A Day 3 session featured famous comedian Dr. Glaukomflecken and legendary corneal specialist Dr. Reza Dana for the Richard L. Lindstrom Medal lecture.
Day 3 (Sunday) is our final day of coverage here in Los Angeles for the American Society of Cataract and Refractive Surgeon’s Annual Meeting (ASCRS 2025), and Sunday’s Main Stage session was sizzling.
Though the two keynote speeches were markedly different in scope, they addressed dual challenges at the core of ophthalmology: pushing scientific boundaries while navigating America’s baffling, and oftentimes byzantine, healthcare system.
The juxtaposition of a groundbreaking lecture on corneal neuropathy, paired with a comedian-ophthalmologist’s call to arms for healthcare reform, perfectly encapsulated the profession’s evolving identity—one that demands both microscopic precision and megaphone-level advocacy.
Hidden corneal conspirators: Neuropathy and inflammation
Dr. Reza Dana (United States), recipient of this year’s prestigious Richard L. Lindstrom Medal, upended conventional wisdom about corneal disease with compelling evidence that two processes—neuropathy and inflammation—conspire to drive corneal pathology.
“Neural dysregulation and inflammation co-conspire,” Dr. Dana explained as he laid out the central thesis of his award lecture. “One amplifies the other, leading to corneal disease.”
READ MORE: Old Wives’ Tale or Science? Breast Milk’s Healing Effect on Corneal Wounds
His presentation methodically dismantled the view of the cornea as merely “a slab of collagen” by revealing the complex neural networks involved and significant immune cell population.
The correlation between epitheliopathy severity and neuropathy degree suggests not mere coincidence but causality, and he pointed to a familiar foe to make his case.
“The more severe the ocular surface disease, the more severe the neuropathy,” Dr. Dana noted.
Dr. Dana’s investigation into pain mechanisms identified substance P, a neuropeptide, as a principal driver, binding to neurokinin-one receptors expressed by vascular endothelial cells, immune cells and afferent nerves. “Topical antagonism of this receptor can significantly suppress the different manifestations of pain, like hyperalgesia and allodynia,” he said, adding that his team hopes to develop this discovery into clinical trials within the next two years.
Evidence from corneal angiogenesis formed another pillar of his argument about neural dysregulation and inflammation. Dr. Dana illustrated the bidirectional relationship with neuropathy: “When we ablate the nerves, we see a significant diminishment in the threshold for angiogenesis,” he said.
Another key discovery of a relationship between ocular surface disease and corneal endothelial cell density. “Even with severe dry eye and severe allergy, we can see this decrease in the density of corneal endothelial cells,” he noted, initially finding this counterintuitive since the posterior stroma and endothelial cells are not innervated.
READ MORE: The Corneal Innovations Poised to Transform Ophthalmology
The key turned out to be the melanocortin pathway, driven by alpha melanocyte-stimulating hormone (alpha-MSH). “We’ve shown that there is a very high constituent expression by the corneal endothelial cells for receptors that bind alpha-MSH,” Dr. Dana explained. “In retrospect, perhaps not a big surprise. Why? Because the corneal endothelial cells are neural crest derived.”
In a mouse model of Fuchs’ dystrophy, administration of alpha-MSH prevented the development of the classic phenotype, reducing cell loss from 56% to 18% and maintaining the normal hexagonal mosaic of endothelial cells. The impact on corneal thickness was equally impressive—138 microns in controls versus 87 microns in alpha-MSH treated mice.1
Dr. Dana concluded with clear clinical guidance: “When you see patients early on that have any sign of neuropathy or epithelial disease or inflammation, the key point is to prevent this vicious cycle from taking hold,” he said.
“Provide lubricants and ocular surface optimization to patients with any manifestation of epithelial disease. You can look at biologics or autologous serum for neuropathy. And then use anti-inflammatories—judiciously, not too much.”
From TikTok to Capitol Hill: The new advocacy frontier
The scientific gravitas of Dr. Dana’s lecture gave way to the razor-sharp wit of Dr. William Flanary—better known to millions as social media sensation Dr. Glaukomflecken—who delivered a compelling case for physician and patient advocacy in an era of American healthcare dysfunction.
“I don’t know if you guys are aware, but we’re having some problems in the healthcare system lately,” Dr. Flanary deadpanned, before recounting his first exposure to advocacy at the Academy’s Mid-Year Forum in 2016—just after Medicare’s Sustainable Growth Rate (SGR) was eliminated.
One of his first lessons about advocacy? “If you just whine enough about something, eventually, you’re gonna get your way,” he quipped to uproarious laughter.
Dr. Flanary highlighted recent advocacy wins, including the No Surprises Act, Aetna rescinding its prior authorization requirement for all cataract surgeries, PBM reform and Oregon’s progress on the Corporatization of Medicine Act to prevent private equity ownership of medical practices.
Dr. Flanary’s personal journey transformed after his cardiac arrest in 2020. Following his recovery, he faced a nine-month battle with his insurance company over $20,000 in charges they initially refused to cover—despite his in-network hospital stay—because of out-of-network doctors.
This experience battling with big health insurance catalyzed his social media advocacy. A video about prior authorizations, where he satirized the process of non-medical professionals making medical decisions, garnered millions of views and over 30,000 comments from patients sharing similar experiences.
One piece of advice in particular for dealing with legislators resonated with the crowd. “You know more than them, and your expertise is valuable and important,” he advised. He supplemented this with another story from his residency, where he showed legislators a simple diagram of an eyeball with a needle in the subconjunctival space.
“Only medical doctors should do this,” he argued successfully during a scope-of-practice battle, and this was another main message of his talk—that doctors should be at the tip of the spear for both providing healthcare and advocating for patients.
“There are two big things that need to happen in order to effectively advocate for change,” Dr. Flanary explained. “Number one is you have to communicate that there’s a problem. The second thing is, that they’ve got to know what the problems are.” He pointed to the educational divide between what physicians know about healthcare operations and what the public understands.
Dr. Flanary’s mission is to help bridge this gap with his social media sketches and comedy, including a “30 days of healthcare” series explaining everything from basic insurance concepts to complex topics like pharmacy benefit managers and automated claim denials. “This is a different type of advocacy… I am talking to the people who vote for the legislators,” he said.
He illustrated the power of public pressure with a recent example: After the UnitedHealthcare CEO shooting, though Dr. Flanary bemoaned the “remarkable lack of sympathy”, but was encouraged by an unprecedented increase in public attention to health insurance policy. And this can have results.
“Public pressure on these companies works because they care about their bottom line, and we can use that against them,” Dr. Flanary observed.
For physicians looking to engage in advocacy, Dr. Flanary emphasized storytelling over statistics. “People don’t care about statistics… but they do care about things that appeal to their personal experiences, their emotions,” he said. “We all have stories that we can tell about the healthcare system and how it’s affected our patients and how it’s affected us.”
He concluded with a practical call to action, urging physicians to maintain a presence both in person and on social media to connect with patients and transform the healthcare system for better.
“If we’re not out there talking about these things, people are going to get incorrect misinformation from people who don’t have patients’ best interests at heart,” he warned. But if Dr. Glaukomflecken and allies for advocacy have anything to do about it, the current American healthcare hellscape can change—one social media post at a time.
READ MORE: Get all the top moments from ASCRS 2025 in one place here.
Editor’s Note: Reporting for this story took place during the annual meeting of the American Society of Cataract and Refractive Surgery (ASCRS 2025) being held from 25-28 April in Los Angeles, California, United States.
Reference
- Kahale F, Deshpande N, Alemi H, et al. Treatment with Neuropeptide alpha-Melanocyte Stimulating Hormone Suppresses Progression of Fuchs Dystrophy in a UV-induced Mouse Model. Invest. Ophthalmol. Vis. Sci. 2023;64(8):635.
