Eyeworld

137 February 2018 EW MEETING REPORTER Dr. Wiggs was also asked about younger patients, and she said that those patients who present with glaucoma before age 50 may partic- ularly benefit from genetic testing. There is a select group of genes that can cause early onset disease. Most of the time, those cause high ten- sion glaucoma, which is slightly dif- ferent from the disease she discussed in her presentation. Editors' note: Dr. Wiggs has no finan- cial interests related to her presentation. Macular ganglion cell imaging David Huang, MD, Portland, Oregon, said that macular imaging and ganglion cell analysis should be done routinely. He said it helps to detect damage or to follow up on progression. Although it is correlat- ed with RNFL, the correlation is only moderate. In patients with moderate to advanced glaucoma, the macu- lar ganglion cell analysis is a better parameter to follow. Angelo Tanna, MD, Chicago, weighed in on using ganglion cell analysis, particularly for myopic patients. Overall, there is strong evidence to support the idea that in higher myopia, the ganglion cell analysis has better accuracy. How- ever, he noted that this is a very individualized decision. For each patient, you have to look at the data and see which imaging technique provides the best information in that case. There's a region of the RNFL and optic disc that can pos- sibly be missed with RNFL analysis but can be picked up with ganglion cell analysis. Editors' note: Dr. Huang has finan- cial interests with Optovue (Fremont, California). Dr. Tanna has financial interests with various ophthalmic companies. Sustained-release glaucoma treatments Annette Giangiacomo, MD, At- lanta, spoke about sustained-release glaucoma treatments in her presen- tation, highlighting three possible new therapeutic options in trials and not currently available. The ideal sustained drug deliv- ery system is effective, decreases IOP variation, is safe, increases adher- ence, has the potential for higher bioavailability, and has lower drug waste, she said. The first potential new option Dr. Giangiacomo highlighted was a punctal plug, the Evolute platform (Mati Therapeutics, Austin, Texas), which she said is a silicone plug that is non-biodegradable and non-bio- erodable. It has a drug-eluting core that is sealed along the sides and dis- tal end. There is a constant, precise rate of drug elution. The benefits of this option, Dr. Giangiacomo said, are that the drug is delivered to the tear film only, which minimizes systemic absorp- tion and therefore adverse events; the drug is delivered for 3 months; it's preservative free; it has the po- tential for increased adherence and convenience; and it's cosmetically invisible but easily detectable. Dr. Giangiacomo said a Phase 2 trial has been completed with 179 patients, and Phase 3 trials are underway. There is, however, the potential disadvantage of the plug falling out without the patient knowing. The second therapeutic option she highlighted was a conjunctival polymer ring, the bimatoprost ring (Allergan). This is an inert polymer ring with sustained-release bimato- prost. It's flexible and sits on the conjunctiva. She added that the ring is inserted under the upper eyelid and positioned into the inferior fornix with a cotton swab or scleral depressor. It elutes a daily dose of 7 mcg for 6 months and is available in multiple sizes. Benefits of this option, accord- ing to Dr. Giangiacomo, are that it's noninvasive, delivers the drug for about 6 months, can be removed at any time, and is comfortable after a few days. In addition, its safety makes it suited for early glaucoma. This polymer ring has undergone a Phase 2 trial of 6 months of study with 13 months of open label exten- sion. Finally, Dr. Giangiacomo highlighted intracameral implants, specifically bimatoprost SR, with drug embedded in the biodegradable NOVADUR platform (Allergan). It is injected intracamerally and has a slow release of medication. This option is available in four doses. Editors' note: Dr. Giangiacomo has no financial interests related to her presentation. Sjögren's syndrome: Detection of early and late antibodies in dry eye patients Cynthia Matossian, MD, Doylestown, Pennsylvania, spoke about looking for biomarkers of Sjögren's syndrome in dry eye pa- tients. First, she said that Sjögren's syndrome is a systemic autoimmune condition that affects the salivary and lacrimal glands. Patients usually present with dry mouth and dry eye, but since patients often do not complain of dry eye when they see their primary care physician, it can go undiagnosed. There can be a 3- to 10-year lag time in diagnosis, Dr. Matossian said, and this can lead to frustrated and uncomfort- able patients. She added that there is a 19-fold increase in the risk of non-Hodgkin's lymphoma in these patients. Dr. Matossian detailed a retro- spective study in which she took blood samples from patients with dry eye disease in order to evaluate the presence of antibodies associated with Sjögren's. She noted the two biomarkers (traditional biomarkers) associated with Sjögren's syndrome (SS-A and SS-B), but she added that there are also three new biomarkers (novel biomarkers). She took blood samples from 78 patients with dry eye disease, and 41 patients (52.6%) were positive for one or more of all the biomark- ers tested as part of the diagnostic panels. Her study results showed that 32 patients (41%) tested positive for novel biomarkers only. Meanwhile, two patients (2.6%) tested positive for the traditional biomarkers and novel biomarkers, and one patient (1.3%) tested positive for only the traditional biomarkers. Dr. Matossian noted that there can also be overlap with connective tissue diseases, and she said this shows how important it is to have a low threshold for patients with dry eye disease who are not getting better on traditional dry eye treat- ments. She suggested working with rheumatologists and said additional studies are needed. Editors' note: Dr. Matossian has financial interests with Bausch + Lomb (Bridgewater, New Jersey). continued on page 138 View videos from Hawaiian Eye 2018: EWrePlay.org John Hovanesian, MD, discusses data surrounding patient satisfaction in a refractive cataract surgery practice.

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