Ophthalmology

Future increases in imaging speed will improve performance and functionality for OCT and OCT angiography (OCTA), said James Fujimoto, PhD.

Findings from studies investigating intravitreal corticosteroids for treatment of diabetic macular edema (DME) provide information about their efficacy and safety, including some understanding of how they compare with anti-VEGF therapy.

Wide-field retinal imaging can be performed using a commercially available swept-source optical coherence tomography (SS-OCT) platform (DRI OCT Triton, Topcon) and only the internal fixation light for patient navigation provided detailed images of both normal and pathologic peripheral retinal findings.

A new hypersonic liquefaction vitrectomy system, called Vitesse PPVX (Bausch + Lomb), offers several advantages over currently available vitrector technology. The device received FDA 510k approval in April 2017.

Adaptive optics could allow clinicians to monitor the progression of retinal diseases cell-by-cell, according to Jacque Duncan, MD.

Accumulating evidence is cause for concern and underscoring the need for more research evaluating the safety of anti-VEGF injections for ROP, according to Robert L. Avery, MD.

Anti-vascular endothelial growth factor (VEGF) remains the gold standard therapy for diabetic retinopathy, but “when treating diabetic macular edema (DME), “about half of the patients treated with VEGF inhibitors do not respond to therapy,” said Tine Van Bergen, PhD, a scientist with ThromboGenics, Leuven, Belgium.

After 12 months of treatment with intravitreal aflibercept injections, both treatment-naïve and pre-treated patients demonstrated visual acuity gains. Visual acuity improvement was higher in treatment-naïve patients.

A newly approved system (3D OCT-1 Maestro, Topcon) combines a high-resolution, color, non-mydriatric retinal camera with the latest spectral-domain optical coherence tomography (OCT) technology, and stands out for its versatility as well as its quality and ease of use.

Intravitreal sirolimus 400 mcg (Ospiria, Santen) demonstrated positive results in pivotal trials investigating it as a treatment for non-infectious uveitis of the posterior segment. A New Drug Application is under FDA review.

Despite the failure of 2 clinical trials involving a combination therapy of platelet-derived growth factor (PDGF) inhibitor and anti-vascular endothelial growth factor (anti-VEGF) therapy, a third phase III study continues.

After 5 years of follow-up in the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT), the visual acuity gains achieved during the first 2 years of anti-VEGF treatment were not maintained, the choroidal neovascular lesions continued to evolve with evidence of persistent activity in some eyes, and there was increased retinal thinning and geographic atrophy (GA).

Advancements in retinoblastoma have occurred in the areas of treatment, genetic testing, and diagnostic imaging.

Vitreoretinal lymphomas are both deceptive and deadly. While there are only about 350 cases reported annually in the United States, median survival is less than 5 years, said Rajesh C. Rao, MD.

The gene therapy technology already exists to treat most inherited retinal disease. The current challenge is to drive down the costs of implementing the technology.

The FDA recently granted regulatory approval for tocilizumab (Actemra, Genentech), the first approved therapy for the treatment of adults with giant cell arteritis.

Endoillumination for vitreoretinal surgery continues to improve with the introduction of brighter, safer light sources with color filters that may allow opportunities for better tissue visualization.

Compounded pharmaceuticals have been used for decades, but does that mean they are reliable and safe? “Absolutely,” asserted Dante Pieramici, MD. “The literature disagrees,” said Julia Haller, MD.

Local therapy plays a significant role in the treatment of uveitis, either as monotherapy or in combination therapy. Alongside a number of pharmacotherapeutic agents, new products and technologies are in development that could expand clinicians’ options and improve outcomes.

The UK’s National Institute for Health and Care Excellence (NICE) has given preliminary approval to dexamethasone 0.7 mg intravitreal implant (Ozurdex, Allergan) and adalimumab (Humira, AbbVie) for sight-threatening non-infectious posterior uveitis.

The efficacy of intravitreal bevacizumab (Avastin, Genentech) for improving vision in patients with center-involving diabetic macular edema (DME) has been demonstrated in several clinical trials.

All three anti-vascular endothelial growth factor (anti-VEGF) agents that are commercially available have demonstrated efficacy for the treatment of diabetic macular edema (DME). However, it is clear from the results of clinical trials that outcomes with bevacizumab are not as good as those obtained using ranibizumab or aflibercept, according to Jean-François Korobelnik, MD.

Eyes operated on with pars plana vitrectomy needed fewer reoperations over 180 days than eyes subjected to scleral buckling (SB) in a retrospective comparison of patients with rhegmatogenous retinal detachment (RRD).

Evidence supports the involvement of an important pathway in retinal ganglion cell dysfunction and death in traumatic optic neuropathy.

Key components in retinopathy of prematurity trials include risk factors, predictive models, telemedicine and tele-education trends, and treatment.

A phase III study program investigating abicipar pegol (Allergan) for the treatment of neovascular age-related macular degeneration (nAMD) is underway based on promising efficacy and safety results in phase II studies.

Earlier this month, a jury convicted West Palm Beach retina surgeon Solomon Melgen, MD, on 67 counts of Medicare fraud. This high-profile case hit very close to home, as myself and another retina specialist from my own community were on opposing sides of the case.

Laser photocoagulation is a time-tested, well-defined, and effective treatment for retinopathy of prematurity (ROP) with requirements for follow-up that are much more manageable compared with anti-vascular endothelial growth factor (anti-VEGF) therapy, argued David K. Wallace, MD, MPH.

Anti-VEGF therapy for Zone I retinopathy of prematurity (ROP) is associated with better structural and functional outcomes than laser therapy, but also a longer recurrence risk period, said Helen A. Mintz-Hittner, MD.

I have been encouraged as a retinal specialist with all the excitement and promising new treatments in gene therapy. Given that there are several retinal diseases with known inherited patterns and confirmed genetic loci responsible for the clinical manifestations, our field is primed to benefit from the expansion of knowledge in this arena.