Amar Shah, MD, is a cataract, refractive, and cornea surgeon at Mid-Ohio Eye.

Rates of Hyperosmolar Tear Film After Cataract Surgery, With Amar Shah, MD

2025 American Society of Cataract and Refractive Surgery (ASCRS) Annual Meeting

 highlighted a significant gap in ocular surface recovery following 

, with more than a third of patients showing elevated tear film osmolarity one month after surgery despite standard postoperative care.

The study at the Cincinnati Eye Institute enrolled 71 patients scheduled for cataract surgery. Tear osmolarity was measured using the ScoutPro Osmolarity System before surgery and again at the 30-day postoperative visit. Hyperosmolarity was defined as ≥ 315 mOsm/L, following ASCRS guidelines for ocular surface disease (OSD).

At baseline, 44% of patients (31 of 71) were found to have hyperosmolar tear film. Among the 59 patients who returned for the 30-day follow-up, 31% of those with normal osmolarity preoperatively developed hyperosmolarity. Meanwhile, only 50% of those who started with elevated osmolarity saw normalization by day 30, despite treatment with antibiotics, corticosteroids, NSAIDs, and artificial tears.

, presenting investigator Amar Shah, MD, a cataract, refractive, and cornea surgeon at Mid-Ohio Eye, noted that a central feature of dry eye disease is hyperosmolarity of the tear film. He indicated the value of obtaining information on whether a tear osmolarity is elevated or abnormal, suggesting its presence can lead to light scatter comparable to a grade two or three cataract.

“While in a cataract, the amount of light scatter is pretty constant, because the cataract is either there or not,” Shah told 

. “In hyperosmolar tear film, the light scatter is more fluctuating between blinks or throughout the course of the day. This can be a little bit harder to identify, because we can't see alterations in osmolarity at the slit lamp.”

Shah emphasized that the persistence of hyperosmolarity despite a conventional drop regimen suggests the need for more targeted interventions. He pointed to options ranging from preservative-free artificial tears to prescription therapies like cyclosporine, lifitegrast, or punctal occlusion.

“This suggests that despite what we consider routine post-operative drops, there certainly could be an opportunity to add additional treatment to address these alterations in tear osmolarity,” Shah told 

. “This can range from as simple as over-the-counter interventions like high-quality, preservative-free artificial lubrication or ointments, or it could be escalated up to any number of our bevy of available prescription treatment options.”

With increasing use of premium intraocular lenses and rising patient expectations, Shah stressed that managing the ocular surface is critical to visual outcomes.

“There’s an opportunity to be a little bit more aggressive in our management of ocular surface disease, pre- and post-operatively, especially in our modern era where patients' expectations are higher,” Shah told 

. “The utilization of advanced technology interactive lenses is increasing, and the bar that we need to meet and exceed is growing higher and higher.”

Shah AP, Barfell AD. The Prevalence of Hyperosmolar Tear Film in Patients Pre- and 30-Days-Post Cataract Surgery. Paper presented at the 2025 American Society of Cataract and Refractive Surgery (ASCRS) Annual Meeting. April 25-28, 2025. Los Angeles, CA.

Shah explores the impact of hyperosmolarity on tear film post-cataract surgery, emphasizing the need for enhanced dry eye management strategies.

Rate of Hyperosmolar Tear Film After Cataract Surgery, With Amar Shah, MD

Amar Shah, MD

) is the third leading cause of cancer-related death despite only accounting for 3% of all new cancer diagnoses.

 Obesity is a well-known risk factor for multiple types of cancer, including PDAC. In fact, there exists a relative risk of PDAC of 1.10 for every 5-unit increment increase in body mass index (BMI).

 While bariatric surgery has been demonstrated to reduce overall cancer incidence and mortality, conflicting data exist regarding the effects of bariatric surgery on PDAC.

We performed a retrospective case-control study utilizing the National Inpatient Sample (NIS) database from October 2015 to December 2020. All adult subjects (age ≥18 years) with a BMI >40 kg/m2 or >35 kg/m2 with ≥1 metabolic comorbidity were identified and stratified into those with and without a history of bariatric surgery (Roux-en-Y gastric bypass or sleeve gastrectomy).

, Tenth Edition Clinical Modification (ICD-10-CM) codes were used to define variables of interest. Baseline characteristics and comorbidities among the 2 groups were compared using chi-squared and Wilcoxon rank-sum tests and logistic regression analysis was performed to assess the risk of PDAC after adjusting for multiple risk factors, including tobacco use, acute and chronic pancreatitis, diabetes mellitus and various stages of obesity.

Over 19 million subjects were included, 1,656,329 of whom had a history of bariatric surgery. Patients with a history of bariatric surgery were significantly younger, more frequently female (75% vs 58%), had higher rates of class 3 obesity (69% vs 52%) and lower prevalence of hypertension, hyperlipidemia, chronic kidney disease, Charlson Comorbidity Index (CCI) ≥3, tobacco use, acute and chronic pancreatitis and pancreatic cancer (0.1% vs 0.2%) while having a higher prevalence of OSA (

 <.001). Additionally, in-hospital mortality (0.5% vs 1.8%), total hospital charges and overall length of stay were lower in the bariatric surgery cohort compared to the nonsurgical cohort (

 <.001). After adjusting for multiple comorbidities and risk factors, history of bariatric surgery was demonstrated to significantly reduce the risk of PDAC on both univariable (odds ratio [OR], 0.50; 95% confidence interval [CI], 0.44 - 0.56) and multivariable analysis (OR, 0.68; 95% CI, 0.61 - 0.77).

This is the largest analysis to date investigating the effects of bariatric surgery on pancreatic cancer risk reduction and serves to clarify previously inconclusive data. We have shown bariatric surgery to exhibit an independently protective effect against PDAC oncogenesis. It is reasonable to suggest that patients at increased risk of PDAC as well as other obesity-related malignancies may be recommended for surgically-assisted weight loss earlier and more frequently.

With advancements in minimally invasive bariatric procedures, expanding patient eligibility and indications for surgery, increasing utilization of bariatric surgery and endoscopic bariatric and metabolic therapies may help alleviate the growing burden of pancreatic cancer.

Surveillance, Epidemiology and End Result (SEER) Program. Surveillance Research Program, National Cancer Institute. 2023 Apr 25. https://seer.cancer.gov.

Aune D, Greenwood DC, Chan DS, et al. Body mass index, abdominal fatness and pancreatic cancer risk: a systematic review and non-linear dose-response meta-analysis of prospective studies. Ann Oncol. Apr 2012;23(4):843-52. doi:10.1093/annonc/mdr398

Schauer DP, Feigelson HS, Koebnick C, et al. Bariatric Surgery and the Risk of Cancer in a Large Multisite Cohort. Ann Surg. Jan 2019;269(1):95-101. doi:10.1097/SLA.0000000000002525

Adams TD, Stroup AM, Gress RE, et al. Cancer incidence and mortality after gastric bypass surgery. Obesity (Silver Spring). Apr 2009;17(4):796-802. doi:10.1038/oby.2008.610

Sjöström L, Gummesson A, Sjöström CD, et al. Effects of bariatric surgery on cancer incidence in obese patients in Sweden (Swedish Obese Subjects Study): a prospective, controlled intervention trial. Lancet Oncol. Jul 2009;10(7):653-62. doi:10.1016/S1470-2045(09)70159-7

Tee MC, Cao Y, Warnock GL, Hu FB, Chavarro JE. Effect of bariatric surgery on oncologic outcomes: a systematic review and meta-analysis. Surg Endosc. Dec 2013;27(12):4449-56. doi:10.1007/s00464-013-3127-9

Bulsei J, Chierici A, Alifano M, et al. Bariatric surgery reduces the risk of pancreatic cancer in individuals with obesity before the age of 50 years: A nationwide administrative data study in France. Eur J Surg Oncol. Apr 2023;49(4):788-793. doi:10.1016/j.ejso.2022.11.013

Fan H, Mao Q, Zhang W, Fang Q, Zou Q, Gong J. The Impact of Bariatric Surgery on Pancreatic Cancer Risk: a Systematic Review and Meta-Analysis. Obes Surg. Apr 05 2023;doi:10.1007/s11695-023-06570-x

Wilson RB, Lathigara D, Kaushal D. Systematic Review and Meta-Analysis of the Impact of Bariatric Surgery on Future Cancer Risk. Int J Mol Sci. Mar 24 2023;24(7)doi:10.3390/ijms24076192

A history of bariatric surgery was associated with up to 50% reduced risk of PDAC among a national cohort.

Bariatric Surgery is Associated with Reduced Risk of Pancreatic Cancer: Analysis of a US National Database

Bailey Flora, MS, RD, ND

Fola May, MD, PhD, is an associate professor at the David Geffen School of Medicine and associate director of the UCLA Kaiser Permanente Center for Health Equity.

The Nuances of Noninvasive Screening for Colorectal Cancer, with Fola May, MD, PhD

As colorectal cancer screening options expand, patients are faced with more choices than ever before—each with different strengths, limitations, and implications for care. While the growing menu of tests increases accessibility, understanding the nuances between them is essential for informed decision-making.

“Fundamentally, these tests are different,” Fola May, MD, PhD, an associate professor at the David Geffen School of Medicine and associate director of the UCLA Kaiser Permanente Center for Health Equity, told 

, emphasizing that the decision should be tailored to the patient’s preferences.

Despite the emergence of several new noninvasive tests, colonoscopy remains the most comprehensive screening tool, offering both preventive and diagnostic benefits by allowing physicians to find and remove precancerous polyps and detect cancers directly. For those unable or unwilling to undergo colonoscopy, stool-based tests like FIT and FIT-DNA can also detect cancer and, to a lesser extent, precancerous lesions.

The latest development in noninvasive colorectal cancer screening is the emergence of blood-based tests, the first of which was approved by the FDA in 2024.

 While they may be easier to access, May was careful to note key limitations to these tests, at least in their current formation, including their lack of sensitivity for precancerous lesions.

“If you're picking a blood based test, you're accepting that that test will likely miss a precancerous polyp and will mostly be looking for cancers, usually stage 2 and beyond,” May said. “Everyone has different preferences. I let patients decide what's best for them. To me, it's very important that they understand those nuances of the test.”

May goes on to emphasize that noninvasive tests are intended for average-risk individuals and not those with a family history or high-risk conditions such as inflammatory bowel disease or polyposis syndromes, additionally noting these patients should start screening earlier.

Editors’ note: May has relevant disclosures with Kimberly-Clark, Medtronic, Takeda, Freenome, Geneoscopy, and Exact Sciences.

Brooks A. FDA Approves First Blood Test for Primary Colorectal Cancer Screening. 

. July 29, 2024. Accessed April 21, 2025. 

https://www.hcplive.com/view/fda-approves-first-blood-test-primary-colorectal-cancer-screening

May describes differences between colorectal cancer screening tests and which might be right for patients based on their preferences and values.

Folasade (Fola) May, MD, PhD

Young shared with his real-world experiences with etranacogene dezaparvovec gene therapy.

A Positive Outlook on Gene Therapy for Hemophilia B Post-Discontinuation, with Guy Young, MD

Pfizer recently announced that it was discontinuing development and commercialization of fidanacogene elaparvovec an adeno-associated virus (AAV) vector-based gene therapy for the treatment of hemophilia B.

The therapy was approved only 1 year ago, in April 2024, under the name Beqvez.

Upon approval, fidanacogene elaparvovec joined pioneer gene therapy etranacogene dezaparvovec-drlb, approved by the FDA under the name Hemgenix for the same indication in 2022.

HCPLive spoke with Guy Young, MD, Director, Hemostasis and Thrombosis Program, Children’s Hospital of Los Angeles, and Professor of Pediatrics, Keck School of Medicine of University of Southern California, who served as an investigator on the etranacogene dezaparvovec program and who has administered it in the commercial setting, to learn more about his outlook on gene therapy in the hemophilia B field amidst the discontinuation.

Young stressed that his outlook on gene therapy in the field remained positive. He shared his experiences with etranacogene dezaparvovec in the real world and the patient and clinician reception.

“I think that the field is ready. We're seeing more and more patients receiving this,” Young said. “I think with gene therapy, there was all this excitement, and then it… kind of died off. But I think we're at that point where, where the tide is going to turn… the future products will be either different or better, or offer things that Hemgenix cannot offer… I think that hemophilia patients are excited about and are ready for products that can provide them the potential for getting cured.”

Young’s relevant disclosures included Genentech/Roche, Grifols, and Takeda, BioMarin, Novo Nordisk, Sanofi, Spark, Takeda, and UniQure.

Santhosh C. Pfizer stops commercialization of hemophilia gene therapy Beqvez. Reuters. February 21, 2025. Accessed April 25, 2025. 

https://www.reuters.com/business/healthcare-pharmaceuticals/pfizer-says-it-will-end-global-development-gene-therapy-beqvez-nikkei-reports-2025-02-20/

U.S. FDA Approves Pfizer’s BEQVEZ™ (fidanacogene elaparvovec-dzkt), a One-Time Gene Therapy for Adults with Hemophilia B. News release. Pfizer. April 26, 2024. Accessed April 25, 2025. https://www.businesswire.com/news/home/20240425269649/en/U.S.-FDA-Approves-Pfizer%E2%80%99s-BEQVEZ%E2%84%A2-fidanacogene-elaparvovec-dzkt-a-One-Time-Gene-Therapy-for-Adults-with-Hemophilia-B

Johnson V. FDA approves first gene therapy for hemophilia B. HCP Live. November 23, 2022. Accessed April 25, 2025. https://www.hcplive.com/view/fda-approves-first-gene-therapy-hemophilia-b.

Guy Young, MD

I think we've gone through a litany of different ideas about the drugs and how we use them. One of the concerns that many people have when anything new comes out is, is it reliable? I know, certainly, when drugs come out, is it effective, is it safe, and then can my patients get it? We ask the same questions with laboratory tests. Is it effective? Is it reliable? Can my patients get it for free or covered through insurance? With that, I think I'd like to get the last part. I'm going to hear from both of you. What advice do you have for your colleagues treating rheumatoid arthritis in the community setting? Joy?

I think we've come a long way. I think rheumatologists need to commend themselves. First of all, rheumatologists are still the subspecialty that still listens to patients. We still examine our patients. We use all of our clinical tools, we don't rely just on testing alone. However, we are probably the group of subspecialists that question and ask those questions on how this test is going to benefit our patients. And so I think that we do look at science, and the fact that we are getting these studies that are showing us consistently that looking at the signaling and whether a patient is going to have a response or not have a response to certain medications, and as we get into more precision medicine, and we see that these tools are going to help us to get our patients into low disease activity quicker and get to that treat to target quicker, I think we're going to rely on them more. Like Bob has said, it's going to take us a few years. There's going to be our early adopters that are going to look at this and look at that science and study it and say, ‘This is a tool in my toolbox, I’m going to use it with my clinical exam. I’m going to use it with all my laboratory testing, and I’m going to move into that direction quicker, and I’m going to see the response probably in my patients a little bit quicker.’ Then there are going to be the early adopters. There are going to be our colleagues that are going to take a little bit more time. But I think over the next few years you're going to see a big change in how we approach our patients. We're going to be commended for how quickly we take care of the patient journey and get these patients in low disease activity, and maybe at some point, rheumatoid arthritis will not have the stigma that it has had over the last several years, at least in my career, that this is a "crippling" disease process. Thank you.

Joy said it very nicely, and I would like to add that this technology has great potential. We're only scratching the surface based on the data on looking at the signal of nonresponse to TNFs [tumor necrosis factor], and hopefully getting more patients involved and more data collected will strengthen the argument that this is a reliable piece of information that will really help us guide therapy. Second, I look forward to the day that the adoption by CMS [Centers for Medicare & Medicaid Services] and adoption by the commercial insurance carriers will help us guide therapy and allow us to have this be an affordable option for us to use and not have the worry of large out-of-pocket expenses and concerns about that. Then, I just think that this really has the opportunity to help guide our patients to get to those treat to target goals, low disease activity, remission. That would ultimately lead to getting our patients to our goals as providers, as doctors, and also to the patient goals of improving those quality-of-life and patient-reported outcome things that we measure.

I think both of you hit the nail right on the head. We need more tools. We need more information. We need more accessibility to these tools because although we've had a tremendous explosion of therapeutic options, we haven't had any real guidance. To have a test that may guide our hand in therapy, even for just the first decision or even beyond that, because as we both and all know here, the therapy selection right now comes down to what are we most comfortable with? What came first? Maybe comorbid conditions, but mainly insurance mandates. Use this, then that, then this because that's our formulary. That's our sequence. I think many of us are feeling choked by this because as scientists, as rheumatologists, we are data-driven. We know better, and we know that as this science evolves in the 21st century, precision medicine is the way we can learn from our oncology colleagues. With that, I'd like to give a thanks to all of you for this rich and informative discussion. Before we conclude, I'd like to get final thoughts from each of you. Joy?

I wholeheartedly agree with everything that has been said here today. We're in a very rich environment that we have a lot of potential, a lot of hope, down the line by having a good collaboration with the science, with the testing, to give our patients that precision medicine that we want to achieve and to get these patients into the remittive state that they should be able to get into. By using good science and showing insurance companies that we are scientists, that we use evidence-based medicine to make some of our decisions. I hope through the work of the CRSO [Clinical Research Support Office], Bob, and my other colleagues, and I know myself I've tried to work in that area as well, that we'll be able to convince our insurance payers that this is the way to go for our patients and to get them into low disease activity in remission as quickly as possible.

I'm going to throw one out there. I'll put on my advocacy hat for a minute and just say that we've been really trying to improve formulary construction based on efficacy and safety. That flies in the face of the payers and the PBMs [pharmacy benefit managers] who basically construct formularies based on what's most profitable to them and not at all what's related to safety or effectiveness. I see this being a real tool that we can use from the advocacy standpoint in fighting the PBMs, in other words, being a PBM buster. That it could blow up their whole paradigm. I'm doubly excited, not only based on the science and how patient outcomes can be affected by utilizing this, but also utilizing it as maybe a cajole against the payers and against the PBMs who are unfortunately in control of what we prescribe and getting in the way of the doctor-patient relationship.

Well, Bob and Joy, thanks to you and our audience for this rich and informative discussion. If you enjoyed the content, please subscribe to our e-newsletters to receive upcoming peer exchanges and other great content right in your inbox.

Nehad Soloman, MD; Joy Schechtman, DO; and Robert Levin, MD, share final thoughts and takeaways on the treatment of rheumatoid arthritis in the community setting.

Clinical Pearls for RA Management

Joy Schechtman, DO

Andrea Nguyen, PA, shares her clinical pearls on taking care of patients with AD.

Clinical Pearls on AD Management

This is a video synopsis/summary of a panel discussion involving Melodie Young, NP, and Andrea Nguyen, PA.

In this segment, the discussion centers on providing advice and encouragement for healthcare professionals, particularly those entering the field or adjusting their approach to adhere to newer guidelines for managing atopic dermatitis (AD). The speakers acknowledge the increasing prevalence of AD, emphasizing the substantial number of patients with significant body involvement who may require more than just topical therapies.

The advice includes a systematic approach to learning about the various therapeutic categories, such as monoclonal antibodies, biologics, oral Jack inhibitors, and topicals. The recommendation is to start with a focused exploration of one category to build confidence before expanding knowledge across all therapy options. Anticipating continuous development in the next 5 to 10 years, there is emphasis on creating an efficient workflow and clinic template to streamline the prescription process for these complex therapies.

The conversation concludes with the suggestion of possible future discussions on using telemedicine for AD management, highlighting its effectiveness in treating chronic diseases like AD.

Video synopsis is AI-generated and reviewed by HCPLive editorial staff.

Clinical Pearls on AD Management 

Melodie Young, NP

The panel discusses the mechanism of treatment-emergent hypophosphatemia that occurs following the administration of certain intravenous iron formulations.

Treatment-Emergent Hypophosphatemia Following Administration of Intravenous Iron

Video content above is prompted by the following:

Treatment-emergent hypophosphatemia is now widely recognized as a phenomenon that can occur following administration of certain IV iron formulations and within the first 2 weeks after administration. Can you discuss the mechanism of treatment-emergent hypophosphatemia?

Michael Auerbach, MD

Vice Chief of Education, Fellowship Program Director

Division of Gastroenterology and Hepatology at UNC Health Care

Experts discuss the recent use of biosimilars like inolimomab as treatment for ulcerative colitis (UC).

Biosimilar Treatment Options for Patients With UC

Millie Long, MD, MPH

The panel concludes the discussion with key takeaways on the evolving treatment landscape for COPD.

Key Takeaways on the Evolving COPD Treatment Landscape

Video content above is prompted by the following question:

What are your key takeaways on the evolving COPD treatment landscape?

Nicola Hanania, MD, MS

Dr Linda Stein Gold, Dr Mona Shahriari and Dr Seemal Desai share advice for improving psoriasis care for patients with skin of color.

Advice for Dermatologists in Treating Psoriasis in Patients With Skin of Color

This is a video synopsis/summary of a panel discussion involving Linda Stein Gold, MD; Mona Shahriari, MD, FAAD; and Seemal Desai, MD.

The discussion focuses on the implications of research findings for patients with skin of color in psoriasis treatment. The speakers emphasize the importance of utilizing data-driven approaches to guide treatment decisions and advocate for increased diversity in clinical trial participation to ensure representative study populations.

They discuss the significance of cultural sensitivity in patient interactions and highlight the need for continued investment in research and development to generate data that can inform clinical practice effectively. The transcript concludes with a call to action for dermatologists to play a critical role in improving outcomes for all patients with psoriasis, underscoring the value of sharing knowledge and fostering collaboration within the medical community.

Overall, the conversation emphasizes the importance of evidence-based approaches, cultural competence, and ongoing research efforts in addressing the needs of diverse patient populations with psoriasis.

Authors