Ophthalmology

Pharmacologic activity in the retina realm continues to hold much excitement for new therapies to treat retinal disorders.

In this Q&A with members of the Ophthalmology Times Europe Editorial Advisory Board, participants take a look at some of the top challenges and opportunities facing ophthalmologists in Europe today.

Aflibercept, an anti-VEGF agent, can enable treatment interval extensions and provide rapid and sustained vision gain in retinal vascular diseases as well as significantly reducing the severity of diabetic retinopathy.

Retina specialists who are Diabetic Retinopathy Clinical Research Network investigators offer views on whether laser panretinal photocoagulation or anti-VEGF therapy deserves consideration as first-line treatment for proliferative diabetic retinopathy.

Aflibercept (Eylea, Regeneron Pharmaceuticals) intravitreal injection, administered according to an as-needed regimen, improved the anatomic outcomes in many eyes refractory to monthly bevacizumab or ranibizumab injections that had persistent or recurrent fluid. However, half of the patients might require aflibercept injections every 4 weeks in order to achieve a completely dry retina.

A novel vascular endothelial growth factor receptor 2 (VEGF-R2) topical eye drop, PAN-90806 (PanOptica, Inc.), may revolutionize the treatment of neovascular age-related macular degeneration by making intravitreal injections of anti-VEGF drugs a thing of the past for certain patients and eliminating the risk associated with the intravitreal injections.

Adalimumab (Humira, AbbVie), an immunosuppressive biologic therapy, improves the symptoms of noninfectious active uveitis, but causes some adverse events and does not cure the disease, researchers say.

The inverted internal limiting membrane (ILM) flap technique is not only a safe and effective procedure for treating macular holes, but compared with conventional ILM peeling, it is significantly more effective for achieving macular hole closure in certain situations, said Stanislao Rizzo, MD, at Retina Subspecialty Day 2016.

A permanent keratoprosthesis (KPro) can help restore the vision of patients with severe corneal disease, but clinicians must watch out for complications, according to Donald J. D’Amico, MD. Dr. D’Amico of the Weill Cornell Medical College, New York, described some of those complications in his Pyron Award Lecture during the American Society of Retina Specialists 2016 Annual Meeting.

Use of voretigene neparvovec in gene therapy demonstrates positive outcomes to treat a gene mutation in patients with retinal dystrophy.

Earlier treatment of patients with DME who have had visual acuity loss results in the need for fewer intravitreal injections of ranibizumab over the long term.

The increasing prevalence of diabetes, which implies a rise in the number of cases of diabetic retinopathy, suggests that ophthalmologists need to ensure their knowledge of this disease is up-to-date. Hazy memories of a long-ago medical school lecture from an endocrinologist or the guidelines in an outdated textbook are inadequate given changes in the understanding of the pathogenesis, diagnosis, and especially the treatment of diabetes.

A digitally assisted vitreoretinal surgery system offers enhanced visualization for surgeons and observers, better ergonomics for greater surgeon comfort, and may improve patient safety by allowing use of lower endoillumination levels.

A real-world safety study of fluocinolone acetonide implant (Iluvien, Alimera Sciences) in patients with chronic DME (328 eyes from 292 patients) showed that 81.6% of patients did not require initiation of IOP-lowering therapy during the study and 60% of patients included in this registry study gained vision after injection of Iluvien that was sustained over the study period.

The Argus II Retinal Prosthesis System (Second Sight Medical Products) is providing a safe option for restoration of some visual function in patients with severe vision loss associated with retinitis pigmentosa.

By shrinking the core technology of optical coherence tomography to the size of a coin-and reducing its cost-a team of European scientists hopes to improve early diagnosis and screening of retinal diseases.

Complications of silicone oil occur when it is inadvertently placed in anatomic areas other than the vitreous cavity, migrates, or emulsifies. Methods for avoiding these issues and their management are discussed in this article.

An oral anti-VEGF/PDGF inhibitor had no dose-limiting toxicity and improved visual acuity and OCT findings in patients with exudative age-related macular degeneration in a phase I study.

Retina surgeons discuss the need for face-down positioning after macular hole surgery. The interpretation of what constitutes “face-down” is key to their messages.

When followed over time, about 75% of patients in the RIDE/RISE trials who had the highest risk of progression to proliferative diabetic retinopathy benefited from ranibizumab with “robust” regression of diabetic retinopathy severity levels.

The Comparison of Age-related Macular Degeneration Treatment Trial (CATT) follow-up study found that the initial gains in visual acuity achieved with two anti-vascular endothelial growth factor drugs were lower than those achieved at the end of the 2-year CATT study.

Minimally invasive vitrectomy surgery with 27-gauge equipment is improving with the development of new technology that is increasing efficiency and expanding functionality.

A new handheld pediatric vision scanner can detect amblyopia and strabismus with over 90% accuracy. The device can be used to screen children too young to read or recognize letters as well as those of school age since the only requirements are to sit still for a few seconds and look at a smiley-face target in the machine.

Retinal tumors have taken on a new importance because of links to systemic disease, according to Carol Shields, MD. Through these links, specialists are improving the diagnosis and treatment of retinal tumors. Dr. Shields highlighted astrocytic hamartoma, retinoblastoma, and retinal capillary hemangiomoblastoma.

Some laser pointers available for less than €20 exceed the legal limits on their power by as much as 127 fold, according to Australian researchers. They have called on regulators to consider a ban on green laser pointers.

The transcription factor XBP1 appears to have an expanding role in endothelial cell survival and retinal vascular degeneration as it relates to aging and diabetes.

Oxidative stress stemming from a growing accumulation of visual cycle adducts may play an important role in the pathogenesis of AMD, suggest new findings.

Retinal changes might serve as a marker for Parkinson’s disease, an experiment in mice suggests. And the therapy also points to a potential treatment.

Intas Pharmaceuticals of Ahmedabad, India, seems to have overcome the manufacturing problems that led to ocular inflammation in 10% of the patients injected with the first three batches of razumab, a biosimilar for ranibizumab, according to two ophthalmologists who have administered the drug.

As a physician passionate about treating and helping patients with retinal disease, I continuously seek out and study new treatment modalities. It can be a very scary time for patients when faced with retinal conditions, such as macular degeneration, retinal detachments, and diabetic macular edema (DME).