This Week in Ophthalmology: Week of December 2, 2024

Editor's note: The below transcript has been lightly edited for clarity.

Hello, I am David Hutton of Ophthalmology Times. Welcome to another episode of This Week in Ophthalmology, a program looking at some of the week’s top headlines from the Ophthalmology Times website.

We recently spoke with Dr. Alexander Fein, who discussed how to approach a patient presenting with transient vision loss, what this type of vision loss can mean, and what additional testing might be needed to determine the best plan for care. Let’s check out that conversation.

Alexander Fein, MD: Hi, I'm Alexander Fein. I'm a neuro-ophthalmologist at the Stein Eye Institute and Doheny Eye Institute at UCLA. My topic was to talk about the what to do when you have a patient with transient vision loss and their examination is normal, and they come to your clinic a couple of days later. And really the key point is, is to try and differentiate, was it monocular or binocular, and particularly to determine if you have any suspicion for if it was a vascular event. Factors of that would be if it was a monocular event, occurring only in one eye, of vision loss, classically, with a curtain coming down, but patients might not be able to describe it that way. A vascular monocular vision loss is a stroke equivalent or a TIA equivalent, and should be treated as such. These patients need to be seen urgently or emergently in the emergency room or a TIA clinic to get urgent vessel imaging and MRI in order to make sure that we rule out any form of stroke or TIA and get them on the proper antiplatelet or anticoagulant medication. They should also get lab tests for hemoglobin, A1c and lipid panel in order to modify their vascular risk factors, make sure they don't have diabetes or hyperlipidemia, so you can get them on the right medication to prevent further attacks.

The name of the game is secondary prevention once they come in with this episode. I think often the challenges come from getting the right history. Often patients have trouble differentiating between monocular and binocular symptoms, and this vision loss that you might be concerned about may just be a migraine aura, but often patients will have difficulty determining whether it was just in 1 eye or both eyes. That being said, if you have any level of suspicion that this was a vascular event, better to be safe than sorry and get the imaging, get them to the emergency room, so they can be seen by the emergency department in vascular neurology. The important thing to know is that, just like time is brain, time is retina. The longer that they, the more that they get these episodes, the more that damage can be done. And the thing that you should know is that transient vision loss in 1 eye is the same as a transient ischemic attack in the brain, and it portends further visual loss in the future.

We also spoke to Brian Francis, MD, from the Doheny Eye Institute and the UCLA Department of Ophthalmology, who shared insights on MIGS techniques and the labs and didactic available.

Brian Francis, MD: Hello everyone. My name is Brian Francis, and I'm a glaucoma specialist. I work for the Doheny Eye Institute and the UCLA Department of Ophthalmology out there in Los Angeles. So we have our presentation is actually a didactic and two skills transfer labs. So our topic is minimally invasive glaucoma surgery techniques. And what we've done is we brought together all of the currently available minimally invasive glaucoma surgery techniques that are FDA approved, and we put them essentially under one roof, so that during the didactic you're there to learn about how to do the different procedures and some of the data, and what are some appropriate patients to choose for the procedure itself. And then in our skills transfer labs, we have actually all of the companies have brought their devices, and there's dry lab or wet lab available so that all the attendees can get hands on with each of the devices and learn exactly how to how the setup is, how to do the procedure.

And we have all the instructors are seasoned glaucoma specialists who have done MiGs, you know, since, since its inception. So we're really excited to be able to bring that, all the technologies together under one roof. We think it's, I think it's the only opportunity to have every single MiGs technique and technology available at one sitting. So we're very proud of that. Well, I think it's very good for for several different glaucoma specialists. So if you're just getting started, or if you're a comprehensive ophthalmologist who's looking to get into MiGs, and you're not sure what procedure would be right for you, then this is a great area to where you can see all of them at once and make your decision, you know, based on, hands on, you know, ability to do the procedure and what what you feel speaks to you. I think it's also great for even seasoned glaucoma specialist, we're looking to add new techniques to their armamentarium. We do have, for example, in our in our lab, today and tomorrow, we have some brand new techniques that have really just launched. We're getting back into the suprachoroidal Outflow space. So we're happy to have, you know, kind of the latest launched procedures.

And that's not that one's not even in the in the media guide. So we have, we try to get the latest and greatest for everyone. Well, I think it helps. It's part of skills transfer. So I think anytime you know, when you're a surgeon and a physician, you need to evolve your practice. You need to evolve your skills. So we're, you know, I'm always telling the residents and our trainees, the fellows, that you don't just learn during your your residency or fellowship. This is a lifelong learning process. And so you should be practicing glaucoma and, you know, bringing in new technologies, new techniques, new procedures and new information, you know, on a yearly basis. And so this, you know, this meeting and our course, I think, is one way that we're allowing people to do that so they can bring that, that knowledge and their technology back to their practice and use it in their own patients. So I just, so I don't forget them, I'm going to read out all of the technologies that are available in our didactic and in our lab. So we have trabecular micro bypass stents, obviously, such as eye stent and hydrous. We have all the AB internal goniotomy and visco dilation procedures such as the cahok Dual Blade streamline, travex Omni iTRAQ advance. And we also have, as I said, the newest technology, which is going back into this suprachoroidal space, and that's with the ion Trek cyclopent alloflow procedure. So we've moved beyond, you know, the problems with cypass, and we're getting back into the suprachoroidal space

David Hutton: And now, some headlines. Galimedix Therapeutics has initiated Phase 1 trials of oral GAL-101, targeting amyloid beta aggregation. Promising safety and efficacy in ophthalmic models suggest potential for treating dry AMD, glaucoma, and neurodegenerative eye diseases.

Read More: Galimedix Therapeutics initiates Phase 1 trial of oral GAL-101

VivaVision Biotech reports positive Phase 2 trial results of VVN461 for postoperative inflammation treatment following cataract surgery.According to the company, VVN461, a non-steroidal dual JAK1/TYK2 immunomodulator, achieved its primary endpoint, demonstrating statistical and clinical efficacy compared to vehicle in treating post-operative inflammation following cataract surgery.

Read More: VivaVision Biotech reports positive Phase 2 trial results of VVN461 for postoperative inflammation treatment following cataract surgery

In other news, more than 300 patients have been randomly assigned in Ocular Therapeutix’s SOL-1 phase 3 trial for OTX-TKI. According to the company, SOL-1 is a superiority study being conducted under a Special Protocol Agreement (SPA) with the US Food and Drug Administration (FDA).

Read More: Over 300 patients randomized in Ocular Therapeutix's SOL-1 phase 3 trial for OTX-TKI

Thank you for joining me for another episode of This Week in Ophthalmology. For more the latest headlines and videos, be sure to visit OphthalmologyTimes.com