Breakthrough corneal technologies on display at APAO-AIOC 2025 could revolutionize corneal treatment amidst a worldwide donor shortage.
Ophthalmic translational medicine represents the critical bridge between scientific discovery and patient care. And with a perpetual, worldwide shortage of donor corneas, advancements in this field are more critical than ever for saving sight—especially in the developing regions that represent vast swathes of the Asia-Pacific region.
This was the topic of a Day 3 symposium at the 40th Asia-Pacific Academy of Ophthalmology Congress, held in conjunction with the 83rd Annual Conference of the All India Ophthalmological Society (APAO-AIOC 2025), where top minds showcased the promising developments that may soon transform corneal disease management.
Three steps to regeneration
Dr. Sayan Basu (India) presented a practical three-pronged approach to corneal regeneration that addresses the worldwide shortage of donor corneas, particularly in developing regions.
“We want to find solutions that are affordable and practical,” Dr. Basu stated before detailing his team’s three-pronged approach.
First up is stem cell therapy using human limbal mesenchymal stem cells (HLMSCs) for corneal and ocular surface inflammation, which has completed phase I trials with promising results—even in post-infectious cases. The HLMSCs are mixed with commercial fibrin glue and applied topically under local anesthesia.
The second part of his approach involves hydrogels which are created after converting discarded corneal stromal buttons into a powder. “These hydrogels are sticky, so you can apply them in lacerations to prevent wounded corneas from developing scars,” he explained.
The third piece of the puzzle is 3D bioprinted lenticular corneal tissue that integrates cells with scaffolding. “With 3D bioprinting, we can customize the shape, size and curvature of lenticules,” he said, adding that this could eventually treat refractive errors and keratoconus. The technology is currently in preclinical animal trials, with human studies expected within two years.
Personalized approaches to dry eye
Rising dry eye rates around the world have been met with a largely frustrating reality: Many patients fail to respond to standard therapies, leading to an endless cycle of clinical visits and mounting dissatisfaction. This challenge has driven researchers to seek more precise methods for characterizing individual disease states.
Dr. Pooja Khamar (India) and Dr. Julia Chan (Hong Kong) believe that personalized medicine is the answer.
“We are moving towards a world of personalized medicine where diagnostic tests specific to each patient will determine treatment,” Dr. Khamar explained. “Based on what combination of biomarkers tell you, you have to decide what treatment to give rather than one size fits all.”
To this end, her team has developed a microfluidic device that analyzes eight biomarkers from tear samples in just 90 minutes. The system employs AI to interpret biomarker combinations, guiding treatment decisions with unprecedented precision.
The technology uses a Schirmer strip to collect tears, which is then processed with a patented buffer solution and analyzed in a specialized cartridge. The resulting AI-based report indicates whether the eye is healthy or shows subclinical or active inflammation based on the specific biomarker profile.
According to Dr. Khamar, the system’s versatility extends beyond dry eye. “This kit is not just for dry eye or keratoconus,” she said. “It can be used for many other unhappy patients with vascular occlusions, retinal conditions, myopia, and glaucoma.”
Complementing this biomarker approach, Dr. Chan has established a specialized tertiary dry eye clinic that bridges the gap between patient expectations and clinical reality through comprehensive assessment and personalized care.
“The challenges of dealing with dry eye disease include mismatched expectations,” Dr. Chan observed. “Patients perceive themselves as having a serious condition, but their concerns are often dismissed.” Her clinic combines nurse-led comprehensive assessments with physician expertise in a structured format that allocates significant time for each patient.
A surprising discovery emerged from Dr. Chan’s clinical work: Many primary dry eye patients without diagnosed autoimmune conditions show high antinuclear antibody (ANA) titers. “In healthy populations, around 10 percent of patients have an ANA titer above 1:160,” she said. “But in these primary dry eye patients who don’t have Sjögren’s syndrome, there’s an increase in the number of patients with high ANA titer level.”
These patients demonstrate fundamentally different tear film characteristics, suggesting distinct treatment needs and potential new pathways for responses. “Antinuclear antibodies in dry eye disease may cause fundamental differences that can inform many basic scientific research directions,” she concluded.
New frontiers in corneal drugs
Poor drug penetration, rapid clearance and compliance issues have spurred innovative approaches to ophthalmic drug delivery—including two approaches to corneal ailments from world-famous researchers, Profs. Namrata Sharma (India) and Jod Mehta (Singapore)
Fungal keratitis, a leading cause of corneal blindness in developing countries, has long been hampered by poor drug penetration. This is the thrust behind Prof. Sharma’s research on netasol, a soluble 1% formulation of natamycin that achieves higher corneal penetration than the standard 5% suspension.
Prof. Sharma indicated that in clinical trials, netasol demonstrated remarkable cure rates. The formulation’s enhanced solubility allows it to reach deeper corneal layers, addressing a critical limitation of conventional therapy.
“Deeper ulcers can also be treated with netasol,” she noted, pointing out that the formulation’s enhanced solubility allows it to reach deeper corneal layers, addressing a critical limitation of conventional therapy.
Meanwhile, for allergic eye disease, Prof. Mehta Singapore Eye Research Institute has engineered a nanoliposomal tacrolimus formulation delivered via subconjunctival injection. A single injection provides 3-4 months of immunomodulation, eliminating the compliance challenges associated with daily drops.
“Tacrolimus is way more potent than cyclosporine, but its lipophilic structure has limited its use as an eye drop,” Dr. Mehta noted. By encapsulating tacrolimus in nanoliposomes, his team has overcome this barrier, creating a sustained-release system with applications potentially extending to graft-versus-host disease and Stevens-Johnson syndrome. The first-in-human trials were recently completed, with promising early results.
Resisting antibiotic resistance
The spectre of antibiotic resistance looms large over the treatment of bacterial infections worldwide, and especially in cases of ophthalmic infection.
Novel approaches that target host-pathogen interactions rather than the bacteria directly may offer alternative therapeutic strategies, and Dr. Wai Kit Chu (Hong Kong) has uncovered a surprising pathway in Pseudomonas keratitis.
His research has revealed that contact lens wear increases norepinephrine levels on the ocular surface, promoting bacterial infection through the ADRB2 receptor pathway by creating gaps between epithelial cells.
“This pathway works on the corneal epithelial cells instead of inhibiting the bacteria,” Dr. Chu explained. His team has demonstrated that ADRB2 receptor antagonists can reduce infection severity in animal models, suggesting a novel therapeutic approach.
By targeting the host response rather than the pathogen directly, this approach could complement traditional antibiotics, potentially addressing the growing concern of antimicrobial resistance. It also helps explain why contact lens wear is such a significant risk factor for Pseudomonas infections, beyond the mechanical trauma typically cited.
Editor’s Note: Reporting for this story took place during the 40th Congress of the Asia-Pacific Academy of Ophthalmology (APAO 2025), being held in conjunction with the 83rd Annual Conference of the All India Ophthalmological Society (AIOC 2025) from 3-6 April in New Delhi, India.