Featured RETINA Paper: Anti-VEGF Halts Progressive Retinal Nonperfusion in Diabetic Retinopathy. Conversation with Mrinali Gupta, MD.
Nemo Patel, MD Ophthalmology Resident Bascom Palmer Eye Institute University of Miami In the late breaking developments section, Dr. Lloyd Aiello discussed the DRCR network’s findings of ETDRS 7 field imaging vs. ultrawidefield (UWF) imaging. It was discussed that peripheral lesions exist in approximately 41% of eyes and can worsen the severity score almost 8% of the time. The purpose of the study was to determine if UWF photography could accurately assess the effect of peripheral lesions on the rate of diabetic retinopathy (DR) progression in the protocol AA study. The area of the UWF image was masked to be equivalent to the ETDRS image area. It was found that 59% were scored the same and 96% were scored within one step. This data suggests that protocol AA will be able to address the effect of peripheral lesions on the rete of DR progression. During the panel segment, there was agreement on the high utility of UWF photography and angiography for guiding diabetic retinopathy treatment. Dr. Emily Chew then discussed the phase 2 trial of ciliary neurotrophic factor (CNTF) for macula telangiectasia type 2. This was a prospective, multi-center, single-masked, sham controlled study with 99 eyes and 24 months of follow up. The medicine was delivered with an implant. The primary outcome was ellipsoid zone loss as measured by en-face OCT. CNTF treatment slowed ellipsoid area loss by 31% and led to functional benefit in reading speed when compared to untreated eyes. There was an increase in retinal thickness in the treated group. There was no difference in visual acuity. The implant was well tolerated and none were removed. There was an effect of miosis in 18% of eyes. These are exciting results and we await the phase 3 trials. Dr. Mark Gillies discussed the treatment patterns and reactivation times for neovascular AMD in Australia. The induction phase was defined as time until inactivity and the maintenance phase was defined as beginning after the induction phase. The study selected neovascular AMD patients in the maintenance phase receiving VEGF inhibitors in a treat and extend pattern. The most common reactivation interval was 8 weeks. The risk of reactivation increased exponentially after 12 weeks of extension. Longer induction phases were associated with worse visual outcomes and earlier reactivation. 50% of eyes reactivated within the first year. Only 50 % of eyes had the interval decrease after the first reactivation which highlights variable practice patterns.