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54 EW MEETING REPORTER Reporting from the 2013 Association for Research in Vision and Ophthalmology meeting, Seattle July 2013 ARVO 2013: AREDS, IVAN, and more by Michelle Dalton EyeWorld Contributing Writer Most of the attention was on posterior segment, but plenty of anterior segment news was released T his year's Association for Research in Vision and Ophthalmology (ARVO) meeting was the site of two major announcements: results from the second Age-Related Eye Disease Study (AREDS2) and second year results from the Alternative treatments to Inhibit VEGF in Agerelated choroidal Neovascularization (IVAN). In all, 11,500 attendees had the opportunity to review hundreds of posters and presentations over the course of the five-day meeting. Here are a few of the highlights. AREDS 2: Drop omega-3s, beta carotene Adding the carotenoids lutein and zeaxanthin, the omega-3 fatty acids DHA and EPA, or both to a formulation of antioxidant vitamins and minerals that has shown effectiveness in reducing risk did not further reduce risk of progression to advanced age-related macular degeneration (AMD), the National Eye Institute study found. "Oral supplementation with the Age-Related Eye Disease Study (AREDS) formulation (antioxidant vitamins C, E, and beta carotene and zinc) has been shown to reduce the risk of progression to advanced AMD," said Emily Y. Chew, MD, Bethesda, Md., and colleagues in a study released during the conference. "Observational data suggest that increased dietary intake of lutein and zeaxanthin, omega-3 long-chain polyunsaturated fatty acids (docosahexaenoic acid [DHA] and eicosapentaenoic acid [EPA]), or both might further reduce this risk." The Age-Related Eye Disease Study 2 (AREDS2) Research Group examined whether adding lutein + Editors' note: Dr. Chew is on staff at the National Eye Institute. toring in Ocular MicRorganisms (ARMOR) study. The 2012 data set included 456 isolates of Streptococcus pneumoniae, Staphylococcus aureus, coagulase-negative staphylococci (CoNS), Pseudomonas aeruginosa, and Haemophilus influenzae from 25 sites across the United States. Study authors reported that resistance rates have remained relatively stable over the four-year period, with the new data reducing some of the fluctuation seen in previous years. However, a number of bacterial isolates demonstrated resistance to many commonly used antibiotics. For example, more than 33% of S. aureus and CoNS isolates were resistant to three or more antibiotics, especially MRSA and methicillin-resistant CoNS isolates that were multi-drug resistant more than 73% of the time. In a second study, investigators compared the prevalence and distribution of ocular pathogens in recent (2009-2011) bacterial conjunctivitis clinical trials to earlier studies (20042007). A total of 2,348 isolates were recovered from 3,379 patients enrolled in five multicenter, randomized, double-masked clinical studies evaluating Besivance (besifloxacin ophthalmic suspension, Bausch + Lomb) 0.6%, of which 1,324 isolates were from the earlier period and 1,024 isolates from the later. All isolates were evaluated for baseline frequency, microbial eradication, and antimicrobial susceptibility profiles. While the five most frequently isolated bacterial species remained the predominant conjunctivitis pathogens across all five trials, the researchers identified 15 uncommon pathogens in the more recent set of studies. ARMOR declares resistance rates remain stable IVAN: Lucentis, Avastin essentially identical Bausch + Lomb (Rochester, N.Y.) reported on the fourth year results from its Antibiotic Resistance Moni- The two-year results of the Alternative treatments to Inhibit VEGF in zeaxanthin, DHA + EPA, or both to the AREDS formulation might further reduce the risk of progression to advanced AMD. A secondary goal was to evaluate the effect of eliminating beta carotene, lowering zinc doses, or both in the AREDS formulation. AREDS2, a multicenter, randomized phase 3 study was conducted in 2006-2012, enrolling 4,203 participants 50 to 85 years of age at risk for progression to advanced AMD with bilateral large drusen (tiny yellow or white deposits in the retina of the eye or on the optic nerve head) or large drusen in one eye and advanced AMD in the fellow eye. "There was no apparent effect of beta carotene elimination or lowerdose zinc on progression to advanced AMD," Dr. Chew said. More lung cancers were noted in the beta carotene versus no beta carotene group (23 [2%] vs. 11 [0.9%]), mostly in former smokers. When the group looked at just those participants in the study who took an AREDS formulation with lutein and zeaxanthin but no beta carotene, their risk of developing advanced AMD over the five years of the study was reduced by about 18% compared with participants who took an AREDS formulation with beta carotene but no lutein or zeaxanthin. "Eliminating the beta carotene in favor of lutein/zeaxanthin gives us a formula that everyone at risk for AMD can use safely," she said, stressing she's not adverse to omega-3s, just that they do not add any additional protection. continued on page 58