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AAO recap: Clinical trial updates, new innovations presented at America's biggest ophthalmic conference

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A combination of posters, podium presentations and instructional courses provided invaluable revelations to the ophthalmic community.

The 2022 American Academy of Ophthalmology (AAO) Annual Meeting took place in Chicago, Illinois, US, from September 30-October 3. A combination of posters, podium presentations and instructional courses provided invaluable revelations to the ophthalmic community.

Paediatrics

Higher incidence of new strabismus in paediatric patients following tube shunt surgery

Dr Maria A. Guzman Aparicio and Dr Teresa C. Chen, from Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, United States, found that paediatric patients have a significantly higher incidence of new-onset strabismus after tube shunt surgery for glaucoma compared with adults.

According to past literature, adults who undergo Ahmed (New World Medical) and Baerveldt (Abbott Medical Optics) tube shunt surgeries have postoperative strabismus 2% to 12.7% of the time after 1 to 5 years; in children, the percentages range from 3% to 4.2% with Ahmed valve surgery after 16 to 24 months of follow-up.

In their current study with longer follow-up periods, Drs Guzman Aparicio and Chen sought to compare the frequency of strabismus after tube shunt surgery in the adult versus paediatric populations and to identify risk factors for strabismus after tube shunt surgery.

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Younger patients often require repeat corneal crosslinking, study finds

At the 2022 American Academy of Ophthalmology meeting, Dr Philip Dockery, MPH, presents, "Effectiveness of corneal crosslinking in young patients."

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Comparing dry eye disease in adult and paediatric populations via the IRIS Registry

A study of dry eye disease (DED) in children found that the average age of onset of DED is at 12.51 years compared with the average of 61.06 years in adults. The highest prevalence in children was seen between 12 to 15 years of age, according to lead author Dr Vivian Paraskevi Douglas, DVM, MBA, MSc, and colleagues from Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, United States.

Although DED is highly prevalent in adults, with rates ranging from 5% to 50%, little is known about the disorder in paediatric patients, which sparked the interest in this study.

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Retina

Pooled TENAYA, LUCERNE Phase 3 data reports safety, efficacy, lower treatment burden with faricimab for nAMD

The 2-year results of the TENAYA and LUCERNE studies indicated that faricimab (Vabysmo, Genentech), the first intraocular bispecific antibody that inhibits both angiopoietin-2 and vascular endothelial growth factor-A was safe and efficacious for treating neovascular age-related macular degeneration (AMD).

Dr Rishi Singh, FASRS, reported the highlights of the pooled results of the trials on behalf of the study investigators.

TENAYA and LUCERNE were Phase 3 global, randomized, double-masked 112-week trials designed to assess the efficacy, safety and durability of faricimab in treatment-naïve patients with neovascular AMD.

At week 60, patients in the faricimab arm were treated according to a protocol-driven treat-and-extend–based regimen.

Dr Singh reported that, compared with baseline, gains in vision and decreased central subfield thicknesses following treatment with faricimab out to every-16-week dosing were similar to those achieved with aflibercept (Eylea, Regeneron) with every-8-week dosing with fewer injections, through week 112.

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Fluid dynamics in wet macular degeneration: How fluid type affects visual acuity

At AAO 2022, Dr Justis Ehlers presented a talk entitled, "Defining the Fluid Problem in Neovascular AMD: To Dry or Not to Dry?"

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Retinal detachment rates following acute retinal necrosis are unaffected by early treatment with antivirals, vitrectomy

Dr Ines Lains, PhD, and colleagues from the Massachusetts Eye and Ear, Harvard Medical School, Boston, reported that adjunct treatment with intravitreal antivirals or early pars plana vitrectomy (PPV) did not improve the rates of retinal detachment (RD) in patients with acute retinal necrosis (ARN).

ARN is rare but can have devastating visual consequences, Dr Lains explained. Over time, patients with ARN have a high risk of developing retinal traction and necrotic retinal breaks, which can lead to the development of a RD.

“RD is one of the most common consequences of ARN,” she said. Systemic antivirals are the mainstay treatment for ARN, and even though clinicians may empirically add intravitreal antivirals or early PPV, data on this topic remains controversial.

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Risk factors for developing rhegmatogenous retinal detachments in fellow eyes identified in study

William Kearney, MS, Dan Gong, MD, and colleagues from Massachusetts Eye and Ear, Harvard Medical School, Boston, identified risk factors for the development of rhegmatogenous retinal detachments (RRDs) in the fellow eye of patients who developed an RRD in one eye.

RRDs are sight-threatening conditions associated with potential morbidity, and patients with a unilateral retinal detachment frequently ask about the risk of developing an RRD in their fellow eye.

The investigators pointed out that this question is clinically relevant for identifying fellow eyes with an increased risk of developing an RRD and may help improve the ability to diagnose RRDs earlier. “This early diagnosis is essential since early repair increases the success rate of retinal reattachment surgery and improves visual outcomes,” Kearney said.

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No negative effects in DMO patients reported following pandemic-imposed health care restrictions

Bryce Johnson, BS, and associates from the Department of Ophthalmology, University of Texas Southwestern Medical Centre, Dallas, found that to their surprise diabetic macular oedema (DMO), a leading cause of vision loss, was not negatively impacted by the changes imposed by the COVID-19 pandemic.

Because a healthy lifestyle is key to prevention of progression of DMO, they conducted a retrospective chart review to assess the impact of truncated medical services during the pandemic.

The study includes 570 patients who had been diagnosed with DMO between January 2019 and July 2021.

The parameters studied were haemoglobin A1c, body mass index, adherence to scheduled appointments, and need for therapy.

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Glaucoma

Is the robot-assisted procedure the future of MIGS?

Investigators from the Icahn School of Medicine at Mount Sinai, New York, United States, reported that robot-assisted microinterventional glaucoma surgery (MIGS) has potential for interventions in the anterior segment, according to Dr Gautam Kamthan, Assistant Director of Ophthalmic Innovation and Technology at New York Eye and Ear Infirmary of Mount Sinai. They reported the first such feasibility of robot-assisted ophthalmic gonio-surgery.

Dr Kamthan and co-investigators studied the potential for use of this approach by comparing robotic interventions preclinically to the standard manual approach in synthetic eye models for MIGS. Three robotic systems have been developed by theNew York Eye and Ear Robotics Program: the µ-RoboticGonio Surgery System, the T-Rexµ-RoboticFlexible Goniotomy and iStentµ-Robotic Implantation System.

A comparison of the surgical precision between manual and surgical procedures speaks to the rationale for robotic-assisted procedure. Manual procedures are characterized by 100-µm tremor peak-to-peak vector magnitude, 500 to 1,000-mN human finger force sensing resolution and 182-µm root mean square tremor amplitude with manual vitreoretinal surgery, Dr Kamthan explained.

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Cataract & Refractive

Investigators report positive visual outcomes one year after monocular implantation of small aperture IOL

Dr Mark H. Blecher dives into his AAO 2022 topic: "One-Year Visual Outcomes Following Monocular Implantation with a Small Aperture IOL."

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Cornea

Utilising AAO cornea preferred practice patterns for corneal oedema, opacifications, ectasia and bacterial keratits

David Hutton discusses the AAO 2022 talk, "Corneal Oedema, Opacifications, Ectasia, and Bacterial Keratitis: Diagnosis and Treatment Strategies from the Preferred Practice Pattern Guidelines," with presenter Dr Francis S. Mah.

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Increased smoking-related ocular symptoms linked to cigarettes than electronic cigarettes

Investigators from McGill University, Quebec, Canada, and Stanford University, Palo Alto, California, United States, reported that young smokers had more ocular symptoms resulting from cigarette smoking than those who smoked electronic cigarettes. However, those who used both reported severe to very severe ophthalmic symptoms, according to Anne Xuan-Lan Nguyen from McGill University, Quebec, Canada, first author of the study.

The investigators conducted an observational, cross-sectional online survey to determine the frequency and severity of ocular symptoms in young e-cigarette and cigarette users.

A total of 4,351 Americans aged 13 to 24 years responded to the survey questions regarding the use or non-use of nicotine e-cigarettes and cigarettes and the use during the previous 7 and 30 days.

Dual users were defined as those who used both products. The outcomes included the general vision status and frequency and severity of ocular symptoms that included ocular discomfort, pain, burning, itching, redness, dryness, glare, blurry vision, eye strain, and headaches.

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