/Ashvattha-Therapeutics-to-Present-at-ARVO-Retina-World-Congress-and-AOS-Annual-Meeting.html

Ocugen to Present on Modifier Gene Therapy Platform at Association for Research in Vision and Ophthalmology 2025 Annual Meeting and Retina World Congress. Ocugen Inc. April 29, 2025. Accessed April 30, 2025. https://www.globenewswire.com/news-release/2025/04/29/3070074/0/en/Ocugen-to-Present-on-Modifier-Gene-Therapy-Platform-at-Association-for-Research-in-Vision-and-Ophthalmology-2025-Annual-Meeting-and-Retina-World-Congress.html

Ocular Therapeutix™ to Participate in Upcoming Investor and Scientific Conferences. Ocular Therapeutix. April 29, 2025. Accessed April 29, 2025. https://www.globenewswire.com/news-release/2025/04/29/3070022/0/en/Ocular-Therapeutix-to-Participate-in-Upcoming-Investor-and-Scientific-Conferences.html

Oculis to Present its Innovative Late-Stage Pipeline Candidates at Upcoming Ophthalmology Conferences. Oculis Holding AG. May 1, 2025. Accessed May 1, 2025. https://www.biospace.com/press-releases/oculis-to-present-its-innovative-late-stage-pipeline-candidates-at-upcoming-ophthalmology-conferences

Companies working in the retina space have announced that data from clinical trials will be shared at this year’s meeting in Fort Lauderdale, Florida.

RWC 2025: Companies to share data at meeting in Fort Lauderdale

The European Medicines Agency (EMA) granted Orphan designations to MCO-010 (sonpiretigene isteparvovec) across 5 categories of retinal dystrophies. The US Food and Drug Administration (FDA) also granted RMAT designation for MCO-010 in Stargardt disease (SD). The EMA and FDA actions suggest regulatory agency recognition of the potential of MCO-010 to address significant unmet needs.

The EMA Orphan designations cover several categories. These include non-syndromic and syndromic rod-dominant and cone-dominant dystrophies, as well as macular dystrophies. This has the potential to provide disease-agnostic regulatory paths forward for dozens of retinal conditions. In the European Union, EMA Orphan status provides opportunities for protocol assistance and up to 10 years of market exclusivity following approval.

The new FDA RMAT designation for SD builds on prior Orphan Drug and Fast Track designations for both retinitis pigmentosa (RP) and SD. In the United States, Orphan, Fast Track, and RMAT designations provide opportunities for accelerated development and review, flexibility in trial design, and 7 years of market exclusivity upon approval.

Regarding this designation, Sulagna Bhattacharya, CEO of Nanoscope, ins quoted in the company’s press release

, saying, “Securing RMAT designation for Stargardt disease in addition to our prior FDA designations for SD and RP is a major validation for our therapies that warrant expedited development and review. Combined with 5 EMA Orphan designations, these achievements highlight the global momentum behind our MCO platform as a potential vision-restoring therapy for patients with few or no treatment options.”

MCO (multi-characteristic opsin) is a one-time, in-office, intravitreal disease-agnostic therapy platform that is designed to restore vision in patients with photoreceptor degeneration, including RP, SD, and geographic atrophy (GA). This therapy works by activating highly dense bipolar retinal cells to become light sensitive and employing the remaining visual circuitry following photoreceptor death. Notably, MCO does not require genetic testing, surgical intervention, or repeat dosing, which may enable broad patient applicability within existing retina office workflows.

Nanoscope Therapeutics saw positive results in the RESTORE Phase 2b/3 multicenter, randomized, double-masked, sham-controlled clinical trial for RP (NCT04945772), a rolling BLA submission to the FDA has been initiated.

Promising results have also been seen in the STARLIGHT Phase 2 clinical trial of MCO-010 in Stargardt disease (SD) (NCT05417126), and the company plans to initiate a Phase 3 registrational trial in 2025.

A Phase 2 program for MCO in GA is expected to start by the end of 2025.

Other IND-ready programs include Leber congenital amaurosis (LCA).

Nanoscope Strengthens Global Regulatory Pathways for MCO-010 with FDA RMAT and Five EMA Orphan Designations. Nanoscope Therapeutics. News Release. September 2, 2025. Accessed September 2, 2025. https://www.prnewswire.com/news-releases/nanoscope-strengthens-global-regulatory-pathways-for-mco-010-with-fda-rmat-and-five-ema-orphan-designations-302543344.html

Nanoscope Therapeutics. Nanoscope Therapeutics Initiates Rolling Submission of Biologics License Application to FDA for MCO-010, the First Gene-Agnostic Therapy to Treat Retinitis Pigmentosa. Prnewswire.com. Published July 14, 2025. Accessed July 14, 2025. https://www.prnewswire.com/news-releases/nanoscope-therapeutics-initiates-rolling-submission-of-biologics-license-application-to-fda-for-mco-010-the-first-gene-agnostic-therapy-to-treat-retinitis-pigmentosa-302503892.html

MCO-010 receives Orphan and RMAT designations, highlighting its potential as a groundbreaking therapy for various retinal dystrophies.

Canonical

clinical

EMA grants Orphan designations to MCO-010, FDA grants RMAT in Stargardt disease

identifeye HEALTH has launched its retinal screening platform. The platform is a compact, app-based system that is FDA-registered under a 510(k)-exempt classification. The company is initiating pilot programs with health systems and community-based providers.

The system is designed for point-of-care environments, allowing nurses and medical assistants to capture high-quality retinal images with minimal training. The company has stated that the identifeye Camera can help to lower common barriers to screening, including time constraints, cost, and limited specialist availability.

The goal is to help triage patients who need specialist care while reducing bottlenecks in the healthcare system.

 had the opportunity to speak with Vicky Demas, CEO of identifeye HEALTH to discuss how this advancement in technology can benefit patients and ophthalmologists. Demas is an engineer by training who has spent the last 25 years working at the conjunction of technology and healthcare.

The conversation discussed not only the identifeye Camera and retinal imaging platform, but also how technology and AI has the power to transform the field of ophthalmology and positively impact other areas of healthcare and research.

Note: The following conversation has been lightly edited for clarity.

 There's been some recent news with identifeye HEALTH. What are the updates with the company and what are the plans for the future?

Yes, we're super excited. We [identifeye HEALTH] formally registered with the FDA earlier in July. As part of that, we can formally market the device in the US. We're speaking with major health systems to secure placements pilots. Really exciting for the team, especially, and we're out doing community screenings. We're partnering with organizations, returning results to patients who otherwise wouldn't have been able to get their vision checked. We're super excited to be making impact, learning from the field, and figuring out how we can make this a scalable solution.

 Can you speak to the technology and what ophthalmologists should know about what's coming down the line in this field?

 I am an engineer by training, but I've spent the last 25 years working at that interface of tech and healthcare life sciences, which is relevant to identifeye as I was part of the team at Google, actually Google X, that started the Life Sciences Initiative. The goal was to leverage AI and Google infrastructure to solve problems worth solving in healthcare and life sciences. Part of that incredible job I had was to work with industry experts to figure out what those problems should be, and build teams to execute proof of concept, joint ventures, etc. That was when I was introduced to the concept of the eye as a window into the body and health, and the potential of the platform to not only look at ophthalmic diseases in the retina, but also systemic disease in a very scalable way.

I left the space, worked in cancer diagnostics, and when I came back to work on what is now identifeye HEALTH, it was really striking to me that, while there is a ton you can do with AI and image segmentation, annotation, etc., people had overlooked the importance of capturing with ease, a high quality retinal image in a general setting, which has been our focus that identifeye is leveraging AI and automation to make capturing retinal images, I say, as simple as measuring someone's blood pressure, so it can actually happen closer to patients. So that's the biggest innovation with our platform, and what we're really excited to do is now a medical assistant, administrative person in your office can, without a ton of training, capture high quality images.

The device will also check with AI that the image quality is appropriate to be interpreted, whether by a human or an algorithm in the future. It is the high level of what the product does. Our general approach is that we're looking to figure out how to integrate into workflows and help triage patients to specialty care as they're needed, not to substitute, but to make it accessible. We want to figure out how to make sure that patients who should see an ophthalmologist see an ophthalmologist, but those who don't, don't bottleneck the system, don't get inconvenienced.

Where do you see this technology being implemented or the potential to be implemented?

We're certainly thinking of settings closer to patients. For example, primary care would be a good place. Retail pharmacies, they're expanding to be able to really create services around healthcare, primary care. The focus is to be accessible, closer to patients, making screening more convenient, and whether, as we're doing now with a tele-retinal service or with AI automating the report back to the clinician for help assessing and helping the patient stay on top of their health.

When we talk about the potential of AI to play a role in this, how do you think that the landscape of AI overall will play into healthcare in this role and in other roles?

It's been a long time in the making, right? I think of AI will start with anything from the simple things like building classifiers to automate repetitive tasks that humans aren't great at, like. Even self-concordance is not looking great, so AI can certainly start doing a lot more of that, allowing clinicians to do more things that they're uniquely qualified to do.

As an example, multimodal data: These are the types of things that I'm super excited to see happen, but it all has to stay grounded, because even in this very simple case where we're talking about our next product being an autonomous AI classifier for diabetic retinopathy, we really want to figure out the referral at the more than mild diabetic retinopathy threshold. Then you start looking at everyone in the clinical ecosystem, we should be thinking about triaging and risk-stratifying patients who really have to go see someone. I'll say AI has huge potential. I'm excited to see it, but it has to really be very thoughtful and integrated with real, practical workflows.

 What does the timeline look like for identifeye HEALTH, as you are taking these steps and beginning to market?

In the next few months, I hope we will be seeing a ton of placements with I partners, because I really do believe that these have to be strong relationships. We put a lot of thought and energy into making it seamless, but nonetheless, it's a new thing, but we're really looking to work with them to help guide our roadmap. We have the example I gave about diabetic retinopathy screening is something that comes with a lot of organic conversations on what people want to see, or in the interim between here and an autonomous AI to build the comfort level by sort of showing a little bit here is what an annotation tool would do. This is the type of thing that the algorithm uses.

Building tools and features alongside our partners, and more, I'll say progressively, automating things in the workflow, adding the explainability, building the trust. Progress happens at the speed of trust, especially in healthcare. So that's helping patients. We certainly are going to continue with our community screenings, and the team is super excited to see more of an impact where we are having real patient success stories. We're starting to get some clinical data in showing that making this device very easy to use does improve compliance, getting some of those proof points that we need to build. They'll call it the, the baseline for the next steps, while we're also refining our roadmap for more AI products and features

You mentioned earlier, the retina and the eye being kind of this window to other systemic diseases. How could that play a role in, not only, in the AI algorithms, but branching out for that level of trust with other specialties?

There has been a ton of literature on the space speaking about, I'll call them systemic biomarkers that we as humans understand. I think we would start with something like that. For example, you know some of the original publications from Google, they would speak about vessel density, tortuosity, like a-to-v ratio, as examples of cardiovascular risk markers. So obviously that is in a very academic way, saying, here are some features. There's not much to substitute for. We have to run studies now. The benefit of having a first use case that can help a lot of patients, that there is this huge unmet need. If we think of patients living with diabetes, that's a huge population, and they have increased risk for cardiovascular disease, for hypertension. So those are areas of focus for us, as we're thinking about next steps.

There's a lot of data that we can leverage already. But in real life, we could be collecting the data. We need to actually build that body of evidence. There’s no substitution for real data, real studies to prove that we actually have a way to really access information, non-invasively.

identifeye HEALTH unveils a retinal screening platform, enhancing accessibility and efficiency in patient care through innovative technology and AI integration.

Q&A: Vicky Demas on the value of easy to use imaging tools and the potential of AI

jCyte recently announced the dosing of the first patients enrolled in the JC02-88 study for the evaluation of famzeretcel (jCell; jCyte) for the treatment of retinitis pigmentosa (RP).

 Famzeretcel consists of allogeneic retinal progenitor cells (RPCs) administered via intravitreal injection.

“The initiation of the patient dosing in this trial marks an important milestone in our mission to bring a breakthrough treatment to the majority of RP patients who currently have limited treatment options,” John Sholar, CEO of jCyte, said in a press release.

JC02-88 is a phase 2 trial evaluating the safety, tolerability, and efficacy of a single 8.8 million cell injection of famzeretcel. The famzeretcel dose being studied in the JC02-88 study is approximately 50% higher than the highest dose administered in previous jCyte clinical trials.

 Patients enrolled will receive either 1 famzeretcel dose or a sham treatment (control) and will be assessed for safety and vision changes over 6 months.

The trial is supported by the Gavin Herbert Eye Institute, the UCI GMP Facility, Lexitas, and the California Institute for Regenerative Medicine. A subsequent extension study is anticipated following the conclusion of the JC02-88 trial.

A couple of basics are needed to achieve a response to famzeretcel, 

 Based on the neurotrophic mechanism of famzeretcel, it was hypothesized in a phase 2b study that patients with RP need to have sufficient living photoreceptors to enable restoration of visual function.

 Photoreceptors cannot divide and replace dead adjacent photoreceptors. To benefit from neurotrophic factors, a photoreceptor may have lost its function but must still be alive. More specifically, sufficient living cone photoreceptors are needed to achieve a BCVA response to the famzeretcel injection.

Affecting an estimated 2 million people worldwide, with 100,000 in the United States, RP is a rare genetic disorder that leads to progressive loss of the rod and cone photoreceptors in the retina. Typically diagnosed in adolescence, it causes many patients to become legally blind by middle age.

“This is an exciting development for the RP community, and I am eager to see how this promising therapy advances toward providing a novel cell-therapy treatment for a patient population with vast unmet need,” Paul Sieving, MD, PhD, Neil and MJ Kelly Professor of Ophthalmology at UC Davis School of Medicine and immediate past director of the National Eye Institute at NIH, said in a press release.

jCyte Inc. Announces First Patients Treated in JC02-88 Trial for Retinitis Pigmentosa. August 18, 2025. Accessed August 18, 2025. 

https://www.businesswire.com/news/home/20250818947550/en/jCyte-Inc.-Announces-First-Patients-Treated-in-JC02-88-Trial-for-Retinitis-Pigmentosa

Charters L. Retinal progenitor cells: Targeting retinitis pigmentosa. 

https://www.ophthalmologytimes.com/view/retinal-progenitor-cells-targeting-retinitis-pigmentosa

jCyte initiates patient dosing in a new trial for famzeretcel, aiming to transform treatment options for retinitis pigmentosa.

First patients dosed in JC02-88 study

German researchers described a rare case of tubulointerstitial nephritis and uveitis (TINU) syndrome in a teenager,

 the management of which requires a multidisciplinary approach.

TINU is a rare autoimmune disorder that affects the kidneys and eyes concurrently; the most common presentation in the eyes is bilateral, nongranulomatous anterior 

 TINU predominantly affects adolescents and young adults, with a median onset time around 14 to 15 years of age,

 according to Markus Kerner, MD, a general practitioner in Neuffen, Germany, and colleagues.

The clinical presentation is heterogeneous and often nonspecific.

 Renal manifestations may include fatigue, flank discomfort, polyuria, or signs of acute kidney injury

; ocular symptoms are bilateral anterior uveitis with pain, photophobia, or visual disturbances.

 However, some patients can be asymptomatic, and uveitis may be discovered incidentally on ophthalmologic examination,

Renal and ocular symptoms can occur simultaneously or sequentially, which may delay diagnosis.

 Uveitis frequently persists or can relapse.

They described the case of a 15-year-old girl who presented to her general practitioner with complaints of fatigue and polyuria. She also reported a recent intentional weight loss. The onset of TINU occurred after she started treatment with sertraline for depression, suggesting a possible drug trigger.

Evaluation revealed acute kidney injury with elevated serum creatinine and a tubular pattern of proteinuria, mild anemia, elevated ferritin levels, and abnormal urinalysis with proteinuria, glucosuria, hematuria, and microalbuminuria; the patient was admitted to a pediatric hospital. A renal biopsy confirmed acute, nongranulomatous tubulointerstitial nephritis. An ophthalmologic examination revealed bilateral anterior uveitis, confirming the TINU syndrome diagnosis.

Regarding ocular involvement, Kerner and colleagues noted that while the patient had no ocular complaints at presentation, the ocular involvement was not clinically apparent. This agreed with previous reports that the uveitis can be mild, bilateral, and asymptomatic, underscoring the importance of proactive ophthalmologic assessment in patients with unexplained interstitial nephritis.

 “The temporally dissociated onset of renal and ocular findings remains one of the principal challenges in TINU diagnosis,"

Treatment included high-dose oral steroids that resulted in recovery of renal function and general well-being. The patient was followed by pediatric nephrology and ophthalmology.

Kerner and colleagues also noted, “Long-term outcomes in TINU syndrome are generally favorable when the condition is identified early and managed appropriately. Nevertheless, uveitis tends to relapse more frequently than nephritis and may persist or reappear months to years after the initial episode.

 Regular follow-up with both pediatric nephrology and ophthalmology remains essential.”

They concluded, “This case illustrates how clinical vigilance in primary care can facilitate the early recognition of TINU syndrome in an adolescent presenting with nonspecific systemic and renal symptoms.”

Kerner M, Todoroff J, Von Schnakenburg C, Amann K, Müller-Kühnle J. Fatigue, polyuria, and hidden uveitis: a case of tubulointerstitial nephritis and uveitis syndrome diagnosed in primary care. 

 12025;7: e89245. doi:10.7759/cureus.89245

Bograd A, Heiligenhaus A, Reuter S, Tappeiner C. 

A comprehensive review of tubulointerstitial nephritis and uveitis (TINU) syndrome

The syndrome of tubulointerstitial nephritis with uveitis (TINU)

Sanchez-Quiros J, Giralt L, Fonollosa A, Robles I, Carreño E. 

Diagnostic and management strategies of tubulointerstitial nephritis and uveitis syndrome (TINU): current perspectives

Matsumoto K, Fukunari K, Ikeda Y, et al. 

A report of an adult case of tubulointerstitial nephritis and uveitis (TINU) syndrome, with a review of 102 Japanese cases

The tubulointerstitial nephritis and uveitis syndrome

Tubulointerstitial nephritis and uveitis syndrome: case report and review of the literature

Course and outcome of tubulointerstitial nephritis and uveitis syndrome

Tubulointerstitial nephritis and uveitis syndrome

Classification criteria for tubulointerstitial nephritis with uveitis syndrome

Amaro D, Carreño E, Steeples LR, Oliveira-Ramos F, Marques-Neves C, Leal I. 

Tubulointerstitial nephritis and uveitis (TINU) syndrome: a review

Paroli MP, Cappiello D, Staccini D, Caccavale R, Paroli M. 

Tubulointerstitial nephritis and uveitis syndrome (TINU): a case series in a tertiary care uveitis setting

Tubulointerstitial nephritis and uveitis syndrome: characterization of clinical features

Sobolewska B, Bayyoud T, Deuter C, Doycheva D, Zierhut M. 

Long-term follow-up of patients with tubulointerstitial nephritis and uveitis (TINU) syndrome

Khochtali S, Harzallah O, Hadhri R, Hamdi C, Zaouali S, Khairallah M. 

Neuroretinitis: a rare feature of tubulointerstitial nephritis and uveitis syndrome

A rare case of tubulointerstitial nephritis and uveitis syndrome in a teenager highlights the importance of multidisciplinary diagnosis and management.

Multidisciplinary insights into diagnosing tubulointerstitial nephritis, uveitis

An aging population combined with the increasing incidence of chronic disease has led to a steady rise in the number of patients requiring retinal care. 

Thankfully, modern diagnostic imaging and better access to health care have allowed us to catch disease earlier and intervene sooner. Such advances help us achieve better long-term outcomes for our patients, but they also add to the volume and complexity of care.

I practice in Asheville, North Carolina, a city with a large retired population. I manage a high volume of patients with retinal diseases, includ

ing age-related macular degeneration (AMD)

AMD represents approximately 80% of my clinical workload. Making sure these patients have a positive experience while they are in our care requires a fine balance of safety and efficiency. We achieve each element by establishing and following preinjection protocols and building trust with our patients. We believe in tailoring not only the procedure but also our anesthetic approach based on patient needs.

, intravitreal injections (IVIs) remain the gold standard of care. Anti-VEGF agents have revolutionized outcomes, helping preserve sight in millions of patients who would have otherwise lost significant vision. But the treatment comes with a catch: the burden of frequent and repeated injections.

On any given day, I may perform between 40 and 80 injections. That is not unusual in a busy retina practice. IVI schedules are overwhelming for our clinic, but also for our patients. Even those who have been through the process before may be anxious or worried before the injection. 

Particularly for those with bilateral disease, who sometimes require 2 different IVIs every month, there is a lot of associated emotional stress, transportation issues, and physical discomfort. As clinicians, we are always looking for ways to reduce the friction in this process. A smooth and efficient preinjection protocol not only ensures safe, effective, and consistent care but also may reduce patients’ stress and enhance their experience.

Discomfort during IVIs is one of the most common patient concerns. Although the injection only takes a few seconds, poor anesthesia or a rushed preinjection process may make those few seconds feel like a lifetime for a patient.

Over the years, I have explored myriad options to optimize anesthesia. Early in my practice, there were no FDA-approved anesthetics for IVIs. The standard approach was topical drops such as proparacaine and tetracaine, followed by povidone-iodine (Betadine) for antisepsis. Although fast and efficient, the method often left patients wincing in significant discomfort. More than occasionally, I found patients were reluctant to return for follow-up care and IVIs.

Viscous anesthetic gels offer better pain control. Products such as lidocaine hydrochloride ophthalmic gel (Akten; Théa Pharma) and tetracaine hydrochloride 0.5% ophthalmic gel (TetraVisc; OCuSOFT) help keep the anesthetic in place longer, allowing more effective numbing at the injection site. The trade-off, however, is that the thick gel may trap bacteria on the ocular surface, potentially increasing the risk of endophthalmitis.

 Additionally, prolonged exposure of the gel to the cornea, especially when clinic flow is delayed, can result in epithelial toxicity and delayed wound healing, which can lead to large corneal abrasions and days of discomfort.

Subconjunctival lidocaine provides the most complete pain relief but requires additional setup, an extra needle stick, and additional risk to the patient. This lengthens the preinjection process for our staff and reduces clinic efficiency. Even though the time difference may be only one minute per patient, the extra time in a long clinic day can add up to nearly an hour by the end of the day. Although patients feel less pain and discomfort during the injection, some experience anxiety around the numbing injection itself, and many have more prolonged discomfort when the anesthetic effect wears off.

chloroprocaine hydrochloride ophthalmic gel 3% (Iheezo; Harrow)

 and have incorporated it into my injection anesthetic routine. The preservative-free gel is formulated with a lubricating component and is the first FDA-approved ocular anesthetic gel in more than 10 years specifically labeled for ophthalmic use, including IVIs. 

I began using chloroprocaine hydrochloride ophthalmic gel because of its potential to offer more comfort than traditional drops while streamlining the process compared with subconjunctival injection.

 Findings from a phase 3 trial showed that 1 dose (3 drops) achieved sufficient ocular surface anesthesia in less than 90 seconds and lasted approximately 21.5 minutes.

 This is much easier than other protocols that involve the use of multiple drugs and application methods.

Chloroprocaine hydrochloride ophthalmic gel has an established safety profile comparable to other local ocular anesthetics.

 Additionally, it is 75% less viscous than other FDA-approved anesthetic gels (

) and has demonstrated no barrier to the bactericidal actions of povidone-iodine 5%.

In my hands, chloroprocaine ophthalmic gel is preferred to other anesthetic approaches because it is safe, easy to apply, remains localized at the site of administration, and provides consistent anesthesia for most patients. 

The role of anesthetics in streamlining efficiency and elevating patient care.

Mark Michels, MD

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