Bascom Palmer’s 19th annual Angiogenesis, Exudation, and Degeneration Meeting 2022 is a virtual event scheduled for February 11 and 12, 2022. The program is focused on understanding and treating neovascular and exudative diseases of the eye with the emphasis on the revolutionary pharmacologic therapies that are being developed and the clinical management of neovascular age-related macular degeneration (AMD), macular oedema, diabetic retinopathy, and retinopathy of prematurity. Another special focus is the current and future impact of the developing pharmacotherapies on clinical practice and Medicare, according to the program coordinators.

Professor of Ophthalmology and The J. Donald M. Gass Distinguished Chair in Ophthalmology; and 

Professor of Clinical Ophthalmology — all from the Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami.

The scheduled program is outstanding, with a slate of distinguished national and international basic scientists, clinicians, and healthcare experts who will share the latest developments in imaging, translational research, and clinical trials as well as the impact these advances will have on clinical ophthalmology.

Retina specialists expressed enthusiasm about the promise of the information that will be disseminated at the meeting.

According to Dr Anat Loewenstein, chair of the department of ophthalmology, Tel Aviv Medical Centre, Tel Aviv, Israel, and a program panellist, “The angiogenesis meeting is a unique conference in size and scope. First, I think that it includes all the state-of-the-art current treatments of most retinal diseases. At the same time, new modalities of treatment and monitoring are being presented, which allows the audience to not only learn about the current treatments but also gain information about the newly approved ones and the ones that are still under assessment.”

She continued, “It is a big meeting but not too big to prevent fruitful discussion for which there is usually enough time allocated, making that another special feature of this meeting."

Dr Albini, commented, “There is simply no better event, streaming or in-person, to get an update and overview on the amazing novel therapeutics in exudative and degenerative retinal disease.”

This year’s activities begin on Friday, February 11 at 7:50 Eastern time with an opening address by the co-directors.

The following 5 sessions are scheduled for day 1 beginning at 8 am and adjourning at 1:20 pm Eastern time.

Session I: Genetics, Histopathology, and Imaging in Non-Exudative AMD

Session II: Predicting Progression of AMD

Session III: Emerging Therapies for Non-Exudative AMD

Session IV: C3 Inhibition for the Treatment of Geographic Atrophy; 

session IV also will include a panel discussion titled “Clinical trial endpoints for non-exudative AMD” at the conclusion of the session.

Session V: OCT Imaging and Risk Factors for Exudative AMD

The day 2 program, which also will feature 5 sessions, will begin on Saturday, February 12 at 7:50 am with opening comments and run until 2:30 pm.

Session VI: Emerging and Current Therapies for Exudative AMD; the session will include a discussion of the Ranibizumab Port Delivery System presentations.

Session VII: Dual Inhibition of Ang2 and VEGF for the Treatment of Exudative AMD and DMO–An Update from the Faricimab Program; a discussion session will follow.

Session VIII: Diabetic Retinopathy-Imaging and Staging

Session IX: Diabetic Retinopathy-Treatment

Session X: Retinal and Choroidal Vasculopathies and Degenerations

More detailed information about the specifics of each sessions and the speakers can be obtained on the 

 and interested clinicians are invited to sign up.

Articles

Ophthalmologists gather to discuss neovascular and exudative diseases of the eye and the revolutionary therapies on the horizon.

What to expect at Angiogenesis 2022: Fruitful discussion, revolutionary therapies

Active COVID-19 can affect the pupillary diameter, according to Turkish investigator Dr Serap Yurttaser Ocak and colleagues, who reported finding significant differences in the pupillary diameters between when the virus was active and 3 months later.

The authors are from the Department of Ophthalmology, Prof. Dr Cemil Tascioglu Education and Research Hospital, University of Health Sciences, Istanbul, Turkey.

The researchers conducted a study that included 58 patients (mean age, 47.23 ± 1.1 years) with active COVID-19 infections. The scotopic, mesopic, and photopic pupillary diameters were measured at subsequent time points after the light source was terminated, that is, at 0, 1, 2 4, 6, 8, and 10 seconds. The average speed at which the dilation occurred also was determined at 1, 2, 4, 6, 8, and 10 seconds. These measurements then were compared in the same patients 3 months later.

The study showed that the mean scotopic and mesopic diameters were less during active infections compared with 3 months after the infection (

There were no significant differences in the mean photopic pupillary diameter and the mean pupillary diameter at 0 seconds between measurements (

The mean pupillary diameters were significantly lower during active infection at 1, 2, 4, 6, 8, and 10 seconds (p < 0.01, for all comparisons), and the average speeds at which the pupils dilated at each time point were lower during active infection compared with the measurements at 3 months (

The investigators believe that, based on their findings, the impact of COVID-19 on the autonomous nervous system warrants further prospective studies and assessment of pupillary function might be a useful test for determining autonomic dysfunction.

Ocak SY, Ozturan SG, Bas E. Pupil responses in patients with COVID-19. Int Ophthalmol 2021; doi: 

https://doi.org/10.1007/s10792-021-02053-z

Differences in pupil sizes distinguish between active and resolved COVID-19 cases

A team of investigators from the University of California Davis conducted a small, randomly assigned trial that found regularly eating a small serving of dried goji berries may help prevent or delay the development of 

AMD is the leading cause of vision loss in older people, and is estimated to affect more than 

“AMD affects your central field of vision and can affect your ability to read or recognize faces,” said Glenn Yiu, MD, PhD, a co-author of the study

 and an associate professor in the Department of Ophthalmology and Vision Services.

According to a university news release, the investigators found that 13 healthy participants aged 45 to 65 who consumed 28 grams (about one ounce, or a handful) of goji berries 5 times a week for 90 days increased the density of protective pigments in their eyes. In contrast, 14 study participants who consumed a commercial supplement for eye health over the same period did not show an increase.

Investigators noted that the pigments that increased in the group that ate goji berries, lutein and zeaxanthin, filter out harmful blue light and provide antioxidant protection. Both help to protect the eyes during aging, according to the release

“Lutein and zeaxanthin are like sunscreen for your eyes,” lead author 

“The higher the lutein and zeaxanthin in your retina, the more protection you have. Our study found that even in normal healthy eyes, these optical pigments can be increased with a small daily serving of goji berries,” Li explained.

, two species of shrubby bushes found in northwest China. The dried berries are a common ingredient in Chinese soups and are popular as herbal tea. They are similar to raisins and eaten as a snack.

The investigators noted that in Chinese medicine, goji berries are said to have “eye brightening” qualities. Li grew up in northern China and became curious whether there were any physiological properties to “eye brightening.”

“Many types of eye diseases exist, so it is not clear which disease ‘eye brightening’ is targeting,” Li said in the statement.

She researched the bioactive compounds in goji berries and found they contain high quantities of lutein and zeaxanthin, which are known to 

 related to AMD. The form of zeaxanthin in goji berries is also a highly bioavailable form, according to Li, meaning it is readily absorbed in the digestive system so the body can use it.

According to the university release, the current treatment for intermediate stages of AMD uses special dietary supplements, called 

, that contain vitamins C, E, zinc, copper and lutein and zeaxanthin. No known therapy has yet been shown to impact early stages of AMD.

The cause of AMD is complex and multifactorial, according to Yiu, and involves a mix of genetic risks, age-associated changes, and environmental factors like smoking, diet and sun exposure. Early stages of AMD do not have symptoms; however, physicians can detect AMD and other eye problems during a regular comprehensive eye exam.

“Our study shows goji berries, which are a natural food source, can improve macular pigments of healthy participants beyond taking high-dose nutritional supplements,” Yiu concluded in the statement. “The next step for our research will be to examine goji berries in patients with early-stage AMD.”

Although the results are promising, the researchers note that the study size was small and more research will be needed.

1. Glenn Yiu, MD, PhD; Roberta R. Holt, Carl L. Keen, Lawrence S. Morse and Robert M. Hackman. Goji Berry Intake Increases Macular Pigment Optical Density in Healthy Adults: A Randomized Pilot Trial; Nutrients Published Dec. 9, 2021. 

A University of California Davis, United States, study shows that small serving of the fruit increased protective pigments in the eye.

Consuming dried goji berries may protect against AMD

The Foundation Fighting Blindness today announced it has named Jason Menzo the foundation’s president and chief operating officer, effective immediately.

According to a news release, since joining the foundation in 2018, Menzo has had an impact on redefining the non-profit's operations, including fiscal, fundraising, communications, and managerial operations. He is recognized by colleagues and constituents for his passionate leadership style and ability to create innovative partnerships.

In addition, the foundation noted that he was involved in the formation of the RD Fund (Retinal Degeneration Fund), the venture arm of Foundation Fighting Blindness, which was created to further serve its mission. Menzo also is one of the founders of Opus Genetics, the first spin-off company internally conceived and launched by the RD Fund to further the Foundation's mission.

"We are excited to have Jason as president, along with continuing his current operational responsibilities," David Brint, chairman of the Foundation Fighting Blindness board of directors, said in a statement. "He has shown tremendous dedication to the mission and causes of the organization during his tenure."

Foundation CEO Benjamin Yerxa, PhD, noted that Menzo’s impact on the foundation has been undeniable.

“His ability to engage and influence the culture of internal staff alongside our constituents, while also guiding operational and fundraising efforts, has benefitted the foundation and our mission immensely,” Menzo said in a statement.

According to the release, before he joined the foundation, Menzo was a healthcare executive, having led the successful development and launch of several notable ophthalmic companies and brands.

"I am proud of the advances we have made to date and remain focused on new ways we can accelerate future milestones," Menzo said in a statement. "I am excited to focus on the future in an effort to continually expand the foundation's advancement, faster and further than ever before. Our constituents are at the heart of everything we do, and it is an honor to continue my service to them through the efforts of the foundation."

Established in 1971, the Foundation Fighting Blindness is a private funding source for retinal degenerative disease research. According to the release, it. has raised more than $816 million toward its mission of accelerating research for preventing, treating, and curing blindness caused by the entire spectrum of blinding retinal diseases including: retinitis pigmentosa, macular degeneration, and Usher syndrome.

The RD Fund (Retinal Degeneration Fund) is the venture arm of the Foundation Fighting Blindness, and a leading investor in the inherited retinal disease space.

Since joining the foundation in 2018, Menzo has been involved in the formation of the Retinal Degeneration Fund, the venture arm of Foundation Fighting Blindness.

Foundation Fighting Blindness promotes Jason Menzo to president, COO

According to a team of investigators, the “retinal age gap” could see potential use as screening tool, with the microvasculature in the retina a possible indicator of the overall health of the body’s circulatory system and the brain.

The difference between the biological age of the retina, the light sensitive layers of nerve tissue at the back of the eye, and a person’s real (chronological) age, is linked to their risk of death, finds research published online in the 

According to a news release, this “retinal age gap” could be used as a screening tool, suggest the team of Australian investigators, led by Dr Zhuoting Zhu from the Centre for Eye Research Australia.

Investigators note that a growing body of evidence suggests that the microvasculature in the retina might be a reliable indicator of the overall health of the body’s circulatory system and the brain.

While the risks of illness and death increase with age, it’s clear that these risks vary considerably among people of the same age, implying that ‘biological ageing’ is unique to the individual and may be a better indicator of current and future health, say the researchers.

The investigators also noted in the release that several tissue, cell, chemical, and imaging-based indicators have been developed to pick up biological ageing that is out of step with chronological ageing. But these techniques are fraught with ethical and privacy issues as well as often being invasive, expensive, and time consuming.

According to the release, investigators therefore turned to deep learning to see if it might accurately predict a person’s retinal age from images of the fundus, the internal back surface of the eye, and to see whether any difference between this and a person’s real age, referred to as the "retinal age gap," might be linked to a heightened risk of death.

Deep learning is a type of machine learning and artificial intelligence (AI) that imitates the way people acquire certain types of knowledge. But unlike classic machine learning algorithms that are linear, deep learning algorithms are stacked in a hierarchy of increasing complexity.

The release noted that investigators drew on 80,169 fundus images taken from 46,969 adults aged 40 to 69, all of whom were part of the UK Biobank, a large, population-based study of more than half a million middle aged and older UK residents.

Some 19,200 fundus images from the right eyes of 11,052 participants in relatively good health at the initial Biobank health check were used to validate the accuracy of the deep learning model for retinal age prediction, according to the release.

This showed a strong association between predicted retinal age and real age, with an overall accuracy to within 3.5 years, investigators noted in the release.

The retinal age gap was then assessed in the remaining 35,917 participants during an average monitoring period of 11 years.

During this time, 1871(5%) participants died: 321(17%) of cardiovascular disease; 1018 (54.5%) of cancer; and 532 (28.5%) of other causes including dementia.

The proportions of ‘fast agers’—those whose retinas looked older than their real age—with retinal age gaps of more than 3, 5, and 10 years were, respectively, 51%, 28%, and 4.5%.

Large retinal age gaps in years were significantly associated with 49%-67% higher risks of death, other than from cardiovascular disease or cancer.

And each 1-year increase in the retinal age gap was associated with a 2% increase in the risk of death from any cause and a 3% increase in the risk of death from a specific cause other than cardiovascular disease and cancer, after accounting for potentially influential factors, such as high blood pressure, weight (BMI), lifestyle, and ethnicity.

The same process applied to the left eyes produced similar results, investigators said in the release.

According to the news release, this is an observational study, and as such, cannot establish cause. The researchers also acknowledge that the retinal images were captured at one moment in time, and that the participants may not be representative of the UK population.

“Our novel findings have determined that the retinal age gap is an independent predictor of increased mortality risk, especially of non-[cardiovascular disease]/ non-cancer mortality,” the investigators wrote in the release. “These findings suggest that retinal age may be a clinically significant biomarker of ageing.”

Moreover, investigators added that “the retina offers a unique, accessible ‘window’ to evaluate underlying pathological processes of systemic vascular and neurological diseases that are associated with increased risks of mortality. This hypothesis is supported by previous studies, which have suggested that retinal imaging contains information about cardiovascular risk factors, chronic kidney diseases, and systemic biomarkers.”

The new findings, combined with previous research, add weight to “the hypothesis that the retina plays an important role in the ageing process and is sensitive to the cumulative damages of ageing which increase the mortality risk,” they concluded.

1. Zhuoting Zhu, MD, et.al; Clinical Science: Retinal age gap as a predictive biomarker for mortality risk; British Journal of Ophthalmology; Published Jan. 18, 2022; doi 10.1136/bjophthalmol-2021-319807

The difference between retina’s biological age and person’s real age linked to heightened death risk, with a team of Australian investigators finding that evidence suggests the microvasculature in the retina may be a reliable indicator of the overall health of the body’s circulatory system and the brain.

Retinal age gap linked to heightened death risk, study finds

Hovanesian is in private practice at Harvard Eye Associates in Laguna Hills, California, and is a clinical instructor at Jules Stein Eye Institute at the University of California, Los Angeles. Find him online @DrHovanesian. Hovanesian is a consultant for Ocular Therapeutix, EyePoint Pharmaceuticals, Omeros, and several other manufacturers of ophthalmic drugs and devices.

To control pain and inflammation most effectively and responsibly for our cataract surgery patients, we must not only use the appropriate drugs but also ensure they are delivered in the most beneficial manner. We should be mindful of the implications of our pharmaceutical strategies and their impact on our patients.

The opioid crisis may have taken a back seat to the COVID-19 pandemic in terms of headlines, but it certainly has not faded. If anything, it has worsened. Nearly 50,000 people in the United States died from opioid-involved overdoses in 2019, according to the National Institute on Drug Abuse.

 Around 21% to 29% of patients who are prescribed opioids for chronic pain misuse them, between 8% and 12% of people using an opioid for chronic pain develop an opioid use disorder, and an estimated 4% to 6% who misuse prescription opioids transition to heroin.

The chances of developing an opioid use disorder depends on factors, such as length of time one is prescribed opioids for acute pain and length of time that people continue taking the drug. In the United States, the total economic burden of prescription opioid misuse is estimated to be $78.5 billion a year, according to the Centres for Disease Control and Prevention.

It has been reported that opioid-naïve cataract surgery patients who receive an opioid prescription within 7 days of surgery are 1.6 times more likely to be using opioids long-term than those who are not prescribed an opioid following cataract surgery.

 Being older than 50 is a risk factor for chronic opioid use following surgery, therefore most cataract surgery patients are considered at greater risk of opioid dependency.

 It is clear that ophthalmologists, like other physicians, should seek to avoid prescribing opioids whenever possible.

Our cataract patients frequently struggle to adhere to complex postoperative drop regimens. We commonly prescribe 3 different agents—a nonsteroidal anti-inflammatory drug (nSAID), a steroid, and an antibiotic—and expect them to instil these drops as directed. This is a problem, as we know patients do not use their medications properly, with adherence being a major obstacle.

 In fact, 1 study showed that as many as 92% of patients do not correctly instil drops, being hindered by manual dexterity problems and other physical limitations.

 We surgeons seek to not only control pain and inflammation but also prevent it to ensure the best patient experience and optimal visual outcomes, particularly in the setting of premium IOLs.

Today we have the option of adopting delivery platforms that require no effort on the part of patients—this is a sea change in our strategies. One such option is preservative-free Dextenza, a dexamethasone 0.4-mg intracanalicular insert made of a resorbable polyethylene glycol–based hydrogel. The insert is placed within the canaliculus to provide a hands-free and tapered delivery of drug to the ocular surface. It can be inserted preoperatively or intraoperatively, and it takes just 1 minute to do. The highest concentration of dexamethasone is released during the first 2 weeks, and it slowly tapers over a period of about 1 month. The insert demonstrated a retention rate of 99% in the punctum at day 14 in the studies. Phase 3 studies showed there were no significant IOP spikes with the dexamethasone 0.4-mg intracanalicular insert compared with placebo.

Certainly, if there was a concern, the insert can be easily explanted. Regarding pain and inflammation in the phase 3 studies, a significantly greater proportion of eyes in the dexamethasone 0.4-mg intracanalicular insert group had an absence of ocular pain and an absence of anterior chamber cells, compared with the placebo group.

Many surgeons have found they can go completely dropless by combining Dextenza with intracameral moxifloxacin—particularly if they also use intraoperative ketorolac and phenylephrine (Omidria; Omeros). The nSAID lasts for 2 to 3 days, which is adequate for a significant number of patients. In my practice, I have moved to using just 1 postoperative drop for 3 to 4 weeks: once-daily bromfenac (Prolensa; Bausch + Lomb).

Dr Eric Donnenfeld and I conducted a study comparing the 3-drop regimen with a dropless or near dropless strategy in 56 patients and found that patients overwhelmingly favoured the latter regimen (96%). There was no significant difference in patient-reported pain or inflammation as seen on optical coherence tomography, no IOP concerns, and it was less expensive. In other words, the dropless or near dropless approach checked every box.

Although the benefits of sustained-release dexamethasone go well beyond their eliminating need for opioid medications after cataract surgery, avoiding opioids is still a strong and important reason surgeons should consider embracing use of the insert. As a specialty, we need to remain sensitive to the use of narcotics as well as opportunities we have to proactively reduce pain. The amount of effort it takes to incorporate dropless or near dropless cataract surgery into surgeons’ practice is well worth the numerous benefits they and their patients will reap.

1. Opioid overdose crisis. National Institute on Drug Abuse. Accessed October 29, 2021. https://www.drugabuse.gov/drug-topics/opioids/opioid-overdose-crisis

2. Donnenfeld ED, Shojaei RD. Effect of intracameral phenylephrine and ketorolac 1.0%/0.3% on intraoperative pain and opioid use during cataract surgery. 

. 2019;13:2143-2150. doi:10.2147/OPTH.S229515

3. Okeke CO, Quigley HA, Jampel HD, et al. Adherence with topical glaucoma medication monitored electronically the Travatan Dosing Aid study. 

 2009;116(2):191-199. doi:10.1016/j.ophtha.2008.09.004

4. Richter A, Anton SF, Koch P, Dennett SL. The impact of reducing dose frequency on health outcomes. 

2003;25(8):2307-2306. doi:10.1016/s0149-2918(03)80222-9

5. Tsai T, Robin AL, Smith JP 3rd. An evaluation of how glaucoma patients use topical medications: a pilot study. 

6. Robin AL, Novack GD, Covert DW, Crockett RS, Marcic TS. Adherence in glaucoma: objective measurements of once-daily and adjunctive medication use. 

. 2007;144(4):533-540. doi:10.1016/j.ajo.2007.06.012

7. Jones J, Francis P. Ophthalmic utility of topical bromfenac, a twice-daily nonsteroidal anti-inflammatory agent. 

. 2009;10(14):2379-2385. doi:10.1517/14656560903188425

8. An JA, Kasner O, Samek DA, Lévesque V. Evaluation of eyedrop administration by inexperienced patients after cataract surgery. 

. 2014;40(11):1857-1861. doi:10.1016/j.jcrs.2014.02.037

9. Tyson SL, Bafna S, Gira JP, et al; Dextenza Study group. Multicenter randomized phase 3 study of a sustained-release intracanalicular dexamethasone insert for treatment of ocular inflammation and pain after cataract surgery. 

. 2019;45(2):204-212. doi:10.1016/j.jcrs.2018.09.023

10. Walters T, Bafna S, Vold S, et al. Efficacy and safety of sustained release dexamethasone for the treatment of ocular pain and inflammation after cataract surgery: results from two phase 3 studies

 2016;7:1000572. doi:10.4172/2155-9570.1000572

Donnenfeld E, Hovanesian J, Hummel C, Quintero J. Dropless punctal plug dexamethasone, intracameral ketorolac and moxifloxacin compared to conventional topical therapy in cataract surgery. Presented at: ASCRS 2020 Virtual Annual Meeting; May 16-17, 2020.

Drug delivery solutions to manage pain after cataract surgery improves adherence.

Removing opioid prescriptions from cataract surgery

Haag-Streit UK’s iScan80 offers a fully integrated system which includes a full suite of retina, optic nerve and anterior segment scans. (Image courtesy of Haag-Streit UK)

Haag-Streit UK (HS-UK) is launching its Optovue 

According to the company, a manufacturer and distributor of orthoptic, optometry and ophthalmic equipment, the iScan80 is a high-speed OCT system ideal for practices seeking an affordable and versatile OCT system.

The iScan80 now delivers high-speed 80kHz OCT at 80,000 A-scans per second, 3 times faster than the original iScan system. It offers a more simplified scan acquisition, and a wider field of view.

, the iScan80’s streamlined design integrates the operator interface, display, patient interface and scan head into one console, making it ideal for small spaces. The tabletop design offers the flexibility to place it in any room, or transfer from one practice to another.

The company noted the iScan80 offers a range of fantastic features, including an OCT 

, retina mapping, RNFL and Ganglion Cell Complex trend analysis, high-density 3D retinal imaging and in-depth 3D optic nerve head analysis. It also boasts a comprehensive range of anterior scans, including; pachymetry, epithelial mapping, angle scans and vault mapping.

According to Haag-Streit UK, the iScan80 is a high-speed OCT system ideal for practices seeking an affordable and versatile OCT system.

iScan 80 OCT  to launch in UK

Dr Francesco Saverio Sorrentino from the Department of Surgical Sciences, Unit of Ophthalmology, Ospedale Maggiore, Bologna, Italy, reported that intravitreal injection of. preservative-free triamcinolone acetonide (Taioftal, Sooft Italia S.p.A.) was safe and effective for improving vision and reducing the central foveal thickness (CFT) in patients with diabetic macular oedema (DMO). The improvements became evident during an average time of 6 months.

This conclusion was based on the results of a prospective clinical study1 of 49 patients (49 eyes) treated with Taioftal. All patients underwent imaging at baseline and 1, 3, and 6 months after the intravitreal injection of 4 mg/0.05 ml of the drug.

The investigators measured the best-corrected visual acuity (BCVA), CFT, intraocular pressure (IOP), and adverse events to evaluate the treatment effect on vision and macular morphology before and after treatment. All patients were followed for 6 months.

The investigators reported that the median BCVA improved significantly at each evaluation. Compared with the baseline value, the patients had a 6-letter gain at 1 month and 12 letters at 3 months, which represented a 24% gain at 3 months that remained stable to 6 months compared to baseline, a difference that reached significance (p<0.05).

The median CFT decreased significantly at each time point, i.e., a decrease of about 65 microns at 1 month and 155 microns at 3 months, which was a decrease of up to 28% that was maintained out to the 6-month time point, a difference that also reached significance (p<0.05).

The IOP did not increase markedly but was the most frequently observed adverse effect.

Based on their results, the investigators believe that “intravitreal triamcinolone acetonide is an effective, safe, and inexpensive drug used to improve VA and reduce CFT in eyes affected by DMO during an average time of 6 months.”

They pointed out that temporary but never severe IOP elevations were manageable with topical medications. No serious vision-threatening complications are related to the use of intravitreal triamcinolone injections.

Sorrentino FS, Bonifazzi C, Parmeggiani F. Diabetic macular edema: Safe and effective treatment with intravitreal triamcinolone acetonide (Taioftal). PLOS One published online October 1, 2021; 

https://doi.org/10.1371/journal.pone.0257695

The improvement became evident during an average time of 6 months.

Intravitreal triamcinolone effectively manages DMO and increases vision, study reports

Patients implanted with diffractive multifocal IOLs had notable declines in the corrected distance visual acuity (CDVA), distance corrected near VA (DCNVA), and near area of focus (AoF) with aging, according to Dr Ryo Terauchi and associates from the Department of Ophthalmology at the Jikei University School of Medicine in Tokyo, Japan.

The investigators compared the effects of aging in this patient population by dividing patients who had been implanted with diffractive multifocal IOLs into the following 4 groups: those under 50 years of age, 50 to 59 years, 60 to 69 years, and 70 to 79 years.

The CDVA, DCNVA, and an area of focus metric, i.e., the distance, intermediate, and near AoF were measured postoperatively and compared among the age groups.

The respective CDVAs in the 4 age groups declined with age: −0.18, −0.16, −0.14, and −0.10 logarithm of the minimum angle of resolution (logMAR). In patients in their 70s, the CDVA was significantly worse compared with those younger than 50 years and those in their 50s (p = 0.002 and p = 0.049, respectively), Dr Terauchi reported.

He also reported that the respective DCNVAs in the 4 age groups showed the same trend: 0.01, 0.03, 0.03, and 0.08 logMAR. The DCNVA in the oldest group was significantly worse than those in patients younger than 50 years and those in their 60s (p = 0.008 and p = 0.019, respectively).

Finally, the near AoF was smaller in the oldest patients compared with the patients younger than 50 years and those patients in their 50s (p = 0.040 and p = 0.047, respectively). No significant differences were seen in the intermediate and distant AoFs in the 4 groups. However, in patients over 60 years of age, a “steep” decline was seen in the AoF.

Terauchi R, Horiguchi H, Ogawa S, et al. Age-related visual outcomes in eyes with diffractive multifocal intraocular lenses. Eye 2021; https://doi.org/10.1038/s41433-021-01854-x

According to investigators, patients implanted with diffractive multifocal IOLs had notable declines in the corrected distance visual acuity, distance corrected near VA, and near area of focus with aging

Diffractive multifocal IOL linked with progressive decline in vision in aging patients

Dr Firas Rahhal discusses the results of Outlook Therapeutics’ pivotal NORSE TWO trial for ONS-5010. The Phase 3 results show efficacy for the ophthalmic solution of bevacizumab for the treatment of wet macular degeneration.

So what we presented today was a new ophthalmic preparation for bevacizumab. And the background is that bevacizumab is a drug we use a lot; currently, for wet macular degeneration and other diseases, but we use it in a compounded form. Something that compounding pharmacies prepare off the intravenous version, and that makes it off-label. And so there's certain problems associated with that type of preparation.

And so what we're doing now is developing this ophthalmic solution made specifically for the eye of the same drug, essentially the same drug, for wet macular degeneration. And we presented the so-called Phase 3 data today of our trial showing efficacy.

So this would be the pivotal study, so there wouldn't have to be a lot of further data collection. What we showed today, just to review, is that 41.7%, or almost 42% of patients receiving this product gained 15 letters, which means three lines of vision gain, which is very good, and historically comparable to our standards with other name-brand drugs.

It also achieved a really high number of lesser gainers—which is also important and often not talked about as much—five and 10 letters or one- and two-line vision gainers was a very high number approaching 70%. That also compares very favourably with our expectation for this treatment class.

But as far as collecting more data, little to none would be needed now for wet AMD. Actually, the next frontier will be at some point for the company to—maybe next year, I think first quarter—apply for FDA approval, but then to consider testing it in other disease processes like diabetic retinopathy, that we use the off-label Avastin for now.

 Interview occurred in November 2021, referencing the first quarter of next year for BLA filing as first quarter 2022.

Videos

Dr Firas Rahhal discusses Outlook Therapeutics’ Phase 3 pivotal NORSE TWO trial for ONS-5010.

Intravitreal triamcinolone effectively manages DMO and increases vision, study reports

Diffractive multifocal IOL linked with progressive decline in vision in aging patients

Phase 3 NORSE TWO proves ophthalmic bevacizumab effectively treats wet macular degeneration