Eyeworld

EW MEETING REPORTER 64 June 2011 This year's conference boasted more than 5,000 presentations and posters T he annual Association for Research in Vision and Ophthalmology meeting was highlighted this year by an in-depth discussion of the recent Comparison of Age-Re- lated Macular Degeneration Treat- ment Trials (CATT) 1-year results. Study co-chair Daniel F. Martin, M.D., Cole Eye Institute, Cleveland, stressed that although the study was fully funded by the National Eye In- stitute, drug costs were not consid- ered. "When we submitted the proto- col, Lucentis (ranibizumab, Genen- tech, South San Francisco, Calif.) had not even been approved, so we could not know what the pricing strategy was going to be," he said to a standing-room only crowd of more than 1,500. Because a loss or gain of a single letter was not deemed clinically rele- vant, the CATT group eventually set- tled on five letter gains/losses as being statistically and clinically sig- nificant (one line gain/loss), said co- chair Maureen Maguire, Ph.D., Scheie Eye Institute, Philadelphia. Given monthly, Avastin (beva- cizumab, Genentech) used off-label helped patients gain 8.0 letters, while Lucentis helped them gain 8.5 letters. When dosed on a PRN sched- ule, Avastin showed a 5.9 letter gain and Lucentis a 6.8 letter gain. Avastin dosed monthly was equiva- lent to Lucentis dosed PRN, Lucentis dosed monthly was equivalent to Lucentis dosed PRN, Dr. Martin said, but neither Avastin nor Lucentis dosed monthly were equivalent to Avastin dosed PRN. "Those latter results did not show non-inferiority," Dr. Martin said. "What we can say is that the findings are inconclusive at this time." As-needed dosing resulted in about four fewer injections during the first year than in the monthly group, but he added vigilance by study centers to ensure subject com- pliance may not be as easy to ac- complish in real-world settings where patients have to pay for treat- ment. The CATT study enrolled 1,208 patients across 44 centers; 23 pa- tients and one center were excluded from study results because of proto- col breach, Dr. Maguire said. Glaucoma Phase III data showed once-daily tafluprost as comparable to twice- daily timolol in 643 patients with open-angle glaucoma or ocular hy- pertension. Baseline IOPs ranged from 23.8-26.1 mm Hg in patients treated with tafluprost and 23.5-26.0 mm Hg in those treated with timo- lol. At the 12-week end of the study visit, IOPs ranged from 17.4-18.6 mm Hg in the tafluprost group and 17.9-18.5 mm Hg in the timolol group. Treatment effects were seen as early as week 2. A literature review compared the newer diagnostic imaging tools (optical coherence tomography [OCT, Carl Zeiss Meditec, Dublin, Calif.], Heidelberg Retina Tomo- graph [HRT, Heidelberg Engineering, Carlsbad, Calif.], and glaucoma diag- nosis [GDx, Carl Zeiss Meditec)] to white-on-white perimetry in their ability to detect glaucoma. Presen- ters with the Ivey Eye Institute, Lon- don, Ontario, said the data "favors GDx and OCT over HRT for diagnos- tic accuracy in glaucoma compared to a gold standard of white-on-white visual field." The greatest accuracy, however, was with blue-on-yellow perimetry, said Francie F. Si, M.D. Clear lens extraction is more ef- fective than laser peripheral irido- tomy (LPI) as a first-line treatment for angle-closure glaucoma, accord- ing to Qi N. Cui, Ph.D., University of Rochester, N.Y., and colleagues. Provided the probability of a tra- beculectomy following LPI exceeds approximately 6.4%, clear lens ex- traction yields fewer severe adverse outcomes (i.e., endophthalmitis) over 5 years. The incremental cost effectiveness ratio of LPI as opposed to lens extraction suggests an incre- mental cost effectiveness ratio of over $5 million per additional qual- ity-adjusted life years saved, she said. Ocular surface and cornea The average endothelial cell loss fol- lowing Descemet's stripping auto- mated endothelial keratoplasty in patients with Fuchs' endothelial dys- trophy "remains relatively stable up to 2 years post-operatively," accord- ing to a poster from Jennifer Y. Li, M.D., Devers Eye Institute, Portland, Ore. After the second year, there is a "gradual decline" in endothelial cell loss through year 4. In a Phase II dry eye trial, sub- jects receiving SAR 1118 (SARCode, Brisbane, Calif.) demonstrated a re- duction in corneal staining, in- creased tear production, and improved visual-related function as compared to placebo, according to the company. SAR 1118 is a first-in- class, topically administered small molecule integrin antagonist that in- hibits T-cell mediated inflammation. In the randomized, placebo-con- trolled, multicenter trial, which in- cluded 230 subjects with dry eye, SAR 1118 demonstrated dose-depen- dent significant improvements (P<.05) in inferior corneal staining over 12 weeks. Refractive and cataract The occurrence of rhegmatogenous retinal detachment (RRD) after LASIK surgery for the correction of myopia is infrequent (0.19%), ac- cording to J. Fernando Arevalo, Clin- ica Oftal Centro Caracas, Venezuela, and colleagues. They retrospectively analyzed charts of 22,296 myopic eyes post-LASIK. Only 22 eyes (19 patients) developed retinal detach- ment, between 1 month and 13 years after LASIK. Those with RRD had baseline myopia from –1.5 D to –9.75 D. Zinc found in the lenses of pa- tients with Alzheimer's and Down syndrome supports the theory that Alzheimer's is a systemic disorder. Accumulation of amyloid-β in the brain is a principal feature of Alzheimer's disease and Down syndrome. In this study, Lee E. Goldstein, M.D., Boston University, and colleagues analyzed human Alzheimer's and Down syndrome lenses and identified co-localized zinc and amyloid-β in the same cy- tosolic compartments of lens fiber cells. The researchers said these data are the first to establish an Alzheimer's-linked amyloid pathol- ogy outside the brain and may ultimately "pave the way for devel- opment of novel ophthalmic tech- nology for early Alzheimer's detection and diagnosis." by Michelle Dalton EyeWorld Contributing Editor Highlights from ARVO 2011 Retina A total of 6,734 individuals undergo- ing anti-vascular endothelial growth factor (VEGF) treatment for neovas- cular age-related macular degenera- tion (AMD) were compared with the same number of individuals with neovascular AMD who did not un- dergo anti-VEGF treatment. The anti-VEGF group had an 87.9% higher risk of severe ocular compli- cations overall and 2.6% increased risk per injection, said Shelley Day, M.D., Duke University, Durham, N.C. There were 38 cases of endoph- thalmitis in the anti-VEGF group compared with six in the control group; similarly, twice as many peo- ple in the anti-VEGF group had a vitreous hemorrhage (1.8%) com- pared to the control group (0.94%). "Individuals with anti-VEGF in- jections had twice the risk of serious ocular complications, and a diagnosis of proliferative diabetic retinopathy doubled the risk of com- plications," she said. "A previous history of glaucoma surgery in- creased the risk by 70%." The group defined glaucoma surgery as uncom- plicated trabeculectomy or tube im- plants. Population-based studies The duration of diabetes and poor glycemic and blood pressure control are strongly associated with a higher prevalence in diabetic retinopathy, proliferative diabetic retinopathy, diabetic macular edema, and vision- threatening diabetic retinopathy, highlighting the "substantial public health impact of diabetes." The re- sults are based on a population- based study of pooled data from general and diabetic populations in the United States, Australia, Europe, and Asia. A longitudinal study funded by the National Institutes of Health (NIH) suggested the ability to read, recognize faces, or find a street sign will deteriorate significantly over time for adults with age-related geo- graphic atrophy of the macula (GA). A questionnaire was completed at baseline and annually by subjects enrolled in the NIH-funded prospec- tive natural history study of geo- graphic atrophy from AMD from 1992-2000. The reports showed that subjects' difficulty in reading, hazi-

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