Akpek,E., Jones,L., Nichols,K. K., Nijm,L., Pflugfelder,S. Delphi working group. Delphi panel on neuromodulation as a treatment strategy for dry eye disease: Unlocking the potential of natural tear production Ocular Surface 2026;39(January):34-40 [ Show Abstract ]

Purpose
Chronic tear deficiency, through reduced production and/or increased evaporation, is regarded as a root cause of dry eye disease (DED). The goal of treating DED is restoration of the tear film ultimately resulting in ocular surface homeostasis. Multiple therapeutic prescription drugs to manage DED exist with varying speed of onset, overall magnitude of efficacy, and tolerability. Neuromodulation is an emerging treatment modality offering direct stimulation of natural tear production. A modified Delphi study was conducted to explore the role of neuromodulation as a treatment for DED.

Methods
Twenty DED experts participated in three rounds of structured electronic Delphi questionnaires. Consensus, defined as ≥ 80 %, was sought on 18 statements across three key DED topics: unmet treatment needs, the importance of natural tears in ocular surface homeostasis, and neuromodulation as a treatment approach. Statements were refined iteratively based on qualitative feedback and quantitative agreement from the panel.

Results
Consensus was reached on all 18 statements. Panelists affirmed that significant unmet needs persist in managing DED. Panelists agreed that stimulating patients’ natural tear production can help maintain and restore ocular surface homeostasis and that neuromodulation, through the ability to rapidly increase natural tear production, has the potential to effectively fill existing treatment gaps.

Conclusion
This Delphi panel reached consensus on the importance of restoring natural tear production as a primary goal in treating DED. Neuromodulation represents a promising treatment option for DED, offering a rapid and restorative therapeutic approach for natural tear production.

Darge,H., Phan,C.M., Ng,A., Ho,B., Wulff,D., Hui,A., Jones,L. Development of an Eye Model Using 3D-Printing for Correlating Measured Intraocular Pressure with Actual Internal Pressure Current Eye Research 2026;51(1):24-31 [ Show Abstract ]

Purpose: The aim of this study was to develop a 3D-printed eye model to simulate measuring intraocular pressure (IOP) as a training device, and to assess the correlation between measured IOP using common clinical techniques and actual internal pressure.

Methods: The IOP eye model was designed using CAD software and printed with a resin stereolithography (SLA) 3D-printer (Formlabs 3B, Formlabs Inc., MA, USA). Two clinical instruments, Tono-pen (Tono-Pen AVIA, Reichert Ophthalmic Instruments, USA), and Perkins hand-held tonometer (Clement Clarke Perkins Tonometer Mk2, Vision Equipment Inc., USA) were used for IOP measurements of the model. The pressure within the model was adjusted between 7 to 55 mmHg at 5 mmHg increments, and the IOP values of the tonometry were correlated to the internal pressure displayed on the gauge.

Results: The IOP model could reliably produce internal pressure from 0 to 56 mmHg. The results showed that the Tono-pen measurements above 7 mmHg were closely correlated to the internal pressure obtained from the pressure gauge (Pearson r = 0.99, p < 0.0001). However, aligning the mires and measuring IOP accurately with the Perkins device was challenging.

Conclusion: The 3D-printed eye model was able to strongly correlate IOP readings taken with a Tono-pen with internal pressure measured by a pressure gauge. The internal pressure of this model can be regulated and is envisioned as a potential model for practicing tonometry at different ranges of pressure.

Perez, V. L., Chen, W., Craig, J. P., Dogru, M., Jones, L., Stapleton, F., Wolffsohn, J. S., Sullivan, D. A. TFOS DEWS III: Executive Summary American Journal of Ophthalmology 2026;282(February):135-145 [ Show Abstract ]

This article presents an executive summary of the conclusions and recommendations of the third Tear Film and Ocular Surface Society Dry Eye Workshop (TFOS DEWS III) reports, published in the American Journal of Ophthalmology (AJO) in the second quarter of 2025. These reports describe an updated, evidence-based consensus understanding of dry eye disease, together with scientifically-supported strategies for its clinical diagnosis and management. The three comprehensive TFOS DEWS III reports and accompanying editorial are freely available for download from the AJO website (www.ajo.com).

Wong,K. Y., Ho,B., Soomro,A., Jones,L., Liu,J., Phan,C. M. An In Vitro Evaluation of the Effect and Protection of Artificial Tear Formulations on Human Corneal Epithelial Cells in Normal and Dry Eye Disease States Pharmaceutics 2026;18(2):202 [ Show Abstract ]

Background: Dry eye disease (DED) is characterized by tear film instability and a hyperosmolar ocular surface, which significantly impacts ocular health. Artificial tear solutions (ATSs) have been effective frontline treatments for DED, yet current commercially available products often provide only temporary relief, necessitating frequent daily administration. Significant efforts have been made to develop next-generation ATSs that can provide prolonged protective effects for DED. High-molecular-weight sodium hyaluronate (HA) is more commonly used in multi-dose preservative ATSs due to its longer chain lengths and rheological properties that can provide an enhanced retention time and clinical comfort and effects. The current methods to evaluate ATSs have largely focused on human biocompatibility and rheological testing and often overlook the dynamic nature of cellular phenotypes or the protective mechanisms at a cellular level. Therefore, this study developed novel in vitro mammalian cell assays involving human corneal epithelial cells (HCECs) to comprehensively assess ATSs with HA for biocompatibility and efficacy.

Methods: We evaluated cellular viability across varying severities in two distinct DED models: desiccation and hyperosmotic stress. Simultaneously, time-lapse imaging coupled with computational image analyses quantified subtle, yet significant, cellular morphological changes under these stress condition.

Results: Our assays revealed that ATSs provide significant, yet varying, protection against mild, medium, and harsh desiccation stress, as well as hyperosmotic conditions. This study also made a key insight that was the observation that DED conditions induce drastic HCEC morphological changes, including significant cellular monolayer breakage, which were effectively mitigated by the ATS products used in this work.

Conclusions: The assays presented here provide a robust standard for ATS testing, ultimately guiding the selection of more effective next-generation therapies and aiding in a greater understanding of DED pathogenesis.