Ophthalmology

There is subset of patients with resistant or persistent DME that forms the impetus for new treatment strategies, including next-generation anti-VEGF-A and new classes of drugs. Pravin U. Dugel, MD, outlines a list of potential treatment candidates that may lead that paradigm shift.

Two of the top 10 “most-talked-about” articles in JAMA Ophthalmology are about age-related macular degeneration (AMD). One of the current top 5 “most-read” articles in the American Journal of Ophthalmology is also about AMD. Here are a brief synopsis of those three papers.

The American Academy of Ophthalmology’s Preferred Practice Pattern on Age-Related Macular Degeneration “are based on the best available scientific data as interpreted by panels of knowledgeable health professionals.” These patterns offer solid clinical guidelines for treating and counseling AMD patients.

In patients with age-related macular degeneration managed by a treat-and-extend regimen, the visual acuity generally was maintained; lesion reactivation occurred frequently at about eight weeks; and longer induction phases between treatments was associated with worse outcomes.

Voretigene neparvovec-rzyl (Luxturna, Spark Therapeutics) was approved in December 2017 for the treatment of patients with confirmed biallelic RPE65 mutation-associated retinal dystrophy. Clinical trial results and patient selection issues for this gene therapy are discussed.

A well-known dilemma surrounding AMD is that there lacks a universally accepted treatment regimen with anti-VEGF injections. The balance between optimal visual outcomes and treatment burden has led some specialists to embrace the treat-and-extend regimen over monthly treatments.

Since February is designated Age-Related Macular Degeneration Awareness month. For healthcare providers, there are numerous resources available to help promote awareness to patients and to encourage patients to continue (or start) annual visual exams.

Sixteen fellows and residents show just why research in retina is on the cutting edge

Results of the prospective TREX-DME study provide an evidence base for using a treat-and-extend protocol for administering anti-VEGF injections for eyes with diabetic macular edema.

Suprachoroidal triamcinolone acetonide (CLS-TA, Clearside Biomedical) injection resulted in visual and anatomic improvements in eyes with diabetic macular edema, particularly in those that were treatment-naïve. Multiple injections of the investigational treatment were well-tolerated and associated with a low incidence of IOP elevation.

Quantitative assessment of retinovascular features on ultra-widefield angiography images showed significant improvements in leakage and ischemia following treatment with aflibercept in patients with diabetic macular edema and retinal vein occlusion.

Computerized testing of contrast sensitivity function using the Sentio Platform (Adaptive Sensory Technology) may better quantify the visual limitations of patients than traditional letter acuity after retinal detachment repair.

RGX-314 gene therapy offers patients the potential for a lower treatment burden with one subretinal injection of a gene therapy delivering an anti-vascular endothelial growth factor protein.

Advances in optical coherence tomography (OCT) and OCT angiography (OCTA) may enable more objective and accurate diagnosis of ROP in the future.

Early results of a phase Ib/II study investigating light-activated AU-011 (Aura Biosciences) for treatment of small-medium choroidal melanoma show good safety and evidence of efficacy for this novel tumor-targeted therapy.

Management of patients with loss of light perception after open-globe injury has historically been to observe or enucleate the eye with the goal of reducing the risk of sympathetic ophthalmia. Existing data, however, support rethinking that paradigm and instead considering surgery for carefully selected patients who have a chance for recovering vision.

OCT angiography (OCTA) is a revolutionary new tool that adds value to clinical practice. It provides unique insights about retinal and choroidal vasculature compared with conventional OCT along with the advantages of conventional dye-based techniques, said Philip J. Rosenfeld, MD, PhD, at the 2017 Retina Subspecialty Day meeting.

Clinical trials are an indispensable ordeal that are the gold standard for assessing risks and benefits of treatments, said Frederick L. Ferris III, MD.

Development of technologies for sustained drug delivery is a topic of great interest among retina specialists considering the number of chronic conditions that are managed with repeated intravitreal injections.

Results from 3 years of follow-up in the phase III trial investigating treatment with adeno-associated viral vector delivery of human RPE65 (voretigene neparvovec, Spark Therapeutics) show this gene therapy has an acceptable safety profile.