: Heather, taking account of everything that we've been talking about? What advice do you have for dermatologists, and other physicians who are going to encounter vitiligo patients? What advice do you have for them in recognizing and treating vitiligo and counseling patients about this disease?

: I would say my biggest advice is to listen to your patients. That's my biggest advice. Don't make assumptions. Don't assume that it doesn't bother them or that it really bothers them. I also think another big take home is I do always offer my patients hope there are treatments. We have effective treatments, especially on sun-exposed areas. The most I think frustrating thing for vitiligo patients is when someone says, there's nothing we can do. And follow up as needed there's nothing we can do. I don't think that's accurate. The technologies and pharmaceuticals that are coming out right now and will be coming out in the upcoming years are exciting. They offer our vitiligo patients a lot of hope. That's another take home because I do think some people feel vitiligo is something that you just have to live with and you don't need to treat it. Another thing is offer your patients support groups, because it's a disease that people feel very isolated, and reaching out to a support group and participating in group processing meetings, or just even communicating online with people who have your condition, is very helpful for vitiligo patients. And we haven't touched so much on this, but don't forget that we can use camouflage makeup, tell your patients about that, including your male patients because for a lot of patients, it's a very effective way to live with vitiligo.

It's so important. You touch on so many important points, the concept that there's nothing that we can do. Well, first of all, there might be actually something that we can do to achieve repigmentation. But another thing that's been brought up repeatedly is what about halting further disease? Almost certainly we can do something for patients there. And it's not true that there's nothing that we can do. We can do something for the vitiligo that's there. We should be thinking about trying to halt further disease. And then beyond these things, there are masking techniques. And then there's just the community. And knowing that you're not the only person that's suffering from this disease, but there are other people, and it's always useful to know that we're not alone in the world suffering with whatever we're suffering from. And you just raise so many important points about the doctor-patient relationship and the different aspects of the visit and the different aspects of the disease to take time to cover with patients. Thank you so much for that.

: One thing I'd like to mention before Heather goes, if a physician is having difficulty getting coverage for in-office phototherapy or home phototherapy, the global vitiligo foundation website, globalvitiligofoundation.org has sample letters that you can use to get phototherapy coverage in your office, as well as a strong letter for home phototherapy, including references, showing that it works. And then finally an actual four-page handout that you give to the patient that walks them through how to give the treatment to themselves easily at home. I just wanted to mention that.

That's an important point. I want to thank you for watching this 

 Peer Exchange. If you enjoyed the content, please subscribe to our e-newsletters, to receive upcoming peer exchanges and other great content right in your inbox.

And lastly, I want to thank, David, Amit, and Heather, amazing and engaging experts, in vitiligo for their time and for sharing their experiences and expertise.

Dr. Woolery-Lloyd shares her advice for vitiligo providers and tips for helpful communication with patients.

Advice for Providers Treating Vitiligo

Amit G. Pandya, MD, FAAD

Charles Argoff, MD, Albany Medical Center

 Dave, we talked a lot about unmet needs, but what advice you share with physicians taking care of ulcerative colitis [UC]?

 Treat early. But when you’re treating early, it’s important to monitor your patient. Not just symptoms alone but with biomarkers, fecal calprotectin, CRP [C-reactive protein], and then repeating a colonoscopy. With that, the enemy of good is perfect. What we’re seeing now, as we’ve been talking about, is a lot of referrals where patients are cycling through therapies where the colon looked bad. From when it started to 6 months later, it looks significantly better, over 50% better, but they’re not healed. It’s not perfect. Then we switch to the next therapy. We had a nice discussion showing that we want to push that ceiling, but we’re not there.

When we’re looking at the trials, maybe half our patients hit endoscopic remission. We can do better, but that’s about right. If a patient is getting and feeling better, if their biomarkers are improving, if the colonoscopy is looking better, that’s a good thing. Maybe we optimize what we’re on, but we shouldn’t just reflexively switch because we could do a lot of harm in the short term. They might not respond to that mechanism or down the road they could lose response. Some patients respond quickly, and others take 6 months, a year, or longer to fully heal if we could get there. Be patient and monitor the patient.

 “Don’t let perfect be the enemy of good”—I like the way you said that. We must get it right in induction, but we may be OK, given a little time. It’s not opposite messages necessarily; it’s a continuum. To your point, at 6 or 9 months, if you do another colonoscopy and the patient was at Mayo [endoscopic score] 3 and now they’re at Mayo 1 and looking much better, then I don’t think that’s a time to panic and switch to another therapy. We can optimize within that group if there’s the ability to, but we also don’t want to have a patient stuck on steroids for 6 months with a Mayo 2/3 and saying they’re feeling better, but they have a lot of steroid adverse effects. It’s always that fine balance. Marla, what advice do you give physicians treating ulcerative colitis?

 It goes back to what we’ve been saying: first we need to understand the patient’s goals. We start with that. We must understand that our drugs work for symptoms. Most people respond. That’s less of our problem. It’s more the durability and sustainability, and lots of things go into that. We have the ability to say that every drug has its place in the journey. This is a long road. As Dan Present used to say, this isn’t a sprint; it’s a marathon. We can treatments to goal-orient it for the patient, but we must be able to have the right discussion: it’s to keep you out of the OR [operating room], from having a disability or progressive bowel wall damage and the repercussions from that. If we could use the right therapy to heal your lining, you’ll have not only symptomatic improvement but a durable response. You’ll be able to do everything you want to do despite this disease. That’s what we need to get better at.

We get so caught up in trying to push our narrative without making it the narrative the patient needs and wants to hear. How do we meet in the middle? That’s the biggest challenge we face. Ellen discussed that in UC, steroids and 5-ASAs [5-aminosalicylic acids] are it. Even in Crohn disease, that’s what…research showed us. There was a huge gap where there was no exit strategy, so people are free-floating in this gap, asking what’s next. We must have that discussion early to let them know we need an exit strategy.

 Ellen, what advice are you giving your physicians treating UC?

 We can’t underscore enough the importance of an exit strategy when you start steroids. We should look to the rheumatologist, 7 weeks in the best trial. Let’s shorten that when the patient needs another therapy. It’s fascinating—patient engagement. Algorithm medicine works for maybe 80% to 90%, but even the ones who fit into the algorithms don’t want to be there. For the discussion of diet and nutrition, patients often start to have increased fiber because they’re sick, so they’re going to change to a higher-fiber diet. That’s something that we can meet with our colleagues about because that’s simple. Where are the patients? What did they think about the microbiome? How much Coke, how much carbohydrates, sugars, etc? That way, we get a chance to know where the patient is. You don’t want to push our narrative. We must listen to the patient. Where are they? Are they taking NSAIDs [nonsteroidal anti-inflammatory drugs] for their extraintestinal manifestations and driving the disease? In our increasingly pressured world, we must find a time to listen to the patient and understand where they are in terms of complementary medicine while we’re developing what we think is the right approach, the right strategy, for mucosal healing and decreased progression. This is a dialogue with our patients and colleagues who are in the real world.

 The advice, thinking about our trainees or those coming out of fellowship, is exactly what you said. We’ve been saying it goes back to the basics, listen to the patient. It’s amazing that in first 5 minutes of a conversation, you can learn so much that guides your decisions on therapy.

David P. Hudesman, MD; Marla Dubinsky, MD; Ellen J. Scherl, MD; and Miguel Regueiro, MD, provide advice for physicians treating patients with ulcerative colitis.

Clinical Pearls for the Treatment of Ulcerative Colitis

Ellen J. Scherl, MD

James Tumlin, MD, is the president of NephroNet, director of research at Georgia Nephrology, and a professor of medicine in nephrology at Emory University School of Medicine.

Sparsentan and Progression to Kidney Failure in FSGS, with James Tumlin, MD

Findings from a posthoc analysis of the phase 3 DUPLEX study of sparsentan (Filspari) are providing new insight into the dual endothelin angiotensin receptor antagonist’s nephroprotective benefit in patients with 

focal segmental glomerulosclerosis (FSGS)

The data were presented during a late-breaking session at the National Kidney Foundation (NKF) Spring Clinical Meetings 2025 in Boston, Massachusetts, and showed patients with FSGS treated with sparsentan achieved partial and complete remission more rapidly and with higher incidence than those treated with irbesartan. Additionally, patients who reached partial or complete remission showed a markedly reduced risk of progression to kidney failure versus those who did not.

“A substantial number of people have very few options. Prednisone is really not used by most anyone today, certainly not by me,” James Tumlin, MD, president of NephroNet, director of research at Georgia Nephrology, and a professor of medicine in nephrology at Emory University School of Medicine, explained to 

. “CNIs, tacrolimus, and cyclophosphamide are still used, but you still have the same problem with long-term toxicity… We've been desirous of having a new type of therapeutic pathway for quite some time.”

Sparsentan may be poised to address this unmet need in FSGS – in March 2025, Travere Therapeutics submitted a supplemental New Drug Application to the US Food and Drug Administration seeking priority review for traditional approval of sparsentan for the treatment of FSGS, supported by results from the phase 3 DUPLEX study and the phase 2 DUET study.

A multicenter, double-blind, active-controlled trial, DUPLEX enrolled 371 patients 8-75 years of age with biopsy-confirmed FSGS or a documented pathogenic variant in a podocyte protein associated with FSGS, a urinary protein-to-creatinine ratio ≥ 1.5, and an estimated glomerular filtration rate (eGFR) ≥ 30 mL/min/1.73m2 of body-surface area at screening.

Following randomization in a 1:1 ratio, 184 participants were randomly assigned to sparsentan and 187 were randomly assigned to irbesartan. Results showed there were no significant between-group differences in eGFR slope at 108 weeks, despite a greater reduction in proteinuria with sparsentan than with irbesartan.

In the posthoc analysis presented at NKF, investigators investigated the impact of sparsentan versus irbesartan on partial or complete remission of proteinuria and the effect of achieving these thresholds on progression to kidney failure.

Results showed both partial remission and complete remission were achieved more frequently with sparsentan than with irbesartan:

Partial remission: 64.7% vs 43.9% (relative risk [RR], 1.48; 95% CI, 1.23-1.78)

Complete remission: 18.5% vs 7.5% (RR, 2.47; 95% CI, 1.37-4.45)

Additionally, investigators noted partial and complete remission were achieved earlier with sparsentan than with irbesartan.

Of note, irrespective of treatment group, lowering proteinuria to reach partial and complete remission resulted in a marked reduction in progression to kidney failure. For partial remission the odds of progressing to kidney failure were 3% compared with 15.9% without partial remission. For complete remission, the odds of progressing to kidney failure were 2.1% compared with 9.9% without complete remission.

“Those numbers seem similar, but there's a really important point behind that, which is that even a partial reduction in proteinuria has resulted in a profound reduction in the risk of progression of renal disease,” Tumlin explained. “From my standpoint, I think this will be a significant weapon in the argument to change the accepted clinical endpoints for drug development. I suspect that drug development FSGS will explode if that ruling goes through by the FDA.”

Editors’ note: Tumlin has relevant disclosures with Aurinia Pharmaceuticals, Biogen, Mallinckrodt, Novartis, Vertex Pharmaceuticals, and others.

Tumlin J, Tesar V, Trimarchi H, et al. Patients (Pts) in DUPLEX Achieved Partial or Complete Remission of Proteinuria Earlier and More Often With Sparsentan (SPAR) vs Irbesartan (IRB): Implications for Slowing Progression to Kidney Failure (KF) in Focal Segmental Glomerulosclerosis (FSGS). Abstract presented at: National Kidney Foundation Spring Clinical Meetings 2025. Boston, MA. April 9 - 13, 2025.

Brooks A. Travere Therapeutics Submits sNDA for Sparsentan (Filspari) in FSGS. 

. March 17, 2025. Accessed April 14, 2025. 

https://www.hcplive.com/view/travere-therapeutics-submits-snda-sparsentan-filspari-fsgs

Campbell P. Sparsentan Use Could Lower Risk of Kidney Failure, Death in FSGS. HCPLive. November 3, 2023. Accessed April 14, 2025. 

https://www.hcplive.com/view/sparsentan-use-could-lower-risk-of-kidney-failure-death-in-fsgs

Tumlin reviews findings from a posthoc analysis of DUPLEX demonstrating sparsentan’s impact on partial remission, complete remission, and kidney failure.

James Tumlin, MD

Jose Lopez, MD, is a cardiology fellow at the University of Miami JFK Medical Center.

Leveraging SGLT2 Inhibitors, GLP-1 RAs in Heart Failure, with Jose Lopez, MD

Once viewed solely as glucose-lowering agents for 

, sodium-glucose co-transporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists have emerged as powerful tools in the management of 

Initial skepticism surrounding the cardiovascular safety of these agents limited their early use in this population due to early trials raising concern about potential harm. However, more recent research suggests that these agents are not only safe, but also provide meaningful cardiovascular benefits, marking a turning point in how these therapies are viewed in heart failure care.

“When these trials were first conducted, the main point was to make sure these diabetes medications were not harmful to the heart because of earlier trials that had shown neutral or even harmful effects,” Jose Lopez, MD, a cardiovascular disease fellow at the University of Miami Miller School of Medicine/JFK Medical Center, explained in an interview with HCPLive. “When EMPEROR came out and we showed that there was no harmful effect, but actually a benefit, I think it was a really big turning point and a really big part of that shift because we realized these are not just diabetes medications and they can actually be really big players in the space of heart failure, which they have been.”

Lopez emphasizes that SGLT2 inhibitors and GLP-1 RAs are no longer just diabetes medications, referring to both as being “more heart failure medications than anything” and further suggesting SGLT2 inhibitors should be used in almost every patient with heart failure. For those with persistent symptoms, he says GLP-1 RAs can be added later on.

Acknowledging the lack of data on GLP-1 RAs in patients with heart failure with reduced ejection fraction (HFrEF) compared to heart failure with preserved ejection fraction (HFpEF), Lopez notes that use of these medications in this patient population is controversial. However, he indicates a need for additional research before writing GLP-1 RAs off for HFrEF patients, citing small sample sizes, short follow up, and the use of participants with very advanced heart failure as potential limitations to existing research.

“I feel there's still a lot that we don't know,” Lopez said. “I wouldn't necessarily jump to say that these medications are harmful.”

When confronted with the clinical conundrum of both SGLT2 inhibitors and GLP-1 RAs bring indicated in the same patient—for example, a patient with HFpEF, obesity, and diabetes—Lopez says he prioritizes initiating SGLT2 inhibitors and adding GLP-1 RAs on later if needed, noting that this is “almost an everyday situation nowadays.”

Editors’ note: Lopez has no relevant disclosures to report.

Lopez J, Makuvire T, Davis JD, Carbone S. The Short and Sweet on Sodium-Glucose Cotransporter Inhibitors and Glucagon-like Peptide-1 Receptor Agonists in Heart Failure. US Cardiol. 

Lopez discusses the evolving understanding of the utility of SGLT2 inhibitors and GLP-1 RAs in heart failure care, including both HFpEF and HFrEF.

Jose L. Lopez, MD

Addressing Treatment Response and Switching Among Systemic Therapies in Atopic Dermatitis

Video content above is prompted by the following:

Several studies have shown that patients who have not responded to biologic therapy can achieve improved results when switching to a JAK inhibitor. How do these data impact your clinical practice and your threshold for switching systemic therapies for patients?

Experts discuss how data from studies like JADE EXTEND, Heads Up Extension, and LEVEL UP, showing improved outcomes with JAK inhibitors in patients who failed biologic therapy, influence their clinical practice and decision-making when considering switching systemic therapies for patients with atopic dermatitis.

Linda Stein Gold, MD

 Before we conclude, I’d like to get some final thoughts from each of you, if you have any. Let’s start with you, Dr Nordberg.

 From my perspective, treatment-resistant depression and other complex mental health challenges are systems challenges as much as they are clinical challenges. We haven’t moved the needle in treatment effectiveness in about 50 years, and in no small respect that may be because we haven’t changed our systems that provide care. I’m a big fan of looking at developing systems where we’re doing a lot more precision referral work, and to Martin’s earlier point, identifying different providers, clinics, and centers of strength, and referring to strengths. The only way to do that is to collect the data.

There are challenges around collecting the data. It creates vulnerability and a lot of visibility where there hasn’t been historically. One of the things that we’re working on at Reliant Medical Group is trying to be more precise about how and who we refer. A lot of that involves understanding the patient that we’re being presented with, and also understanding how that person matches up with what we believe is the most likely treatment to be effective for them based on data.

I’m pretty confident that if we can do that work in naturalistic settings, we’ll get past the archaic requirement of failing 2 bonafide medication interventions and get more rapidly to something that’s going to allow a care delivery organization to say, “This is a patient with treatment-resistant depression,” and a payer to say “No problem,” and then allows that care delivery organization to connect that patient with a reimbursed intervention that has a likely shot of helping them. That’s a lot of work to be done, but it starts with measurement and having the confidence to integrate that measurement into your clinical routine.

 Well said. To your original point, we haven’t moved the needle much in these past 50 years. You’re calling for improved systems, better measurement, and moving toward precision care. Hopefully that will be supported by the validation of some biomarkers that can lead to more precise and predictive treatments. Would you also agree that part of this as well is that we haven’t had very many new tools in the past 50 years, and potentially having some effective new tools in the toolbox may also help move that needle?

 It may. We also know that there’s a lot of variability between different providers and that there are different kinds of treatments that appeal more to different kinds of patients. The biomarker research is sexy and exciting because of that possibility of carving nature at its joints and being precise. It’s also a long way off. RDoC [Research Domain Criteria] didn’t deliver the promise of precision opportunities for understanding and deep learning about what drives mental health on a physiological level.

We still have a lot of opportunities with the systems and treatments that are already out there. This system still has a lot of room for optimization. It starts with having the courage to collect more data and letting those data start to tell us what kind of a patient this is and the best place for the patient to go based on what we’ve already learned about similar patients. That’s where my focus is, less so on developing novel interventions. It’s important to figure out where the patients that we’ve been discussing fit in that overall model, but we’re not going to be able to figure that out if we’re not collecting the right data.

 For those of us who deal with the fun stuff, the insurance and billing portion of things, like I’ve been saying this whole time, it’s important to make sure that you understand your payers and their guidelines and policies. You have to play that middleman role between the insurance carriers, providers, and patients. We need to make sure that we’re educating our providers so that they know if there are any changes to these policies so that they can find the right fit for patients.

It’s also important to educate the patients in regard to what qualifies them as having treatment-resistant depression and what’s available out there. Be an advocate for the patient with the payer and keep them involved in the process so that they’re not at home wondering, “What’s going on with my prior authorization? When is my treatment going to start?” Let them know everything along the way and be there for them.

 The theme that I’d leave with is the idea of “better together.” If you think about it, there are 3 participants in the goal here. Front and foremost is the patient because they want to get better. They’re suffering. There’s the provider who’s trying their best to figure out the appropriate care. There’s also the payer who wants to make sure that the patient gets access to the benefit that they deserve and that they’re able to go on and live a healthier and happier life. You have to see that triad.

There’s a likelihood that you can blame the insurer or blame someone else, but at the end of the day, it’s about figuring out how to work better together, that triad, because we have a common interest in improving the life of that patient. That’s the part that I like to focus on. What are we doing this for? Who matters the most? The other stuff can be worked out.

 Thank you. Last but not least, Dr Ares-Romero.

 I love that. I love how you ended with that. Because as somebody who treats treatment-resistant depression regularly, I’m very passionate about having my patients improve their lives. Their quality of life is what’s important, and that they get passion and fulfillment from their lives. It’s beautiful to hear that, that we can work together. That’s key, getting the payer together with a provider. It’s not about you or me. It’s about the patient and how can we come together to work together. I love that.

Despite the hurdles and challenges and everything we’ve talked about, it’s an exciting time in psychiatry. This is a time when we have new modalities, new things, all the data collection, all the systems, and the artificial intelligence that we have now that we haven’t explored. There are so many wonderful things coming that I’m excited. I’m excited for our patients. I’m excited for everything that we’re doing.

 Thank you all again. To our viewing audience, we hope you found this 

® panel discussion to be useful and informative.

An expert panel shares insight on the future treatment landscape for treatment-resistant depression. 

Optimizing the Management of TRD

Martin Rosenzweig, MD

 YOSEMITE and RHINE actually had 3 arms, so these were both identical phase three randomized double-masked trials compared to aflibercept. The study involved patients with diabetic macular edema (DME) greater than 325-micron CST, and vision had to be 20/40 or worse.

There were 3 arms that patients could get randomized into. Two of them were faricimab arms, and one was the comparator of aflibercept every 8 weeks. Within the faricimab arms, the patients either received 6 loading doses followed by Q8-week intervals, and that was through the end of the study at 2 years, or they were in the PTI (Personalized Treatment Interval), which Mark basically alluded to as almost like their protocol-driven treat-and-extend interval. This treat-and-extend dosing regimen, which we could go into in a little more detail, had intervals that adjusted from either Q4 weeks all the way up to Q16 weeks. This was based on CST values and BCVA changes at the active dosing visit. This was changed throughout the entire study based on what their visit looked like the time before.

We found that number one, faricimab met its endpoint, which was non-inferiority at year 1. You can also see that this is the data through the end of the study. The data showed that visual gains were equivalent among all 3 groups, both the PTI arm, the Q8-week faricimab, and the Q8-week aflibercept arm. When we look at the CST reduction, you can see that there is a greater trend toward greater drying in the DME patients on both the faricimab Q8 and the PTI arms through year 1 and 2.

I think the most impressive data comes with the patients that are able to get out to Q16-week intervals and Q12-week intervals. We see that during the pooled data, greater than 60% of patients are in the Q16-week at the end of the study. And when we talk about the median number of injections, Mark alluded to the reduction of injections, especially in year 2 in the TENAYA and LUCERNE, we see the exact same thing in this YOSEMITE and RHINE study, where we see in year 2, the faricimab arm and the PTI only received 3 injections as a median versus 5 injections in the comparator aflibercept arm.

We also see that 79% of patients who achieved Q12-week or Q16-week at the one-year mark maintained over 12-week interval dosing, and that stayed through to the end of the study. And lastly, we see that 76% of patients who achieved Q16 weeks at the 1-year mark maintained this Q16 week without an interval reduction through the 2-year mark.

So let's talk about patients with the absence of DME. Absence of DME was just recorded as less than 350 microns. And you can see here that both arms of the faricimab or Vabysmo compared to the aflibercept had a greater percentage of patients with the absence of DME throughout year 1, and this extended through year 2.

But when we talk about looking at the OCT and just seeing a bone-dry OCT, so zero evidence of any intraretinal fluid, we see that those percentages are lower throughout all arms. However, the trend is for a greater drying effect in both arms of the faricimab compared to aflibercept. I do think that both of these arms or both of these studies showed just the importance of that durability that we've been talking about with faricimab compared to aflibercept without causing any reduction in visual gains. And I think this is a part of what we were discussing in terms of our patients who are trying to get that treatment burden down. If we are able to help our patients out by actually decreasing their treatment burden and extending these visits without necessarily compromising their vision gains, that is the Holy Grail.

Transcript is AI-generated and edited for clarity and readability.

Matthew Cunningham, MD, FASRS, provides the highlights of the YOSEMITE and RHINE trials for patients with diabetic macular edema (DME).

Clinical Trial Overview: DME

Matthew Cunningham, MD, FASRS

Optometry’s Future and the Need for Change, with Randall Thomas, OD, MPH

2025 American Optometric Association Conference

 in Minneapolis, MN, Randall Thomas, OD, MPH, Educators in Primary Eye Care, LLC, presented his lecture on emerging therapy options for various 

 to discuss the horizon of upcoming treatment advancements and the overall state of the optometry industry.

Thomas discussed the importance of continuing to practice existing therapies with long and successful track records. Rather than swapping them out entirely for new treatments, Thomas suggests folding new techniques and therapies into existing practice.

“The one thing that’s important to realize is that pharmacological dilation of the pupils is still the gold standard,” Thomas told 

. “It’s important that patients are dilated on a pretty common basis, particularly if they have any symptoms. The good news is that we have an eye drop now that will reverse dilation, called Ryzumvi. If we have a means to reverse that and get them back to baseline more quickly, then that’s a good thing.”

Looking ahead, Thomas discussed potential future treatments for a variety of diseases, highlighting dry eye disease for its relatively limited trial-and-error treatment strategy.

“We know all about dry eye,” Thomas said. “We know all the pathophysiology, we just don’t know how to treat it. I mean, there is no algorithm for treating dry eye, and in many cases, it’s hit or miss, trial-and-error, and that’s state of the art. There’s probably 20 different approaches, and one will work for one patient and not work for another. It’s challenging.”

Concerning barriers to implementing new medications and therapies in optometry, Thomas spoke on the priorities of pharmaceutical companies and the struggle of getting prior authorizations.

“I’m hoping over the next several years, with different administrations, that we can get rid of prior authorization,” Thomas said. “And electronic medical records are a two-edged sword. It can be beneficial, and yet it can really hamper the doctor-patient relationship.”

Thomas called for optometrists to take a more proactive stance in approaching and treating patients.

“Optometrists need to realize that they are truly doctors and therefore need to be on call for their patients. I know good optometrists that are on call and anyone that calls them, if it’s a true medical emergency, they will see them,” Thomas said. “They say it’s one of the best ways we have to grow our practices: being available to people in need.”

Circling back, Thomas advised clinicians on important considerations to keep in mind when analyzing and attempting new therapies or treatments. He pointed out that frontline use of new therapies often ends up uncovering glitches or bugs in the system.

“Every new drug, every new technology, is still working out the bugs. Nothing is perfect when it’s first approved, and we learn things about both drugs and devices after a year or two of widespread therapy,” Thomas said.

1: Thomas R. Current and Emergine Therapies for Ocular Disease: A Clinical Update. Presented at the 2025 American Optometric Association Conference in Minneapolis, MN, June 25-28, 2025.

Thomas discusses emerging therapies, new technologies, and the reform needed to help these new developments reach the patients in need of them.

Randall Thomas, OD, MPH

Shuai (Steve) Xu, MD, MSc, is a dermatologist, a physician-engineer, Ruth K. Freinkel MD professor at the Feinberg School of Medicine, and the CEO and co-founder of Sibel Health.

Artificial Intelligence in Dermatology: Emerging Insights and Diverging Perspectives

AI in Dermatology: Emerging Insights and Diverging Perspectives

Artificial intelligence (AI) technology may be transforming the field of 

, providing clinicians and patients with faster diagnoses, greater diagnostic accuracy, and expanded access to health care. The topic is rapidly becoming one of the most debated in medicine, driven by a heated clash between supporters and skeptics over whether it will truly benefit patients.

A plethora of recent studies have been published regarding new types of AI technology and their use in dermatology. In this 

 feature, 3 speakers were interviewed regarding their contributions to recent AI-related studies in dermatology as well as their more general impressions of the heightened interest in further implementing AI in medicine.

The feature included an interview with Harald Kittler, MD, a professor of dermatology for the Medical University of Vienna, whose international research team had evaluated a learning method in which the accuracy of AI results incorporated human decision-making criteria. The study, which demonstrated a 12% improvement in correct skin cancer diagnoses made by dermatologists, was published in Nature Medicine.

An interview was also conducted with Kailas Vodrahalli, a PhD student in electrical engineering at Stanford University. Vodrahilli touched upon his own team’s research, involving an evaluation of an AI decision support tool using a machine learning algorithm and determining whether the tool could improve the telemedicine-submitted image quality by providing real-time responses to patients. The study concluded that the AI decision support tool’s use, along with their machine learning algorithm, was linked to improvements in the quality of skin disease photographs.

This feature also included an interview with Shuai (Steve) Xu, MD, MSc, a dermatologist, physician engineer, Ruth K. Freinkel MD professor at the Feinberg School of Medicine, and CEO of Sibel Health. His research pointed to the efficacy of the use of haptic feedback on an 

, with occurrences of nocturnal scratching decreasing among adult patients suffering from mild atopic dermatitis.

Kittler, Xu, and Vodrahilli addressed their own findings and discuss the general discourse surrounding AI’s use in dermatology. Each expert’s unique insights, given their differing specialties and backgrounds, allow for an update on new AI research and any current progress AI technology has had in reshaping skin disease detection, clinical decision-making enhancement, and pushing the boundaries of dermatological care.

Check out the feature video posted above to discover more about the findings uncovered by these experts.

Kittler received nonfinancial support from Derma Medical Systems, Fotofinder and Heine, and speaker fees from Fotofinder. Vodrahalli reported receiving grants from the National Science Foundation (NSF) Graduate Research Fellowships Program during the conduct of the study and had a patent for Automated Clinical Image Quality Assessment pending for the work in this study. Xu reported grants from Maruho Co Ltd during the conduct of his study, serves on the advisory board for AbbVie outside the submitted work, and has a patent for WO2023183258 pending.

Barata C, Rotemberg V, Codella NCF, Tschandl P, Rinner C, Akay BN, Apalla Z, Argenziano G, Halpern A, Lallas A, Longo C, Malvehy J, Puig S, Rosendahl C, Soyer HP, Zalaudek I, Kittler H. A reinforcement learning model for AI-based decision support in skin cancer. Nat Med. 2023 Aug;29(8):1941-1946. doi: 10.1038/s41591-023-02475-5. Epub 2023 Jul 27. PMID: 37501017; PMCID: PMC10427421.

Vodrahalli K, Ko J, Chiou AS, Novoa R, Abid A, Phung M, Yekrang K, Petrone P, Zou J, Daneshjou R. Development and Clinical Evaluation of an Artificial Intelligence Support Tool for Improving Telemedicine Photo Quality. JAMA Dermatol. 2023 May 1;159(5):496-503. doi: 10.1001/jamadermatol.2023.0091. PMID: 36920380; PMCID: PMC10018405.

Yang AF, Patel S, Chun KS, et al. Artificial Intelligence–Enabled Wearable Devices and Nocturnal Scratching in Mild Atopic Dermatitis. JAMA Dermatol. Published online February 05, 2025. doi:10.1001/jamadermatol.2024.5697.

In this feature, 3 experts highlight their own research on new technological advances and their views on the benefits and drawbacks of artificial intelligence in dermatology.

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