Retina

I have been disappointed by the outcomes of anti-VEGF monotherapy. I feel that far too many retreatments are required with no clear specified endpoint

Its almost time to close the door on 2006 and welcome another new year. But, before we do that we wanted to take you on a journey through the highs and lows of the past twelve months by reflecting on some of the most significant events to shape your industry this year.

TargeGen has initiated a phase I trial of TG100801, a small molecule, topically applied multi-targeted kinase inhibitor for the treatment of age-related macular degeneration (AMD) and other degenerative eye diseases.

Pseudoxanthoma elasticum (PXE) is an inherited metabolic disease with many systemic manifestations. Although the skin changes are striking, the eye and cardiovascular lesions can be most devastating to the patient.

Retinal venous occlusions (RVO) are the most common visually disabling retinopathy after diabetes and age-related macular disease.1 The pathogenesis of RVO is multifactorial with both local factors and systemic diseases being etiologically important. It is essential that each individual contributing mechanism is established so that a beneficial treatment protocol can be developed to treat this debilitating condition.

Diabetes Mellitus (DM) is a chronic disorder of metabolism in which a defective or deficient insulin secretory response results in impaired glucose utilization and subsequent hyperglycaemia.

Last year, Philip Rosenfeld of the Bascom Palmer Eye Institute in Miami, USA, announced some findings that made the ophthalmology community stand to attention. He claimed that intravitreal administration of the cancer agent, Avastin (bevacizumab), in wet age-related macular degeneration (AMD) patients yielded very positive results. Since then, industry journals have been inundated with reports of the benefits of this agent in an ophthalmic setting.

The high incidence of neurodegenerative retinal diseases that lead to visual impairment and blindness has given rise to new technological and biological advances in the field of ophthalmology. Electronic retinal prostheses are among the most eagerly anticipated, yet complex devices to be developed. The expertise of retinal specialists, surgeons and engineers has been combined to thoroughly research the effect of electrical stimulation on retinal neurons, to develop micro-electronic chips, investigate new encapsulation methods that are bio-compatible and to develop methods of powering the subretinal devices.

Many ophthalmic disorders give rise to neovascularization of the iris and neovascular glaucoma. Almost all of these disorders are characterized by retinal hypoxia and retinal capillary nonperfusion, the same factors involved in the development of retinal neovascularization. One of the most common causes is central retinal vein occlusion (CRVO), which is a visually disabling disease that is second in prevalence only to diabetic retinopathy.

Cataract surgery and AMD: there?s no link

Until recently, treatment options for neovascular (wet) AMD have been limited. Thermal laser photocoagulation - a destructive mode of therapy - was indicated in a minority of neovascular cases, including extrafoveal and some cases of juxtafoveal choroidal neovascularization (CNV). Photodynamic therapy with verteporfin (PDT) marked a new era in the treatment of exudative AMD, since subfoveal lesions were no longer excluded from treatment. However, it remains that not all lesions are eligible for treatment and the beneficial effect of PDT has only been clearly evident in predominantly classic lesions.

Age-related macular degeneration (AMD) is the worldwide leading cause of blindness. The severe form, choroidal neovascularisation (CNV), faces revolutionary times as new treatment modalities are introduced. Whereas one decade ago argon laser coagulation represented the standard treatment method, nowadays different treatments come into our clinical setting: classic CNV responds well to photodynamic therapy (PDT) with "off label" triamcinolone, and now occult CNV can be successfully treated with an array of treatment modalities: PDT, transpupillary thermotherapy (TTT), subretinal surgery, macular translocation, or anti-angiogenic therapy.

What tasks are more important for the ophthalmologist than dealing with a disease that is the second most common cause of blindness overall and the number one blinding disease in the working population?

Research, development, innovation and the quest for excellence go hand in hand with the evolution of the ophthalmology industry. With the new wave of phakic IOLs entering the market, each with its own unique offering and capabilities, it's hard to know which lenses will suit you and your patient best. Furthermore, does the introduction of these new refractive correctors threaten the position of the lasers that we have all come to grow to love? It seems that the laser refractive surgery industry is still going from strength to strength.

A high dietary intake of vitamin E and zinc reduced the risk of AMD.

We need stronger evidence to support the combination of PDT with anti-VEGF therapy or corticosteroids before combination therapy becomes standard care for many of these lesions.

In an exciting time for the treatment of patients with exudative age-related macular degeneration, several new pharmaceutical options are being tested. Most compounds target vascular endothelial growth factor (VEGF), which is implicated in the proliferation of choroidal neovascularization. However, the effects of VEGF can be blocked at different levels.

Meticulous wound closure is key to success with this implant, as well as patients having realistic expectations about visual acuity outcomes after implantation

Use of intravitreal triamcinolone acetonide (IVTA) has increased significantly over the past four years as a consequence of successful reporting of the agent's efficacy in the treatment of cystoid macular oedema resulting from uveitis, birdshot retinochoroidopathy, central retinal vein occlusion and diabetic macular oedema.1-6

The role of vitrectomy must be defined and compared with intravitreal triamcinolone and laser treatment, but vitrectomy may provide a more permanent solution for some eyes

In my hands, 23-gauge vitrectomy is the one procedure for 99% of my cases

In the new treatment era for exudative age-related macular degeneration (AMD) heralded by the availability of locally administered anti-VEGF drugs, intravitreal monotherapy with triamcinolone injection may no longer be considered as a current therapy for this neovascular condition, said Jost Jonas, MD, at the World Ophthalmology Congress.

Age-related macular degeneration (AMD) is a common cause of vision loss worldwide, particularly in industrialized nations, where it is the main cause of blindness among people of 65 and older, explained Paul Mitchell, MD, at the World Ophthalmology Congress.

Novartis Ophthalmics' and Genentech's investigational treatment for AMD has again delighted its developers by meeting its one-year primary efficacy endpoint of maintaining vision in patients with wet AMD during the first year of the two-year ANCHOR study.

The 2005 annual meeting of the American Academy of Ophthalmology (AAO) saw the event record the third highest attendance figures in its history.

Despite recent advances and the promise of new therapies for the treatment of choroidal neovascularization (CNV) resulting from age-related macular degeneration (wet AMD), key challenges remain. These include improving vision outcomes, reducing the numbers of treatments and proving efficacy in different lesion types. While treatment for wet AMD has traditionally centred on monotherapy regimens, the future standard of care may likely focus on combination strategies.

Combination treatment of neovascular age-related macular degeneration (AMD) using verteporfin photodynamic therapy (Visudyne PDT, Novartis/QLT Inc.) plus intravitreal triamcinolone acetonide appears to improve visual outcomes and reduce the number of re-treatments necessary to achieve lesion regression compared with standard PDT alone, albeit with the recognized steroid-associated risks of cataract progression and IOP elevation, said Albert J. Augustin, MD, at the annual meeting of the American Society of Retina Specialists.

"Smoking increases your risk of developing blindness" is the shocking message being transmitted across the UK in a bid to raise awareness.

Investigators caused a stir at the 23rd Annual Meeting of the American Society of Retina Specialists (ASRS) in Montreal, Canada, when they hinted at a potential use of bevacizumab (Avastin) in neovascular age-related macular degeneration (neovascular AMD).