Eyeworld

Reporting from the 2016 ESCRS Congress, September 10–14, Copenhagen, Denmark EW MEETING REPORTER 144 permit early detection and preven- tion, could help guide research into targeted therapies, and may help to predict individual response to thera- py and allow for customized treat- ments. However, Dr. Chew noted that genetic testing of AMD should be avoided at this time. Genetic test- ing remains important in research, she said, and she hopes in the near future that genetic testing will help to predict progression of disease and to guide current and future treat- ments for AMD. Managing ocular injuries Ocular injuries—burns, foreign bodies, trauma, and more—present specific challenges for ophthalmol- ogists. Sometimes these injuries are clearly apparent, while others can present with few symptoms, requir- ing more investigation. Many chemical agents can cre- ate burns on the eye, as can thermal sources, said Per Fagerholm, MD, Stockholm, Sweden. According to published data, patients with these burns are most likely to be young- er males, and most incidents are work-related. "The most important prognos- tic factor is immediate rinsing," Dr. Fagerholm said. After exposure, immediate rinsing with tap water is recom- mended. Once in professional care, Dr. Fagerholm said 5 minutes of rinsing with an amphoteric buffer solution helps neutralize the pH in the eye. Debris should be removed and the eye should be rinsed every half hour for 4 hours with balanced salt solution/Ringer's lactate, then each hour for the next 24 hours. Surgical treatment could consist of debridement of necrotic tissue. Dr. Fagerholm said he would consid- er tenoplasty within the first days of exposure and noted that he also uses amniotic membrane in some cases. Iris injury is an indicator of significant ocular trauma. "If the iris is damaged, then the globe is damaged very significantly," said Boris Malyugin, MD, Moscow. Dr. Malyugin presented several options for iris repair, including iris suturing, which is suitable for less can have an effect on a patient's quality of life. There are published studies that show the relationship between glau- coma medication and quality of life. Dr. Pfeiffer described a study where patients taking a preserva- tive medication were switched to preservative-free. This study found that the switch resulted in reduced symptoms and improved quality of life and patient adherence. Kreissig Award and Lecture Emily Chew, MD, Bethesda, Mary- land, received the 2016 Kreissig Award, which is given for outstand- ing contributions in the understand- ing and treatment of retinal diseases. Dr. Chew also gave the correspond- ing lecture, "Nutrition, genes, and age-related macular degeneration: what have we learned from the trials." Dr. Chew first stressed "we are what we eat." Nutrition is very important, she said, and those who eat diets rich in fruits and vegetables with vitamins A and C tend to have less macular degeneration. She then detailed the Age-Re- lated Eye Disease Study (AREDS) and AREDS2. These looked at people with and without macular degeneration and how different supplements may have an impact on AMD. The AREDS2 also considered lutein/zeaxanthin and omega-3s. Based on results from the trials, the recommendations were to maintain a healthy diet with fish and green leafy vegetables, to stop smoking, and to consider AREDS supplements with lutein/zeaxanthin instead of beta-carotene for those with inter- mediate AMD and late AMD in one eye. Results from the AREDS2 study showed improved safety of the AREDS supplement by substituting lutein/zeaxanthin for beta-carotene. DHA/EPA was not recommended for AMD. There were a number of ancillary studies in AREDS2 relating to cardiovascular disease, cognitive function, and genetic associations, among others. Genetic testing has become im- portant, Dr. Chew said. It may help identify disease mechanism, could Dr. Rama also discussed cultivat- ed limbal stem cell transplantation, which he said is the most recent and accepted procedure for LSCD. How- ever, he noted there is variation in results achieved. Results can depend on the properties of the cultured graft and the surgical technique used to prepare the wound surface, he added. Dr. Rama spoke about the Holoclar (Holostem, Modena, Italy) autologous cultivated limbal stem cell grafts. Advantages are that they have a robust scientific background, a GMP validated culture procedure with quality control of the grafts, good long-term efficacy, are trans- portable, and commercially available in Europe. With this approach there is lower risk for the donor eye, it is repeatable in case of failure, and can be used for treatment of partial bilateral LSCD. However, complexity and cost still remain issues. Trends in glaucoma medication Fixed combination medications, preservative vs. preservative-free, and generic vs. brand name were discussed during ESCRS Glaucoma Day. Gàbor Holló, MD, Budapest, Hungary, said half of all open-angle glaucoma cases eventually require a second medication to lower IOP to a target level. However, that second medica- tion "should not destroy patient adherence and should provide an acceptable quality of life," which is where fixed-combination therapies come in. Fixed-combination medica- tions show no significant difference in efficacy compared to unfixed combinations, Dr. Holló said. They might also increase compliance, in- crease ocular tolerance due to fewer preservatives, and they could be less expensive. Ophthalmologists should note the causal relationship between a side effect and the ingredient might not be immediately obvious with fixed-combination drugs. Norbert Pfeiffer, MD, Mainz, Germany, reviewed preservative vs. preservative-free drops in the con- text of quality of life. Preservatives can cause side effects, he said, which October 2016 continued on page 146

• Cover