The Role of Biologic Therapies in Optometry with Walt Whitley, OD, MBA

At the 2025 American Optometric Association Conference in Minneapolis, MN, Walt Whitley, OD, MBA, optometrist at Virginia Eye Consultants, presented his lecture on the role biologic therapies play in optometry.1

Over the last two decades, a wide variety of biologic therapies have been investigated and approved for several different ocular diseases, including uveitis, scleritis, and orbital inflammation. Medications such as corticosteroids and cytokines have revolutionized the treatment landscape for these diseases, and further drugs in the pipeline currently promise even further advancement.2

Whitley named what he believes are some of the most critical biologic treatments currently on the market, primarily for the neurotrophic keratitis.

“The most common thing that we’re going to see is neurotrophic keratitis, and there’s several different treatments that are available,” Whitley told HCPLive. “We talked about both cryopreserved and dry amniotic membrane. We talked about topical biologic therapies such as cenegermine, which is 1 drop every 2 hours 6 times a day for 8 weeks, which shows the effect of rehabilitating those nerves, regenerating those corneal nerves to help that surface heal to improve our patients’ conditions.”

Whitley also spoke to the confusion and uncertainty inherent in such a wide range of possible treatments. Individual clinicians can often wind up overwhelmed by the sheer volume of choices, according to Whitley.

“The real-world barrier when it comes to incorporating biologics within eye care is often what is available, so there’s confusion because there’s so many different things that are out there,” Whitley said. “Every single time you turn on the TV, there’s a commercial about some type of biologic, so it can get confusing.”

Delving further into this, Whitley described the frustrations born of too many choices, chief among them the conflicting guidelines and regulations.

“The confusion is, where do I prescribe it? What are the steps? How are my patients going to get it? How long are they going to take the medication? So, it’s going to require education for us, the providers, but also for the patients themselves,” Whitley said.

Looking ahead, Whitley expressed interest in a slew of advancements on the horizon, highlighting everything from neuropathic corneal pain to ocular surface disease.

“I’m looking for things that are going to help our patients,” Whitley said. “In my cornea practice, we have many patients that are suffering from neuropathic corneal pain. We know that their corneal nerves are firing abnormally, and so in those cases these patients are in pain and they’re looking for some kind of treatment. If we can find a way to address this for our patients, it is only going to benefit them.”

Additionally, given the status of several biologics as frontline therapies for various ocular diseases, Whitley instead turned his attention to improving both testing and care for various diseases.

“I was part of a neurotrophic keratitis study group, and one of the callouts we had was anytime patients had ≥2 staining or higher, that’s where we needed to check for corneal sensitivity. Is it present? Is it reduced or is it absent? If it’s reduced or absent, then we need to do one of our therapies, whether it’s the membranes, the drops, et cetera, to help our patients.”

References

1. Whitley W. The Role of Biologics in Eye Care. Presented at the 2025 American Optometric Association Conference in Minneapolis, MN, June 25-28, 2025.

2. Lim L, Suhler EB, Smith JR. Biologic therapies for inflammatory eye disease. Clin Exp Ophthalmol. 2006;34(4):365-374. doi:10.1111/j.1442-9071.2006.01225.x