Dry eye disease (DED) can arise from a variety of factors, including inflammation, meibomian gland dysfunction (MGD), and neurosensory abnormalities. Individuals with DED may exhibit a range of clinical signs, including tear instability, reduced tear production, and epithelial disruption, that are driven by different pathophysiological contributors. Those affected often report a spectrum of pain and visual symptoms that can impact physical and mental aspects of health, placing an overall burden on an individual’s well-being. This cumulative impact of DED on an individual’s activities and on society underscores the importance of finding diverse and effective management strategies. Such management strategies necessitate an understanding of the underlying pathophysiological mechanisms that contribute to DED in the individual patient. Presently, the majority of approved therapies for DED address T cell-mediated inflammation, with their tolerability and effectiveness varying across different studies. However, there is an emergence of treatments that target additional aspects of the disease, including novel inflammatory pathways, abnormalities of the eyelid margin, and neuronal function. These developments may allow for a more nuanced and precise management strategy for DED. This review highlights the recent pharmacological advancements in DED therapy in the United States. It discusses the mechanisms of action of these new treatments, presents key findings from clinical trials, discusses their current stage of development, and explores their potential applicability to different sub-types of DED. By providing a comprehensive overview of products in development, this review aims to contribute valuable insights to the ongoing efforts in enhancing the therapeutic options available to individuals suffering from DED.

Background/Purpose: To compare the microbiologic and histopathologic features of Acanthamoeba isolates recovered from patients with Acanthamoeba keratitis (AK) who underwent a therapeutic penetrating keratoplasty (TPK), optical penetrating keratoplasty (OPK), or deep anterior lamellar keratoplasty (DALK) after Rose Bengal Photodynamic Antimicrobial Therapy (RB-PDAT). Methods: Surgical specimens were stained with hematoxylin, eosin, and Periodic Acid-Schiff stains as per institutional protocol at the University of Miami, Bascom Palmer Eye Institute. Analysis of Acanthamoeba cyst depth, number of cysts, and average corneal thickness was established by light microscopy. Results: Seventeen patients with AK underwent surgical intervention and RB-PDAT. Eight patients underwent a TPK and nine patients underwent an OPK/DALK. In the TPK group, average cyst depth was 42.0 ± 52.5 μm from Descemet’s layer and mean corneal button thickness was 661.7 ± 106.5 μm. Comparatively, in the OPK/DALK group, average cyst depth from Descemet’s layer was 261.7 ± 222.7 μm with a mean corneal button thickness of 474.2 ± 126.6 μm. Conclusions: Acanthamoeba cysts were found to penetrate deeper within the cornea amongst patients that underwent an emergent TPK compared to patients that underwent an elective OPK/DALK. This may suggest an association between Acanthamoeba cyst depth and infection severity and provides valuable clinical insights towards understanding factors such as infection recurrence and resistance to treatment.

Background and Objectives: Mobile Eye Units (MEUs) have emerged as practical innovations to overcome geographic, financial, and systemic obstacles to eye care. Although numerous programs operate across the United States and Canada, a narrative review describing their structure, implementation and services, remain limited. This narrative review examines various MEUs models in the United States and Canada, using real-world examples to highlight each model’s structure, services, populations served, and key benefits and limitations. Methods: We performed a narrative review of peer-reviewed and gray literature published from 1990 to August 2025, identifying mobile eye units in the United States and Canada. Programs were grouped into four operational models based on services, equipment, and implementation characteristics. Ophthalmology residency program websites in the United States were also reviewed to assess academic involvement in mobile outreach. Results: We identified four operational MEU models: Fully Equipped Mobile Units (FEMUs), Semi-Mobile Outreach Units (SMOUs), School-Based Vision Mobile Units (SBVMUs), and Hybrid Teleophthalmology Units (HTOUs). FEMUs provide comprehensive on-site diagnostic capabilities but require substantial financial and logistical resources. SMOUs are lower-cost and flexible but offer more limited diagnostics. SBVMUs facilitate early detection in children and reduce school-based access barriers but depend on school coordination. HTOUs expand specialist interpretation through remote imaging, although their success relies on reliable digital infrastructure. Across all models, follow-up and continuity of care remain major implementation challenges. Approximately 21% of U.S. ophthalmology residency programs publicly report involvement in mobile outreach. Conclusions: MEUs play a critical role in reducing geographic and structural barriers to eye care for underserved populations across United States and Canada. However, limited outcome reporting, particularly regarding follow-up rates and continuity of care, hinders broader assessment of their effectiveness. Strengthening the integration of MEUs with patient navigators, integrated electronic health record, insurance support and support of local health networks is essential for improving long-term sustainability and impact.

Purpose: To describe structural and systemic barriers to ophthalmic care experienced by underserved patients, particularly those facing language obstacles, immigration-related constraints, limited insurance coverage, financial hardship, and navigation challenges in an urban setting, and to examine these barriers through a complexity-informed lens. Methods: We conducted a narrative literature review focused on healthcare disparities, patient navigation, complexity in care delivery, and time-sensitive prioritization frameworks in ophthalmology. Findings were integrated with case vignettes drawn from Eyes on Wheels (EOW), a mobile eye care initiative that provides no-cost examinations at Federally Qualified Health Centers (FQHCs) and free clinics. Cases were identified through routine clinical documentation and used to illustrate how structural barriers described in the literature manifest in real-world care pathways. Results: Three recurring system-level issues were identified across EOW encounters: (A) misclassification of medically necessary, time-sensitive ophthalmic care as “non-urgent”; (B) patient disengagement driven by cumulative structural and logistical barriers; and (C) failures that arise when the healthcare system, functioning as a complex adaptive system (CAS), is unable to adapt to patients’ and systems’ changing circumstances. A review of the literature confirmed that these patterns reflect widely documented challenges faced by underserved urban populations. Three EOW case vignettes, selected from seven patients identified in 2024, are presented as illustrative examples of these systemic patterns. Conclusions: Addressing inequities in eye care requires an approach that recognizes how many parts of the healthcare system interact and affect a patient’s ability to receive timely treatment. Vision loss is often the preventable result of systems that are rigid, fragmented, or unable to adapt to a patient’s circumstances. Improving outcomes will require flexible care models, such as mobile clinics, paired with strong institutional support, patient-centered navigation, and consistent assessment of social needs and barriers to care. Sustained progress will depend on collaboration across organizations, adaptable leadership, and policies that respond to the real-world situations in which patients live.