ASRS abroad: Retina specialists converge in Sweden

Attendees are welcomed to Stockholmsmässan Convention Centre. (Image courtesy of Sydney Crago)

This year, the 42nd annual meeting of the American Society of Retina Specialists (ASRS) convened in Stockholm, Sweden, at the Stockholmsmässan Convention Centre. From 17 to 20 July, retina specialists gathered in the capital city to attend scientific sessions, visit industry exhibitions and enjoy long hours of sunlight during conference breaks.

Both prior to and during the meeting, members of the Ophthalmology Times Europe, Ophthalmology Times and Modern Retina teams interviewed retina specialists who presented data and spoke on panels. Theodore Leng, MD, MS, presented on the FARETINA-DME study, which examines faricimab use in patients with diabetic macular oedema (DME). “Faricimab has been out since January of 2020 in the United States, and shortly thereafter in the UK,” Dr Leng said. “What we want to do is look at the real-world evidence behind the use of faricimab in [patients with diabetic macular oedema].”

The FARETINA-DME study used data from the American Academy of Ophthalmology’s IRIS Registry, which includes over 540 million de-identified patient encounters. Dr Leng’s team focused on a 12-month follow up study of 71,000 eyes treated with faricimab from 2022 to 2023. “In this study, 61% of the previously treated eyes were switched from aflibercept,” Dr Leng explained. “In the treatment-naive eyes, on average, in the first 6 months after switching, they got about 3.5 injections, and in the second 6 months, it went down to about two injections. So there was [an] extension that happened after the first 6 months. And in previously treated eyes, which was a majority of the eyes, they had about four injections in the first 6 months on average….and in the second 6 months, it went down to about 2.5 injections. So that did confirm our findings that we anticipated.”

Dr Leng also highlighted an interesting finding from one subgroup in the study. “We did see, specifically with the anatomic data, we had OCT [optical coherence tomography] data available for a subset of these eyes, and in both the treatment-naive and in the previously treated eyes, the mean central subfield thickness (CST) improved by about 30 µm in both sets of eyes. Even in previously treated eyes, which most likely were getting regular treatments with other anti-VEGF agents, once they switched to faricimab, the eyes improved anatomically.”

John T. Thompson, MD, a retina specialist in Baltimore, Maryland, spoke about his presentation, “Long-Term Results of Macular Hole Surgery With Long-Acting Gas Tamponade and Internal Limiting Membrane Peeling.” Examining the long-term results, Dr Thompson said, illustrated how this approach to macular hole repair can eliminate the need for “rescue” procedures such as autologous retinal transplant or embryonic membrane transplant. The study focused on use ofindocyanine green (ICG) to peel ILM internal lining membrane (ILM) with use of a long-acting gas bubble in the treatment of macular holes.

Among a cohort of 250 patients, approximately one-third (83 patients) were followed for at least 5 years. “Initially, in this group of 83 eyes, all of the holes were closed at 3 months primarily. However, there were two eyes that developed late reopening of the macular hole between 6 and 7 years,” Dr Thompson said. “The overall one-surgery success rate for the eyes followed [for] 5 or more years was 98%.”

The visual results were also favorable, Dr Thompson noted, with 52% of eyes achieving a visual acuity of 20/40 or better at the final exam. “To look at it a different way, the average visual acuity improved from 20/100 preoperatively to 20/50 at the final exam. The results were similar at the 1– and 2–year exams. So these visual acuity improvements are maintained,” he said. Complications, including tears and peripheral detachments, did not impact the macula.

Geographic atrophy findings

Eleonora Lad, MD, PhD, vice chair of ophthalmology clinical research at Duke University in North Carolina, spoke about her presentation, “Multiwavelength photobiomodulation significantly reduces risk for vision loss and onset of geographic atrophy [GA] in dry age-related macular degeneration [AMD],” which focused on results of the LIGHTSITE III study (NCT04065490). The study was conducted at 10 retina centres throughout the US. The patients enrolled had high-risk intermediate AMD; 100 participants (148 eyes) were enrolled and randomly assigned photobiomodulation to sham 2:1. “The way photobiomodulation works clinically, is that it improves cellular processes by acting of the cytochrome c oxidase in the mitochondria at the electron transport chain level,” Prof Lad explained. “The three wavelengths are selected to improve the processes involved in the pathobiology of age-related macular degeneration, mainly to improve energy production in the cells, nutrients, and oxygenation, and decrease inflammation.”

The study met its primary end point, with an improvement in best corrected visual acuity of over five letters. “Over 58% of participants had more than five letters' improvement, but closer to 10 letters. And over 18% of patients had more than a 10-letter gain, with a mean of 13.4.,” she said.

But even more importantly, the occurrence of new-onset GA was decreased significantly, she continued. “Whereas the sham group developed GA in about 24% of the eyes, in the photobiomodulation treated group, this only happened in 6.8% of the eyes. This is the first time we see clinically meaningful effects in dry AMD in ophthalmology that are important to us as a community—This is the first to-date devised study that was able to improve visual acuity of over five letters mean, and again, over 10 letters in more than 18% of the patients enrolled.”

The Eye Care Network also learned about selected results from the phase 2/3 SIGLEC trial (NCT05839041) assessing AVD-104 for GA from Rishi P. Singh, MD, vice president and Chief Medical Officer of Cleveland Clinic Martin North and South Hospitals in Cleveland, Ohio. Dr Singh described the novel drug, AVD-104 (Aviceda Therapeutics) and findings from part 1 of the SIGLEC trial.

“This is a dual mechanism action for macular degeneration, in particular, looking at geographic atrophy. We’ve been very blessed to have two of the newer therapies for GA, now focused on activation of complement or O-activation of complement [and] how we can inhibit activation of the complement proteins by inhibiting both C-3 and C-5. This takes a different approach,” Dr Singh said. “This AVD-104 drug takes a very different approach by essentially working on both the cellular and humoral responses.” The study data demonstrated a favorable safety profile, with no significant adverse effects in regard to vascular occlusion or inflammation.

What Dr Singh called “the most remarkable finding in the entirety of the study” was an anomaly among other trials of GA therapeutics, he said. “As the amount of dosing went up in the study, there was improvement in visual acuity, which is the first time we’ve actually seen this, and it should be interpreted with some caution,” he noted. In most cases, patients with GA can hope to slow the progress of the disease and subsequent vision loss. As such, restoring visual acuity is an anomaly. Dr Singh theorised that the novel agent may be affecting cells in the “junctional zone” between the GA lesion and the healthy retinal tissue. “Potentially, what we’re seeing [is that] we’re rescuing the cells that aren’t totally dead, and that might enable functional improvement and structural stabilisation,” he explained.

The Closing Reception was held at the Vasa Museum, home to a 17th-century warship.(Image courtesy of Sydney Crago)

Congress focus: Sustainability

Along with the clinical topics that are a centrepiece for the meeting, the ASRS Congress featured expert panels on pertinent topics. Martin Zinkernagel, MD, PhD, is chair of the Department of Ophthalmology at University Hospital of Bern, Switzerland; he is a EURETINA board member and editor in chief of Ophthalmologica, the official EURETINA journal. At the ASRS meeting, he served on an expert panel discussing sustainability alongside Jacob Grodsky, MD; David Anderson, MD; Scott M. McClintic, MD; Jens Kiilgaard, MD, PhD; and panel organiser Professor Geoffrey Emerson, MD, PhD.

Prof Zinkernagel spoke about the importance of institutional sustainability initiatives. “It doesn’t have to impact your practice,” he said. “The first step is to be aware, to look at your setup, at your consumables—You can get rid of quite a lot of these consumables already without really influencing the workflow you have. You can save money, you can save time, you can save waste.”

He also spoke about including trainees in decision-making
processes around sustainable decision-making. “It’s really important, especially in a university clinic, [to have] regular sessions in the morning to talk about carbon reduction in ophthalmology and retina,” he advised. Because younger practitioners have grown up with sustainability at the forefront of culture, they offer a valuable perspective. “Ask them, 'Where do you think we can save waste in our clinical everyday practice?' Often, the young [trainees] already have thoughts and they give great input, so you can really work on this together.”