Modern Retina Facebook Live from AAO: Drs. David Brown, Rishi Singh, Rick Spaide, and Charles Wykoff talk about the top stories in medical and surgical retina from the previous year, and what they're looking forward to hearing on the podium from Retina Subspecialty Day 2017.
For retina specialists, 2017 was a year of highs and lows. Optical coherence tomography angiography (OCTA) and heads-up surgical systems were some highlights, but they were offset by disappointing clinical trial results for geographic atrophy (GA) and neovascular age-related macular degeneration (AMD).
Still, other innovations at the forefront this year included identifying biomarkers for retinal diseases, and a unanimous recommendation by an FDA Advisory Committee for approval of the first gene therapy to treat inherited retinal disorders.
Surgical, imaging innovations
For David R. Chow, MD, assistant professor, St. Michael’s Hospital, University of Toronto, and director, Toronto Retina Institute, using 3-D imaging is a revolutionary way of performing surgery. Like any other technology, the NGENUITY system (Alcon Laboratories) “has its growing pains, but the things we can do with it will allow us to perform surgery more safely,” he said.
Surgical innovations that seem to be taking hold this year include making internal limiting membrane flaps as a means to close posterior retinal detachments.
“Difficult macular hole surgery is kind of the sexy macular surgery talk du jour,” Dr. Chow said.
“OCTA started off as something that was not all that clinically useful, but now we’re doing it on almost half our patients,” said Richard Spaide, MD, of Vitreous Retina Macula Consultants of New York.
Dr. Spaide is also able to provide OCTA imaging to other specialties (including glaucoma). Using OCTA has led clinicians to realize glaucoma is a macular disease, he said.
Dr. Chow believes that within 5 years technology “will allow us to cover the posterior pole. We will be able to see with exquisite resolution all layers of the choroid, and do it in a noninvasive manner.”
To that end, Judy Kim, MD, professor of ophthalmology, Medical College of Wisconsin, said ultrawide-field imaging for diabetic retinopathy is comparable to the ETDRS, but needs only one image rather than seven, which is a “huge” benefit for patients.
“Peripheral lesions may be a biomarker for disease severity,” she said. “I tell my fellows if you can see more, you can treat more.”
OCTA is not the final frontier in imaging, Dr. Chow said.
“There is now a swept-source OCTA that’s heading to market,” he said.