ASCRS 2024: Dr Richard Lindstrom encourages ophthalmologists of all ages to get involved with YES


Dr Richard Lindstrom speaks about the future of dry eye and shares pearls for young eye surgeons

At this year's ASCRS meeting, Richard Lindstrom, MD, talked about his longstanding history with the organisation, including his involvement with the Young Eye Surgeons (YES) programme. Speaking to the Eye Care Network, he shared pipeline updates from Surface Ophthalmics, and addressed the changing needs of dry eye patients.

Editor's note: This transcript has been lightly edited for clarity.

Emily Kaiser Maharjan: Hi everyone, I'm here with Dr Richard Lindstrom, Chairman of Surface Ophthalmics and founder of Minnesota Eye Consultants. He's also involved in Young Eye Surgeons, or YES, which hosted some events at ASCRS. So welcome, Dr Lindstrom, it's really wonderful to have you here.

Richard Lindstrom, MD: Thank you. So, a little bit about my background at ASCRS, because I started as a Young Eye Surgeon at ASCRS. My first trip was in 1978, which dates me a little bit, and was the first meeting that ASCRS held at the Century Plaza Hotel in Los Angeles, and I presented a paper. What I found as a young eye surgeon still in my training was that I was welcomed. I was immediately included in the group and discussions, and I felt at home right away. Ever since, ASCRS has been critical in in my career. It's basically been been a nurturing environment. And so now I'm at the senior level where I just retired after 50 years from clinical practice. I'm still on the ASCRS executive committee. But, you know, for from from residency to retirement, this was a very valuable organisation for me, so, so I think it's a good thing, if you can to get started early. And that's why YES, or Young Eye Surgeon programmes, were created, to help the young surgeon get engaged early.

EKM: Yeah, that's absolutely fantastic. I think that sounds like such a cool organisation. So I know that that YES hosted a few events at ASCRS, could you tell me about those?

RL: Yes, we try to connect the young eye surgeons, which was valuable for me when I was in that position, with the more experienced eye surgeon, so they can serve as the mentors, and many times you'll establish relationships that are that are lifelong, if you will. And we try to make it fun. So we have, you know, a pub at ASCRS now, a "taproom" as we call it, where you can actually get a beer, and lunch is served there every day. And so we, members of the of the YES committee, and senior members, will meet with younger ophthalmologists and just have a, you know, a BS session, if you will. "Ask me anything" is kind of the way it's set up, any any kind of a question that you might have about your training, or about getting started as a young ophthalmologist. Or "How do I get engaged in ASCRS?" And so that's a good event. We have a lunch meeting where we sit down, again, experienced ophthalmologists that have been, you know, at ASCRS for decades, meeting again with the young eye surgeons, many times their first trip ever, and sharing experiences. And that's the same kind of a thing, you sit around the table with six or seven young doctors, and it's sort of an "Ask me anything you want." You know, I do visit professors a lot too, to residency programs, and they usually don't want me to lecture, you know, on blepharitis or cataract surgery or dry eye. They want to talk about practice. How do you get started, and contracts and the like. And so those kinds of discussions can be very valuable.

EKM: Oh, absolutely. I totally agree. So how can young surgeons get involved with YES, or older surgeons who want to maybe mentor?

RL: Well, if you know someone who's a member of ASCRS, they can expedite it, but it's easy. Just go on the website and put it in, YES, and then you can sign up. And actually, there's no charge. There are, you know, there are virtual opportunities as far as educational programmes. And then of course, we have a large annual meeting. And so, you know, I think it's quite easy to join. And, you know, for the European community, we have a really long standing and quality collaboration between ASCRS and ESCRS. We co-published the Journal of Cataract and Refractive Surgery, which I would like to see every young ophthalmologist start to read, because it covers things that are pertinent to their practices. And it's a joint ASCRS/ESCRS effort. And we work collegiately in our meetings as well. So, so get engaged in ASCRS, but also get engaged in ESCRS, because I think those two organisations probably will help you more in your career than than any other. Absolutely. For the young ophthalmologist, but also for the senior ophthalmologist, both ASCRS and ESCRS are really pretty valuable organisations. Get engaged early, and there's opportunities to grow in many ways, including getting engaged in leadership. So it's a wonderful opportunity. And the sooner you do engage, the greater the opportunity.

EKM: So, turning topics a little bit. Surface Ophthalmics has some dry eye treatments in the pipeline. Do you have any updates on the candidates in the pipeline that you're willing to share?

RL: Sure, happy to do so. I'm the Chairman of the Board at Surface Ophthalmics. It's a small startup company in the USA that was founded 6 years ago. We have completed phase two clinical trials, actually 540 patients. And we've looked at two treatments for dry eye syndrome. Dry eye syndrome is about 10% of the population. But actually, if you look at what the typical eye doctor sees in their practice, it's even a little higher than that. And we have a high quality, artificial tear called Kera Sol that's particularly useful, both in naturally-occurring dry eye but also in something that I call surgical transient ocular discomfort syndrome, or surgery-associated dry eyes. So you do a procedure, let's say cataract surgery, and on the first day that patient's uncomfortable. They've got corneal staining, in a sense, you've induced a dry eye syndrome in that surgical patient. And you need to rehabilitate that. And this particular topical lubricant is especially effective for that indication as well as an adjunct in the treatment of dry eye. Then the other big category is managing inflammatory dry. The typical drugs out there today are cyclosporine-containing drugs like Restasis, or Cequa. And then also we have the Xiidra product, Lifitegrast. And so this particular agent contains Mycophenolate, another immune suppressant, it downregulates T and B cells, and fortunately, upregulates mucin. And this is particularly effective in treating inflammatory dry eye. In our prospective trials, we compared it to both Restasis and Xiidra, and found it was superior. So the products are coming along. The over the counter product will be available next year, it will be called Kera Sol Tears. And it's going to be a really high quality, premium topical lubricant. The Kera Sol product still has to be launched, but it will be next year. The Mycosol product will be entering phase three clinical trials next year as well. So it's still a few years away, but might want to watch for these products. They're gonna start in the USA, but the issues are certainly present in, in the rest of the world as well.

EKM: Of course. I know I'll be keeping an eye out for both of those. So what are some of the misconceptions about what patients want when they're seeking eye dry eye treatments? And how can doctors help close the gap between expectations and reality?

RL: I think there' the USA market, where I practice, there's kind of two groups of dry eye patients. One I call "pharmacist dry eye patients." They just go to the pharmacy and get a bottle of topical lubricants. They have very mild intermittent dry eye, and it doesn't really have a major impact on their quality of life or vision. But then they start to develop, you know, corneal changes with punctate staining. They get fluctuating vision, blurry vision, and then usually they'll seek an eye doctor, an eye care professional. Depending on the country, either MD or OD. And those are not "pharmacist dry eyes," those are "physician dry eyes," where they have what I call discomfort or pain, and then corneal staining. I call it "pain and stain." Those patients, you know, basically need an eye care professional and there are multiple potential treatments available depending on your market. But they often need a prescription product and you need to look for demodex blepharitis, you need to look for appropriate aetiologies, and then treat the patient specifically. So kind of olden days we were lumpers, everybody either had a dry eye or didn't. Now we need to put another word in front of dry eye, that it's demodex blepharitis dry eye, or evaporative dry eye, or aqueous deficient dry eye, or post surgical dry eye or inflammatory dry eye. And then we can pick a specific treatment.

EKM: All right, well, fantastic. Thank you so much for taking the time to chat today, Dr Lindstrom. It's been a pleasure and I really appreciate it.

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