Eyeworld

EW MEETING REPORTER May 2014 57 T he 2014 World Ophthal- mology Congress took place from April 2–6 in Tokyo and welcomed nearly 20,000 attendees. Here is a sampling of coverage from the Congress. WOC 2014 Opening Ceremony The Opening Ceremony began with a performance that was meant to show expressions of the Japanese aesthetics of flower, bird, wind, and moon. It also featured music and dancing, as well as a visual presenta- tion of the four seasons. An opening video took atten- dees on a journey from 1978 to 2014. The last time the World Oph- thalmology Congress (WOC) took place in Japan was in 1978 in Kyoto. A special guest in attendance at this year's Opening Ceremony was Crown Prince Naruhito. Welcome remarks were given by a number of officials. More than 18,000 individu- als registered for WOC 2014, which makes it the largest WOC in history. The Crown Prince of Japan expressed that it was his privilege to attend the ceremony. Many people lose their sight because they do not have access to proper medical eye- care, he said, expressing his appreci- ation for all efforts made by those in attendance to ophthalmology. A number of doctors were honored with awards and lectures. The Gonin Medal was given to Alice McPherson, MD. The Jules Francois Golden Medal was given to Peter Watson, FRCS, FRCOphth. The International Duke Elder Medal was given to Richard Abbott, MD. The ICO Ophthalmic Pathology Award was given to Mark Tso, MD. The Mark Tso Golden Apple Award was given to Charles McGhee, MD. The Bernardo Streiff Gold Medal was given to Bradley Straatsma, MD. The Jose Rizal Medal was given to Dennis Lam, MD. The Jose Rizal International Medal was given to David Chang, MD. Retina controversies highlight nuances of anti-VEGF treatment Age-related macular edema had traditionally been classified into dis- tinct atrophic and exudative forms, said Sebastian Wolf, MD, Switzer- land. In contrast, the new classifica- tion system acknowledges some "interaction between both forms," describing a spectrum based on findings of no apparent changes to normal aging changes, on to early, intermediate, and late AMD—the latter including neovascular changes and any geographic atrophy. Dr. Wolf delivered a talk on the "Controversies of age-related macular edema" at the Retina Subspecialty Day symposium on "Controversies in Retina." These controversies include the findings of large-scale studies that would be mentioned repeatedly by the various speakers throughout the symposium, including the ANCHOR Study, AREDS 1 and 2, and the HARBOR and MARINA trials. Among those findings is the role of vitamin and nutritional supple- mentation. According to AREDS, said Dr. Wolf, high-dose antioxi- dants and zinc supplementation have beneficial effects in the development of neovascular AMD, although not for central geographic atrophy. However, somewhat surprisingly, he said, omega-3 fatty acids had no beneficial effects. Dr. Wolf spoke extensively about treatment with VEGF inhibi- tion, focusing on the differences be- tween fixed (monthly or bimonthly) and flexible (PRN) dosing. MARINA and ANCHOR, he said, showed "very good results with fixed" monthly dosing; results from studies such as PIER that used quarterly dosing were "not as good." Meanwhile, the PRN treatment scheme—while perhaps preferable economically and in terms of pa- tient comfort and reducing potential treatment-related complications— given after a period of fixed treat- ment, showed a decrease in effect after an initial peak achieved during the fixed treatment period, with an outcome dependent on retreatment criteria. Dr. Wolf went on to describe a middle ground between the two schemes: the treat and extend approach, in which the treatment interval between injections is extended by 2 weeks after each subsequent dose, also in response to visual acuity and OCT findings. Studies show that this approach provides results similar to those seen in the MARINA trial—at least to a maximum follow-up of 16 weeks. Anti-VEGF treatment is "a whole different ballgame" when it comes to diabetic macular edema (DME), said Susan B. Bressler, MD, U.S., speaking at the same sympo- sium. Specifically, for DME, a PRN regimen is preferred over fixed regular dosing. In addition to the findings of studies such as RESTORE, REVEAL, RIDE, and RISE, Dr. Bressler dis- cussed the results of the DRCR.net study, which compared sham with photocoagulation against ranibizumab with prompt laser photocoagulation, ranibizumab with deferred laser photocoagula- tion, and triamcinolone with laser photocoagulation. The DRCR.net study used a fairly complex protocol that begins with monthly assessments, with clinical decisions based on OCT findings and visual acuity—essen- tially a PRN regimen based on VA and OCT findings. The outcomes between ranibizumab with prompt laser photocoagulation and ranibizumab with deferred laser photocoagula- tion, while initially similar, begin to diverge at 2 years, with a significant advantage for ranibizumab with deferred laser photocoagulation at 3 years. However, both regimens were superior to sham with laser Reporting live from the 2014 World Ophthalmology Congress, Tokyo Reporting live from WOC2014 Tokyo, Japan continued on page 58 Supported by Carl Zeiss Meditec AG

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