When your child gets the diagnosis of myopia (or near sightedness), there's a lot to take in. Suddenly you're talking about glasses and potentially contact lenses, and because there is no cure, a lifetime of needing those supports to be able to see. Refractive surgery to correct vision is not an option until at least age 18 and has it's own side effects to consider. And then on top of all of this information, your doctor explains that your child not only has myopia, but studies show that their vision will get WORSE every year by an average of 0.50-0.75 diopters until they stop growing, around age 18. 

"What if we don't do glasses then? Or what if we cut the prescription down in the glasses (undercorrect the myopia)?" you might be tempted to think. Studies show that will only make the eyes worsen faster.

For the past several decades as more and more research has been published, there has been no statistically significant, meaningful method of slowing down childhood prescription worsening with glasses, despite efforts with undercorrection, bifocals, prism, and progressives. If a parent wanted to slow down the rate of their child's worsening vision, their only options for myopia management were FDA approved multifocal contact lenses called MiSight, orthokeratology corneal molds for overnight wear, or off-label low dose atropine. All of these options have their own pros and cons, and many parents are hesitant to initiate nightly eye drops or contact lens wear into their young child's day to day routine. 

At least, this was true until September 25, 2025 when the FDA granted marketing approval for the first ever glasses to slow down the progression of myopia: Essilor Stellest. 

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How Does it Work?

Unlike traditional glasses, the Stellest lens has 1021 tiny highly aspheric lenslets arranged in 11 distinct rings 9 millimeters around the central visual axis. Called HALT technology (highly aspheric lenslet target), these lenslets create a phenomenon called peripheral myopic defocus for light falling into the retina. Want to nerd out about peripheral defocus? Read my summary here!

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How Well Does it Work?

Essilor Stellest lenses have a large amount of data to support their effective myopia management benefits. Back in 2021 they were designated as a breakthrough novel device by the FDA based on initial data, and over the ensuing years more and more clinical study data has been compiled both in clinical trials around the US and in other countries where doctors were already prescribing this lens for myopia management. Here's how the data breaks down:

Two Year Study Data: This study included 157 children ages 8-13 with prescriptions between -0.75D to -4.75D who were randomly assigned to single vision (normal) glasses correction or HALT lens correction (Stellest lenses) for full time wear (12 or more hours per day). For those wearing the HALT lens design, there was a 67% slowing of prescription progression (worsening prescription) and 60% reduction in axial length progression (elongation of the eye).

Six Year Study Data: After 6 years of HALT lens wear, a 57% slowing of prescription progression and 52% reduction in axial length progression was demonstrated compared to single vision lens wear. Additionally, the risk of progressing to high myopia (defined as -6.00D or worse) dropped from 38% in the single-vision lens control group to just 9% in the HALT lens group.

These results are comparable to study data for the existing myopia management strategies available, making HALT glasses an excellent option to consider for parents who want to reduce the chance that their children's vision will get worse as they grow. No longer do parents only have the option of starting their child on eye drops or contact lenses in order to keep their prescription as low as possible; with myopia management glasses now FDA approved, doctors can prescribe whatever option is best for the child and their family and keep the child's vision as clear as possible!

CooperVision recently announced the following contact lens product discontinuations:

• Biomedics 55 Premier: Trial lenses discontinued May 1, 2025. Boxes discontinued May 1, 2026
• Biomedics Toric: Trial lenses discontinued May 1, 2025. Boxes discontinued May 1, 2026
• Clariti 1 Day Multifocal: Trial lenses discontinued July 1, 2025. Boxes discontinued January 1, 2026

Clariti 1 Day Multifocal 3 Add via

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Interestingly, neuroadaptation plays a role in the drop's success. On day one only 23.3% of patient reached the goal near vision 1 hour after drop insertion, while on day fifteen 47.9% of patients reached the near vision goal within 1 hour. It is recommended to use the drops daily for 2 weeks to get the best visual performance. A second drop instilled 2-3 hours after the first drop can help extend the length of near vision improvement up to 8 hours. 

While you may read these numbers and say, well only half of patients achieved the goal of 3 or more lines of near vision improvement, is this really that amazing? Counter this with the GEMINI clinical study data from Vuity in which only 26-31% of patients achieved this same visual goal. All signs point to Qlosi being a significant improvement over the existing option on the market.

The most common treatment-related adverse events were headache (6.8%) and instillation site pain (5.8%). Of all Qlosi users, only 1.3% reported moderate treatment-related adverse events. All other adverse events were mild.

While no cases of adverse retinal events occurred during the clinical study, rare cases of retinal detachment have been reported with miotics. Examination of the peripheral retina is advised in all patients prior to initiation of therapy. Patients are advised to seek immediate medical care with sudden onset of flashes of lights, floaters, or vision loss.

Want to learn more about Qlosi? Check out the Defocus Media interview with Dr. Jade Coats.

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The study began in 2018 with children aged between 8 and 13 years old. After completing the initial five-year study phase, participants continued wearing Essilor Stellest lenses for an additional two years to assess the long-term impact on myopia progression.

• The six-year results showed that Essilor Stellest lenses slowed prescription progression by 1.95 D (57% prescription progression reduction) and slowed axial elongation by 0.81 mm (52% axial length progression reduction)
• Risk of progressing to high myopia (defined as -6.00D or worse) dropped from 38% in the single-vision lens control group to just 9% in the Essilor Stellest lenses group

An estimated 19.8 million Americans over the age of 40 have a diagnosis of macular degeneration (AMD), which can cause significant central vision loss as the disease progresses from year to year. Genetics, lifestyle, and diet are all major risk contributors, but the older we live, the aging process also plays a significant role in our increased risk of AMD. By age 80, 30% of Americans have macular degeneration. A number of treatments have changed the way we manage macular degeneration and preserve the vision of those affected. Anti-VEGF treatments for wet macular degeneration are the standard of care to preserve and in some cases even improve vision. Dry macular degeneration has been historically without treatment, but in 2023 the FDA approved two treatments for the most severe form of dry AMD, geographic atrophy. These injections can slow the worsening of this condition but did not show any vision improvement. So for the the majority of patients with AMD (90% of Americans with macular degeneration have the dry form of the disease), there has been no treatment that could improve or restore any vision that person had lost.

Until now.

On November 5, 2024, the FDA approved the Valeda Light Delivery System as the first ever treatment for vision improvement in patients with dry AMD. The treatment is for patients in the early stages of dry AMD that have not progressed to geographic atrophy. The device uses photobiomodulation, a treatment currently used in arthritis, wound repair, physiotherapy and sports medicine, which targets the mitochondria at the cellular level to stabilize metabolic cellular function. In AMD, the macular photoreceptor cells are struggling to metabolize light energy and free radical damage, resulting in the build up of waste and debris (drusen) at the macula, inflammation, and as the condition advances, scar tissue (geographic atrophy) and bleeding inside the eye (wet macular degeneration). By targeting the mitochondria of macular photoreceptor cells to increase metabolism, increase ATP (energy!) production, and boost cellular repair in response to light and free radical damage, tissue function is better preserved and protected. Using this photobiomodulation approach, the Phase III LIGHTSITE trial showed that patients gained an average of 5 letters of improvement in vision over a 2 year period using the device. Let's break down the data from this pivotal study:

The LIGHTSITE III trial was a double-masked, sham controlled, multi-center study that was run at 11 eyecare centers across the United States and included 100 patients (148 eyes) with early or intermediate stage dry AMD. Included study participants were age 50 or older (average age was 74.4), and had best corrected vision of 20/100 to 20/32 Snellen Acuity. Patients with geographic atrophy or wet AMD were not included in this study. If a patient had significant cataract that would affect vision or would require surgery in the next 2 years, or a history of other eye conditions or diseases that can affect vision including glaucoma, retinal vascular diseases, macular edema, amblyopia (lazy eye), or nystagmus, they were also excluded. Because the treatment is light-based, any patients that had light sensitivity disorders (including history of seizure, epilepsy, or migraine) or that were taking photosensitizing medications could not participate.

The Valeda device is an in office treatment that stimulates improvement in cellular metabolism. Currently available in Europe and South America, this device is now FDA approved and will be available in the USA at eye doctor in the near future. via

Treatment: Subjects were given in office treatments with the Valeda device using photobiomodulation at 3 wavelengths: 590 (yellow), 660 (red), and 850 nanometers (near infra-red), or a sham treatment that emitted much less light (the sham mode delivered 50x less 590 nm, 100x less 660 nm wavelengths and no 850 nm wavelengths).  Participants received these treatments over 9 sessions spaced over 3-5 weeks every 4 months for a period of 24 months. 

Results: At 13 months the Valeda-device treatment group had a statistically significant improvement in gained visual acuity over the sham treatment group. At month 13 patients had received 4 series of treatment, and the average change from baseline in best corrected vision was +5.4 letters in the treatment group, versus +3 letters in the sham group. Over half (55.5%) of patients in the treatment group increased vision by more than 5 letters: 26.4% of the treatment group had 10 or more letter gain, and 5.5% had a 15 or more letter gain in best corrected vision. At 24 months, these results were sustained, with an average improvement of 5.9 letters from baseline in the treatment group.

In addition to an improvement in best corrected vision, the treatment group also showed a reduced risk of vision loss over the study period. Only 7% of treated eyes lost more than 5 letters during the 24 months of the study, versus 18% of the sham treatment group who lost more than 5 letters of best corrected visual acuity. 

Also, significantly fewer of the Valeda device treatment group went on to develop geographic atrophy over the 24 month study. 6.8% of the treatment group developed geographic atrophy versus 24% of the sham group. 

The device was well tolerated with 3 participants having device-related adverse events- all of which were dry eye in nature. 5 of the study participants with treatment went on to develop wet AMD versus only 1 of the sham group, but these results were not deemed to be statistically significant on review (treatment versus sham group enrollment was 2:1). 

Stay Tuned: Now that this device is FDA approved, the developer LumiThera will need time to ramp up production and develop access channels. You can sign up on their website to get updates about device availability. They also have a Valeda locator on their website (but right now no offices in the United States are listed). 

With cataract surgery the most commonly performed surgical procedure in the United States (an estimated 3.5 million surgeries are done each year by ophthalmologists in the US!), optometrists take on the majority of post-operative care needs for these patients. Typically the ophthalmologist who performed surgery sees the patient for a 1 day post-op visit, and then releases care to a partnering optometrist for the 1 week and subsequent follow-up visits over the 90 day post-operative period. Optometrists are trained and skilled at handling post-operative care and complications, but handling the billing and coding for post-operative care poses unique challenges because insurances require that the doctor split reimbursements with the surgeon who performs the surgery and who who initiates the post-op care on day 1. If you need a quick reference on filling out insurance claims for post-operative cataract surgery care, this guide is for you!

When you see the patient for their initial post-op visit under your care, you will file CPT code 66984-EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS

• Link this code to the cataract in the eye that just had surgery. Yes, I know there is no cataract now during your post-op care because surgery was done to remove it. But your post-op care is getting partial payment from insurance for the overall procedure, so you're linking it to the cataract that used to be there. It is important that you use the same cataract code that the operating surgeon did. If the codes don't match, insurance will reject. Most surgeons use H25.81X Combined Forms of Age-Related Cataract, but make sure you match what was used in the transfer of care document sent by the surgeon.
• use modifier -55 Post-Operative Management
• use modifier -LT or -RT pending which eye was operated on (and make sure you've linked that to the appropriate cataract code H25.811 for right eye, H25.812 for left eye)
• use modifier -79 if you are initiating post-operative care for the second eye during the global period of the first eye's cataract surgery post-op care

Example of a cataract post-op claim filed to BCBS. This claim was approved and paid by insurance!

Note in the additional claim information section you put the referring doctor (Box 17), initial treatment date (SURGERY DATE!), report care start date is your first day of post-op care, and report care end date is the last day of the 90 day global period. I always spell it all out in Box 19 too.