Ophthalmology in paradise

(Image Credit: AdobeStock/Galyna Andrushko)

Ophthalmologists enjoyed sun, fun, and education during the Hawaiian Eye and Retina 2024 meeting, held January 13 to 19 at the Grand Wailea Resort in Maui, Hawaii.

With combined sessions for the first 2 days, attendees were able to gain insight and information from all viewpoints within subspecialties and a look ahead into 2024. This included what’s new in ophthalmology and how the field will adapt and evolve as the year progresses.

The larger portion of the meeting focused on individual CME/COE/CNE program content for comprehensive ophthalmologists, retina specialists, administrators/office managers, and nurses/technicians/allied health professionals, with speakers tailored to each group. More than 100 faculty members shared insights and pearls with attendees over the course of the meeting.

Retina in focus

Concurrent with Hawaiian Eye in the same venue, the Retina portion of the meeting was targeted toward retina specialists and provided updates on the most recent advances in the subspecialty. This included their integration into everyday practice and insights into varying challenges, such as the implementation of new diagnostic and treatment modalities.

One area that saw a lot of attention was IOLs. Michael Greenwood, MD, from Vance Thompson Vision, Fargo, North Dakota, described how patients in his practice can “test-drive” the visual outcomes achieved with advanced technology IOLs before they undergo cataract surgery.

Greenwood discussed how the GreenMan app gives patients the opportunity to test-drive various IOL options before cataract surgery in multiple immersive environments, including being in an apartment and driving a car. They can do this in normal and low-light conditions and can experience monofocal, toric, and multifocal IOLs and will soon have monovision capabilities. In findings from a study with the technology, 29 of 112 control patients chose an advanced technology IOL in contrast to 69 of 121 patients in the virtual reality group who chose an advanced technology IOL.

“Better educated patients equals happier patients,” said Greenwood.

Eric Donnenfeld, MD, discussed the IC-8 Apthera Intraocular Lens and how it can be utilized in patients with irregular corneas.

“But where I really find this successful is in irregular corneas ... The more complex the eye, the lower the postoperative quality of vision is. The results with the small-aperture optics will be better than those achieved with a conventional IOL, but surgeons should not expect perfect outcomes,” said Donnenfeld.

William Trattler, MD, also took time to discuss pearls for toric IOLs in lower levels of astigmatism. “At the end of the day, when you have these patients with lower levels [of] astigmatism, you can look at formulas and try to determine whether a toric lens will make more sense than just a regular lens. And I think one of the key issues is that for a while we were worried about flipping the axis, but it’s really OK.”

Updates on the PULSAR (NCT04423718) and PHOTON (NCT04429503) studies of aflibercept 8 mg in wet age-related macular degeneration (AMD) and diabetic macular edema (DME), respectively, were given at the event as well. Sunir Garg, MD, reported the 96-week results of the PULSAR study and noted aflibercept 8 mg demonstrated similar improvements in best-corrected visual acuity and central subfield thickness when compared with the 2-mg dose of aflibercept among treatment-naive patients with neovascular AMD.

Roger A. Goldberg, MD, MBA, reported post hoc findings from the PHOTON study, saying that “8 mg aflibercept is preventing the reaccumulation of fluid at a much better rate in these most difficult-to-treat eyes. And I think those are the eyes we’re most passionate about moving to our next-generation therapies. So again, [we see] very compelling data in DME for these difficult-to-treat, very swollen eyes, [demonstrating] that we can slow down the reaccumulation of the fluid significantly better with 8 mg aflibercept vs 2 mg aflibercept.”

On the retina side, Varun Chaudhary, MD, FRCSC, looked at treating patients with retina vascular diseases. Most importantly, he looked at who will and will not respond to treatment and what clues are predictive on imaging.

Chaudhary noted: using fluorescein angiography, retinal nonperfusion is fundamental to diabetic retinopathy and associated with greater risk of progression, anti-VEGF treatment may alter progression of nonperfusion, and increased leakage and predominantly peripheral lesions are associated with greater risk of progression.

Using spectral-domain optical coherence tomography (OCT), the baseline OCT biomarkers may provide insight into treatment response to different agents, and the first meta-analysis was performed to quantify the ability of baseline biomarkers to predict visual acuity outcomes in patients with DME undergoing treatment.

Gene therapy

Looking toward the future, David Eichenbaum, MD, discussed ocular gene therapy, stating, “We’re still in the infancy [period, but] the potential of gene therapy is very exciting.”

In a look at the good and bad of ocular gene therapy, Eichenbaum noted that potential positives of gene therapy are the possibility for a single treatment, the absence of indwelling devices, and continuous protein production forever, the last of which may also be a drawback. However, safety is an “important issue.”

Eichenbaum said higher-dose subretinal gene therapy programs have seen unusual pigmentary changes, with some patients having lost vision from these in the early-phase investigative programs.