Eyeworld

EW MEETING REPORTER 90 Reporting from the American Academy of Ophthalmology (AAO) meeting, October 15–18, Chicago Meanwhile, anti-VEGF, when given for DME, decreases the risk of diabetic retinopathy worsening and increases the chance of improved retinopathy level, he said. Dr. Gross detailed a study comparing the use of ranibizumab (a type of anti-VEGF) and PRP. The study sought to answer if the visual acuity using ranibizumab for PDR was not worse than treatment with PRP at 2 years. A secondary question in the study looked at if there were potential benefits of ranibizumab on vision throughout follow-up, peripheral vision, macular edema, and incidence of vitrectomy. The study concluded that ran- ibizumab injections for PDR were no worse than PRP for visual acuity at 2 years. The ranibizumab injections also showed superior vision over the course of 2 years, reduced incidence of DME, showed less peripheral vi- sion loss, and fewer vitrectomies. There are advantages of both PRP and using ranibizumab, Dr. Gross said. Advantages of PRP include no risk of endophthalmitis or systemic exposure to anti-VEGF, and this option could potentially cost less than ranibizumab injec- tions. PRP has an often long-lasting effect that doesn't require additional treatment, Dr. Gross said, and can typically be completed in one or two visits. Meanwhile, ranibizumab showed a mean change in visual acuity from baseline to 2 years that was no worse than with PRP. The study showed superior mean visual acuity over the course of 2 years, superior mean visual field outcomes, decreased chance of vitrectomies, and a decreased chance of develop- ing DME. EW Editors' note: Dr. Jampol has financial interests with Janssen Pharmaceuticals (Beerse, Belgium) and the National Eye Institute (Bethesda, Maryland). Dr. Gross has financial interests with Acucela (Seattle), Jaeb Center for Health Research (Tampa, Florida), Ohr Pharmaceutical (New York), and Regeneron (Tarrytown, New York). World Medical (Rancho Cucamonga, California). Dr. Medeiros has financial interests with Alcon, Allergan, Carl Zeiss Meditec, Heidelberg Engineering, Reichert (Depew, New York), and Topcon Medical Systems. Diabetic retinopathy A session focused on diabetic ret- inopathy and its treatments. Lee Jampol, MD, Chicago, kicked off the session, discussing diabetic ret- inopathy and mentioning diabetic macular edema and proliferative diabetic retinopathy. The incidence and prevalence of diabetes in U.S. is increasing, he said. Also increasing is obesity, which is a major risk factor for type 2 diabetes. There are 29 million people in the U.S. with type 2 dia- betes, Dr. Jampol said. Additionally, 86 million people in the U.S. have pre-diabetes. He added that 38% of adults in the U.S. are considered obese, while 17% of teens in the U.S. are considered obese. If you have diabetes for long enough, Dr. Jampol said, you get retinopathy, and with people living longer with diabetes, there will be more retinopathy to take care of. Diabetic retinopathy is the most common diabetic vascular compli- cation, he said, and it's the leading cause of new onset blindness in the working-age population. Dr. Jampol said this is the mostly highly feared diabetic complication by patients, and it has a huge socioeconomic impact. Though instrumentation is helping, it's not really digging into the problem yet, he said. Jeffrey Gross, MD, Columbia, South Carolina, discussed anti-VEGF vs. panretinal photocoagulation for proliferative diabetic retinopathy (PDR). Panretinal photocoagulation (PRP) has been the treatment for PDR over the last 4 decades, he said. It substantially reduces the risk of severe vision loss, but it also has some complications, he said. PRP is inherently destructive and can lead to peripheral visual field loss, night vision loss, and exacerbation of pre-existing DME. Kouros Nouri-Mahdavi, MD, Los Angeles, focused his presentation specifically on the lamina cribrosa, the main site of damage in glaucoma. OCT has helped show the following: 1) posterior lamina cribrosa displace- ment is related to glaucoma severi- ty; 2) a decrease in lamina cribrosa thickness is related to glaucoma damage; 3) lamina cribrosa thickness is thinner in normal tension glauco- ma compared to primary open-angle glaucoma; 4) focal defects in the lamina cribrosa can be a biomarker of glaucoma; 5) disc hemorrhages are associated with lamina cribrosa defects; and 6) the lamina cribrosa moves forward with a significant decrease in IOP, making it a possible biomarker for progression. Dr. Nouri-Mahdavi said OCT of deep optic nerve head structures has led to a better understanding of the development of glaucoma dam- age, could help differentiate from non-glaucomatous optic disc neurop- athy, can help determine a response to treatment, and has led to possible new biomarkers to predict disease progression or improvement. Felipe Medeiros, MD, La Jolla, California, discussed the possibili- ty of OCT being used in glaucoma diagnosis before visual field loss or damage to the optic nerve head is observed. He described a study in which cross-sectional OCT was diagnostic in a third of glaucoma suspects 5 to 6 years before the detection of visual field loss. Dr. Medeiros also emphasized the im- portance of longitudinal follow-up of suspects over time, not just mak- ing a cross-sectional assessment. This symposium also featured presentations on OCT angiography, benefits of OCT for corneal and con- junctival disease diagnoses, adaptive optics and imaging in retinal diseas- es, and more. Editors' note: Dr. Leung has financial interests with Alcon, Allergan, Carl Zeiss Meditec, Lumenis (Yokneam, Israel), Santen, Tomey Corp. (Na- goya, Japan), and Topcon Medical Systems (Oakland, New Jersey). Dr. Nouri-Mahdavi has financial interests with Allergan, Heidelberg Engineer- ing (Heidelberg, Germany), and New November 2016 Sponsored by

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