Demodex blepharitis is a chronic inflammatory ocular condition caused by Demodex mite infestation of the eyelid that can negatively impact quality of life. Currently, lotilaner ophthalmic solution 0.25% is the only FDA-approved treatment for Demodex blepharitis. The Demodex Expert Panel on Treatment and Eyelid Health has established consensus that lotilaner ophthalmic solution 0.25% should be considered the preferred first-line treatment for Demodex blepharitis. We report a patient who presented with collarettes, the pathognomonic sign of Demodex blepharitis, meibomian gland dysfunction, and poor visual acuity. The patient also had a history of neovascular age-related macular degeneration. Consistent with the Demodex Expert Panel on Treatment and Eyelid Health consensus recommendations, the patient was treated with lotilaner ophthalmic solution 0.25%, lid scrubs, and warm compresses. At the 2-month follow-up, collarettes had resolved, and signs of meibomian gland dysfunction had improved. This case supports the Demodex Expert Panel on Treatment and Eyelid Health recommendation that lotilaner ophthalmic solution 0.25% should be considered the preferred first-line treatment for Demodex blepharitis.
Introduction:Demodex blepharitis (DB) is a chronic ocular inflammation caused by Demodex mite infestation of the eyelid. DB is often misdiagnosed, as some of its clinical findings and patient-reported outcomes overlap with those of other ocular surface diseases. The Demodex Expert Panel on Treatment and Eyelid Health (DEPTH) has reached consensus on the symptomatology, diagnosis, and treatment of DB. Consensus findings from the DEPTH group include that collarettes are pathognomonic for DB and that lotilaner ophthalmic solution, 0.25%, the first and only FDA-approved treatment for DB, should be the first-line treatment for the disease. This case series highlights two instances of misdiagnosis that were subsequently re-evaluated using consensus findings from the DEPTH group, leading to a correct diagnosis and effective treatment with XDEMVY® (lotilaner ophthalmic solution) 0.25%. Case Reports:Two cases of patients with DB are presented. In the first case, a 75-year-old female presented with collarettes, reduced meibomian gland secretions, and lid margin erythema. After an unsuccessful initial treatment for bacterial infection, the patient was diagnosed with DB and prescribed lotilaner ophthalmic solution, 0.25% twice daily for 6 weeks, which improved all clinical findings and patient-reported outcomes. In the second case, a 62-year-old male presented with ocular discomfort, dry eye, and burning and itching sensations. After an unsuccessful initial treatment for dry eye disease, collarettes were detected, and the patient was diagnosed with DB. Subsequent treatment with lotilaner ophthalmic solution, 0.25% reduced collarettes and resolved patient-reported symptoms. Conclusion:These cases highlight patients with DB who were initially misdiagnosed and eventually treated with lotilaner ophthalmic solution, 0.25%. Each case exemplifies the utility of the DEPTH consensus findings in improving the diagnostic path for patients and eye care providers. Future case series from other groups will continue to shed light on the best practices for diagnosing and treating patients with DB.
PURPOSE:To evaluate visual acuity, refractive outcomes, central corneal thickness (CCT), and safety after femtosecond laser-assisted lamellar keratectomy (FLK) for granular corneal dystrophy (GCD). METHODS:This retrospective study included patients with GCD who underwent FLK between January 2013 and December 2025. FLK was performed using a planned flap thickness of 120 μm and diameter of 7.5 mm, followed by intraoperative mitomycin C 0.02% for 1 minute. Best-corrected visual acuity (BCVA), refractive outcomes, and CCT were analyzed in patients with ≥30 days of follow-up. Linear mixed-effects models were used to account for intereye correlation. RESULTS:Twenty-eight eyes of 18 patients (mean age 51.5 years, 9 female, 9 male) met inclusion criteria. Ten patients underwent bilateral FLK (20 eyes). Mean BCVA improved from 0.37 logMAR preoperatively to 0.27 logMAR postoperatively (P = 3.89 × 10-4). Mean sphere changed from +0.30 ± 2.22 diopters to 0.62 ± 2.24 diopters (P = 0.21), and mean cylinder changed from -1.39 ± 0.90 diopters to -1.04 ± 0.86 diopters (P = 0.10). Mean CCT decreased from 517.5 to 438.4 μm (P = 8.77 × 10-6). No intraoperative or postoperative complications were observed. CONCLUSIONS:FLK for GCD was associated with significant improvement in BCVA, nonsignificant and minimal refractive change, and a mean CCT reduction of 83.9 μm.
The enVista Aspire (EA) and enVista Aspire Toric (ETA) lenses are monofocal intraocular lenses (IOLs) with intermediate-optimized optics designed to broaden depth of focus. This study describes outcomes with these IOLs in real-world clinical practice. This multicenter, retrospective, real-world case series study included six cataract surgeons in the USA. Surgeons provided a convenience sample of ≥ 5 study IOL implantation cases and completed a retrospective experience survey. Outcomes included visual acuity (corrected and uncorrected distance visual acuity [CDVA, UDVA] and uncorrected intermediate visual acuity [UIVA]), refractive outcomes, and safety (adverse events and visual changes). The surgeon survey captured IOL utilization patterns and surgeon experience as supplementary descriptive findings. The analysis included 141 eyes (88 EA and 53 ETA) from 84 patients. Patients were aged 62–84 years, with postoperative follow-up ranging from approximately Days 1–6 to 4 months. At the last available postoperative visit, monocular CDVA of 20/25 or better was achieved by 97.2
