Eyeworld

Reporting from the 2017 American Academy of Ophthalmology (AAO) annual meeting, November 11–14, New Orleans EW MEETING REPORTER 86 December 2017 AAO Opening Session: Awards, honors, and named lectures The 2017 AAO Opening Session began with an address from AAO President Cynthia Bradford, MD, Oklahoma City, who spoke about the various reasons why ophthal- mologists choose their profession and the importance of "[taking] some time to think about why you chose to be an ophthalmologist." Several awards and honors were also presented, including the Laure- ate Award, the AAO's highest honor, to Irene Maumenee, MD, New York, for her work in ophthalmic genetics. David Karcher, executive director of ASCRS, was honored with a Distin- guished Service Award for his impact on the profession through his lead- ership of the organization. Highlights of the Opening Ses- sion were the Marmor Lecture and Jackson Memorial Lecture. The Mar- mor Lecture was presented by Henry Butler, a musician and photogra- pher blinded by congenital glauco- ma. He played a couple of songs for attendees and spoke about "being a daring individual," not limiting oneself to what people expect or say you can or cannot do. The 74th Jackson Memorial Lecture was delivered by Daniel Martin, MD, Cleveland, on "Intra- vitreal Therapy for Retinal Disease: From CMV to CNV." In his lecture, shown to be effective at dislodging the clot. Technological advances, such as robotic assistance and 3-D imaging, is making the technique easier, Dr. Kadonosono said. Another innovation presented was hypersonic vitrectomy, which Carl Awh, MD, Nashville, Tennes- see, described as a new method of vitreous removal that uses ultrasonic power. According to Dr. Awh, Vitesse (Bausch + Lomb), which was FDA approved earlier this year, is capable of 1.7 million "cuts" per minute, but he noted that it's not really cutting, rather "hypersonic liquefaction" of the vitreous. Because the probe had no inner needle, the inner lumen is larger and has improved flow. There have been 46 U.S. cases with Vitesse since September, and Dr. Awh described his own experi- ence of 23 cases. In terms of com- plications, Dr. Awh had one retinal break in eight cases of detached reti- na and one case of hitting the IOL. Advantages of Vitesse include high suction making it easy to engage the vitreous and controlled dissection that allows for close work near a mobile retina, Dr. Awh said, adding that it's also capable of re- moving silicone oil. Editors' note: Dr. Awh has financial interests with Bausch + Lomb. Dr. Kadonosono has no financial interests related to his presentation. is a need to redefine what's consid- ered atrophy in age-related macular degeneration due to the multiple pathways causing it and the im- portance of early recognition for possible early intervention. While there are a number of tools available to assess atrophy, Dr. Sadda said OCT specifically has some advantag- es. However, there wasn't a con- sensus definition for atrophy with OCT until recently when a group of retina specialists came together to create this terminology, setting two definitions. Complete retinal pigment epithelium (RPE) and outer retinal atrophy (cRORA) consists of hy- pertransmission of at least 250 μm, a zone of attenuation/disruption of RPE +/–BL complex of at least 250 μm, and evidence of overlying photoreceptor degeneration. cRORA cannot have a scrolled RPE or other signs of tear. Geographic atrophy, Dr. Sadda explained, is a subset with- in this definition. Incomplete RPE and outer reti- nal atrophy cannot fulfill all the cri- teria for cRORA; it must have some hypertransmission but it's often discontinuous, some irregularity of the RPE +/–BL complex, and detect- able photoreceptor degeneration. While we are now able to define these criteria and recognize atrophy in OCT, Dr. Sadda said, there will still be questionable cases, which is where multimodal imaging will be critical. Editors' note: The physicians have no financial interests related to their presentations. Innovation in retinal intervention Retina Subspecialty Day covered several innovative options for dif- ferent cases where the retina needed intervention. Kazuaki Kadonosono, MD, Yokohama, Japan, presented several cases where a microneedle injection was used to recanalize eyes with central retinal artery occlusion. The technically challenging procedure involves injecting tissue plasmino- gen activator into the blocked artery with a 47-gauge needle, and it has continued on page 88 View videos from AAO 2017: EWrePlay.org Edward Holland, MD, describes nano-thin DSAEK and compares results to those of DMEK.

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