Eyeworld

123 September 2017 EW MEETING REPORTER down to the level of whether a pa- tient even has diabetes or not. Though diabetic retinopathy detection can be challenging, with artificial intelligence Dr. Schaal said early and automatic detection is feasible. "This has the promise to save sight, save a lot of money, and really change the way we handle medi- cine," she said. Editors' note: Drs. Gupta and Schaal have financial interests related to their presentations. New technology and the FDA Malvina Eydelman, MD, Wash- ington, D.C., an ophthalmologist and director of the FDA's Division of Ophthalmic and Ear, Nose and Throat Devices, gave attendees a brief overview of how new technolo- gies move through the FDA in a bid to gain approval. When you hope to bring a new medical product to the market, you first need to understand what retrobulbar blocks, Dr. Gupta said she has switched to topical anes- thetic with intracameral lidocaine. XEN patients also need to be able to tolerate needling at the slit lamp postop, when needed. As for efficacy, Dr. Gupta said 55% of XEN patients were off all medications, according to one study. Dr. Schaal discussed her own research during this session that involved using artificial intelligence based on OCT and OCTA images to detect early diabetic retinopathy. "The goal of our research is to develop an objective, automatic technology for unbiased diagnosis of retinal disease," Dr. Schaal said, noting that by eliminating physician bias with automatic pattern recog- nition, patient outcomes can be im- proved and unnecessary treatment avoided. Dr. Schaal and her team devel- oped an algorithm for the automatic detection of retinal layers, which is accurate even in the presence of pathology. With this algorithm and OCT analysis, they can identify Cutting-edge technology A wide range of new innovations and technologies for various condi- tions, including glaucoma, diabetic retinopathy, and oculoplastics, were discussed during one session. Priya Gupta, MD, Iowa City, Iowa, spoke about the latest in min- imally invasive glaucoma surgery (MIGS) devices, focusing on the XEN Gel Stent (Allergan, Dublin, Ireland), InnFocus MicroShunt (Santen, Osa- ka, Japan), and CyPass Micro-Stent (Alcon, Fort Worth, Texas). Dr. Gupta gave tips for CyPass insertion into the supraciliary space, creating an outflow channel for aqueous into the suprachoroidal space. The blunt guidewire for the stent is positioned at the scleral spur and the stent is inserted with its three retention rings engaged a bit proximal to the ciliary body band, Dr. Gupta said. According to the COMPASS trial, 77% of those who received the CyPass saw at least a 20% reduction in IOP compared to 60% in the con- trol group; 85% of CyPass patients required no medication compared to 59% in the control group. InnFocus, which is still an inves- tigational device, is not as minimally invasive as other devices, Dr. Gupta said, because it is inserted through a scleral flap. But, she noted, it seems to show promise for more intermedi- ate or advanced glaucoma patients. According to research at 1 year of follow-up, 80% of patients with the InnFocus reached a pressure of 14 mm Hg or lower and 62% were on no medications. Dr. Gupta offered a few of her personal pearls for working with the XEN. Due to the surgeon's temporal position for the surgery, Dr. Gupta said she pays careful attention to the patient's brow and cheek anatomy, as too prominent of a cheekbone could lead to too nasal stent place- ment, leading to further compli- cations. Though she used to give PhD, Worcester, Massachusetts, took up the conversation to describe research and trials for therapeutic agents that could slow progression. On the diagnostic classification front, Dr. Schaal said new imaging modalities—spectral domain OCT and fundus autofluorescence—in addition to color fundus photog- raphy allows clinicians to follow progression of geographic atrophy, which is especially important for clinical trials. AREDS showed that a high dose of antioxidants taken by the patient can decrease progression of late-stage AMD by 25%. It is now a requirement, Dr. Schaal said, for physicians to consult with patients about antioxidant vitamins and minerals that could slow progres- sion. "This is the only thing we can do to try to prevent progression of geographic atrophy today," Dr. Schaal said, noting, however, that there is some debate regarding if these vitamin regimens are safe for all patients. Dr. Schaal also presented re- search on the potential therapeutic agent lampalizumab (Genentech, San Francisco), a monthly intravitre- al injection that blocks complement factor D, which is associated with the inflammation that can cause AMD progression. A Phase 2 clinical trial of the drug found it to be safe without serious side effects. It also showed a 20% reduction in geographic atrophy progression. Patients who genetically are carriers of comple- ment factor I (CFI) could benefit even more, Dr. Schaal said, with those patients in the study seeing a 44% reduction in geographic atro- phy area progression. Lampalizumab is now entering Phase 3 trials. Editors' note: Drs. Schaal and Payne have no financial interests related to their presentations. continued on page 124 View videos from WIO 2017: EWrePlay.org Cynthia Matossian, MD, discusses navigating industry relationships.

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