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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.

Articles

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

At the Angiogenesis, Exudation and Degeneration meeting, Dr David Brown presented his talk, “CANDELA: High Dose Aflibercept for Neovascular AMD.” Dr Brown is the Director of Clinical Research at Retina Consultants of Texas.

I'm David Hutton of Ophthalmology Times, and our team is providing virtual coverage of Bascom Palmer's Angiogenesis conference held in Miami. Joining me today is Dr David Brown, Director of Research at Retina Consultants of Texas, who will discuss Phase 2 results for high dose aflibercept 8 milligram in wet AMD. Thank you for joining us today, Dr Brown. Tell us about these exciting results.

Thanks, David. This is the first presentation of the 44-week results of the CANDELA study. And if you go through time, in almost every anti-VEGF trial we've done, we've seen a dose response curve: Half milligram did better than 0.3 in ANCHOR and MARINA, bevacizumab did better than ranibizumab in CAT, higher molar blockade you saw aflibercept did better than ranibizumab and, in the head-to-head trials, more anti-VEGF blockade.

So the big question is, can we do better with a higher dose of what's currently the market leader, aflibercept?

We tested 8 milligrams versus 2 milligrams in 106 patients, 53 patients in each arm. You know, there was some question whether this would make a difference. If you look at the HARBOR data with ranibizumab. There wasn't a difference when you made it four times higher dose. This is a different molecule though aflibercept is bispecific, right? It gets placental growth factor and anti-VEGF; it's also a larger molecule than ranibizumab.

What did we find? We found that in a population that was not a strict monthly, although it wasn't what I call the criminal retreatment criteria of many of the other trials, you had physician discretion on when to treat based on fluid.

It was masked, so it's head-to-head. At every time point, there was better anatomy with 8 milligrams. In other words, you dried up more of the retina. That was statistically significant. If you looked at fluid in the entire macular scan, almost double the amount of dry patients.

And more importantly, we actually saw a visual acuity benefit with this treatment paradigm in this population. 7.9 letters gained with the 8 milligram aflibercept versus 5.7 in the 2 milligram, and these time points were pretty consistent throughout that the higher dose, dried out more retinas, and improved the visual acuity.

It certainly shows us that it's probably a better drug, especially in a population where you're not treating monthly—and that's more real world because things get in the way, right? Christmas, Hanukkah, gallbladders—you miss appointments. And so in the real world, I'm hoping we can get this molecule.

Currently, it's being tested in a Phase 3 DME and AMD. That's a little different. When you do something for registration, you'd have to go against labelling, so it's going against aflibercept load and then every eight weeks, but we'll see. We're doing extended dosing out to 16 weeks, and I think it may be a decent competitor for the new faricimab and upcoming Kodiak molecules.

You mentioned that Phase 3 trials. Really what's the next step for this?

Basically, they're fully recruited. There'll be one-year trials. You know, they'll have to do some more studies to try to get the kind of label that faricimab got, the 4-week to 16-week, but we'll see.

We were concerned about a couple of things. I'm always worried about systemic safety when you're using an anti-VEGF that strong in the eye. We didn't see anything in this trial. We had two patients with increased hypertension. Fortunately, one was 2 milligram and one was 8 milligram, and we saw one patient with mild inflammation in the 8 milligram arm.

You know, as we get bigger, we got to make sure that we're not causing inflammation like a, you know, brolucizumab was a lot of protein in a molecule; this will be certainly more protein. So they're not out of the woods, but it's a promising start.

 This transcript has been lightly edited for clarity.

Videos

At Angiogenesis, Dr David Brown presented the Phase 2 results of the CANDELA study for high dose aflibercept 8 milligram for wet AMD; here, he discusses those results.

High dose aflibercept shows improvement for wet AMD patients in CANDELA

Dr Anat Loewenstein discusses her presentation at the Angiogenesis, Exudation and Degeneration meeting. Her talk, “Detection of Diabetic Retinopathy from Ultra-Wide Field Scanning Laser Ophthalmoscope Images: A Multi-Centre Deep-Learning Analysis,” delves into how artificial intelligence can aid in patient screening. In testing, the deep learning model scored well in sensitivity, specificity and accuracy.

I'm David Hutton of Ophthalmology Times. The Bascom Palmer Eye Institute at the University of Miami is hosting its Angiogenesis, Exudation and Degeneration 2022 virtual edition. Joining me today is Anat Lowenstein, MD, who is presenting “Detection of Diabetic Retinopathy from Ultra-Wide Field Scanning Laser Ophthalmoscope Images: A Multi-Centre Deep-Learning Analysis.” Thank you for joining us today. Tell us about your presentation.

 Thank you, David. I'm very happy to tell you about my presentation on diabetic retinopathy detection from ultra-wide field scanning laser ophthalmoscope images.

So we all know that usually diabetic retinopathy screening uses a limited field of view, 45 to 50 degrees. And theoretically, ultra-wide field imaging can be an alternative to the existing model. But interpretation of these images does require expertise of human graders that are very knowledgeable in diabetic eyes.

We're suggesting models of deep learning to detect variability and assess the referral and vision-threatening diabetic retinopathy, which are important parameters that we want to use.

So in order to do that, we develop models to assess both ability to evaluate a referral diabetic retinopathy and vision-threatening one. And we use the transfer learning procedure for each such a model.

Basically, we looked at almost 10,000 images from almost 2,000 eyes with diabetes. And we had sets for training and validation, the primary set and external testing the external data sets. And when we looked at the sensitivity, specificity and accuracy, we could see that they're pretty high for the primary dataset, 86.5% 82.1% and 83.1%, respectively. So pretty high sensitivity, specificity and accuracy, which were shown by our model.

Also, we were able to show on the receiver operating curves that the performance of the deep learning is on referable diabetic retinopathy were pretty high. So pretty good results on that front as well.

And also for vision-threatening diabetic retinopathy. Again, the area under the receiver operating curve, it was able to show us the rate of accuracy pretty high with our model.

Basically, we were able to show that the diagnosis performance of the deep learning system for detecting referrable diabetic retinopathy and vision-threatening diabetic retinopathy in both primary and external validation sets were pretty high with the ratio of sensitivity, specificity and positive predictive value for both was around 90%. So pretty high and good performance.

And we will show some examples of AI with diabetic retinopathy with referral that the current neuropathy and so forth. So basically, we are able to show high performance in both variability and severity of diabetic retinopathy. And we suggested as a model to facilitate screening of patients with diabetes, for referrable and vision-threatening diabetic retinopathy.

We believe that such readability is crucial for the screening of this disease, it can identify hidden lesions and allows for objective identification of diabetic retinopathy severity.

Of course, our study has advantages and limitations. One of the advantages is that we have multiple ethnicities and geographical location.

But of course, there are also limitations such as the fact that some lesions cannot be captured by the system, maybe artifacts that do affect the prediction. And in the proliferative diabetic retinopathy primary data set, we had a limited number of images.

Of course, the fact that OCT imaging was not used to evaluate the ground truth of diabetic macular oedema is a major limitation of our trial. But I think I can conclude that the deep learning system did demonstrate their high rate of identifiable referable diabetic retinopathy cases and that the model has the potential to be implemented in clinical settings, and therefore reduce the burden of both patients and clinicians. Thank you very much, David.

This transcript has been lightly edited for clarity.

During her talk at Angiogenesis, Dr Anat Loewenstein outlines how artificial intelligence could revolutionize diabetic retinopathy screening.

Leveraging deep learning for diabetic retinopathy detection with ultra-wide field imaging

On February 11, 2022, Dr SriniVas R. Sadda presented a talk, “Choriocapillaris and Atrophy Associated with Neovascular AMD,” at the Angiogenesis, Exudation and Degeneration meeting, hosted by Bascom Palmer.

Dr Sadda is a professor of ophthalmology at the Doheny Eye Institute at UCLA.

 Dr Sadda, thank you so much for joining us. At this year's Angiogenesis meeting, you will be giving a presentation regarding choriocapillaris and atrophy associated with neovascular AMD. Could you give us a little bit more highlights of your talk?

I spoke on the relationship between the choriocapillaris and atrophy associated with wet AMD. And one of the great things in the last few years is that OCT angiography has allowed us to actually study the choriocapillaris. And we've learned a lot about the relationship between the choriocapillaris and a number of different diseases.

And my area of interest in particular has been in the topic of choriocapillaris and AMD. And we've learned, for example, that the choriocapillaris worsens as the AMD disease progress goes along. And in fact, the status of the choriocapillaris may actually predict the rate of progression of atrophy in the life.

We also observe that, for example, in patients with wet AMD, the choriocapillaris tends to be poor in the areas that develop neovascularisation. And maybe neovascularisation is developing as a compensatory response to that poorer choriocapillaris. Whereas in eyes with atrophy, the choriocapillaris is diffusely abnormal throughout the macula. And maybe that's why those eyes go on to develop atrophy, because they don't have even a good enough choriocapillaris to develop neovascularisation.

One of the things that we've also observed is that patients who have type one neovascularisation—or neovascularisation below the RPE—that such patients seem to be protected against the development of atrophy. In fact, sometimes we think about this as maybe being some type of a cure for atrophy.

And we wondered whether or not the choriocapillaris—or whether or not the development of a circulation like the choriocapillaris—may be a reason why these neovascular lesions may actually be protecting against the development of atrophy.

So most recently, we've studied the small vessel circulation that develops at the surface of these neovascular lesions, these type one lesions in particular. And what we observed was that lesions that seem to be less associated with atrophy, they tend to develop a better or more extensive small vessel circulation. Sometimes we call that the neo-choriocapillaris—whether that's the right term or not remains to be determined.

But the point is that this small vessel circulation that these membranes may be developing may be an important reason or mechanism as to why they can actually rescue the retina against atrophy.

And so if that's the case, and again, these are small studies still, and we'd like to see them replicated by other investigators as well. But if that proves to be correct, then it might be that in our future, our goal—with regards to treatments of wet AMD—may have to also consider what are we doing to the choriocapillaris, or this new small vessel circulation arising on the surface of these neovascular lesions in order to get the best long-term outcomes for our patients.

And what might be a next step in this research?

So really, the next step is replicating our findings. I'm a big believer that to really be confident in a result, you want that to be replicated by different cohorts, different studies, but also by different investigator teams. So I think that's important. I'd love to see that.

And I think the next important step for us personally in my lab is really thinking about, well, what happens to this in context of different treatments? Because I sort of suggested that this may have some implications for us and how we treat patients, and if that's the case, we need to understand the impact of, for example, different treatment strategies on the development of this neo-choriocapillaris circulation.

At Angiogenesis, Dr SriniVas R. Sadda discusses how choriocapillaris may predict the rate of progression of atrophy.

Author | OTE Staff Reports

Articles

High dose aflibercept shows improvement for wet AMD patients in CANDELA

Leveraging deep learning for diabetic retinopathy detection with ultra-wide field imaging

Exploring the link between choriocapillaris, atrophy and neovascular AMD

iScan 80 OCT to launch in UK