Top Retina Highlights From the American Academy of Ophthalmology 2020 Conference

Although attendees of the first ever all-virtual American Academy of Ophthalmology (AAO) saw a major change in format, the  innovative developments around diagnosis and treatment of retinal disease presented at the conference maintained the same high degree of interest, with more than  8500 attendees. Here, we review some of the “can’t-miss” sessions and presentations that ophthalmologists logged in to view. 

Outcomes for Brolucizumab 

Marco Zarbin, MD, PhD, and a team of collaborators that included Charles Wykoff, MD, PhD, and Mathew MacCumber, MD, PhD, reported “real-world” safety outcomes for patients initiated on the recently approved anti-vascular endothelial growth factor (VEGF) agent for neovascular age-related macular degeneration (AMD), brolucizumab. The authors performed a retrospective analysis of the IRIS registry and Komodohealth medical/pharmacy claims database and identified more than 20,000 patients who received a brolucizumab intravitreal injection. The incidence of retinal vasculitis was 3.3% and overall incidence of concomitant retinal vasculitis with vascular occlusion was 2.1%.¹

Retinal Detachment After Penetrating And Lamellar Keratoplasty 

With the number of corneal transplant procedures increasing rapidly in the United States, Durga Borkar, MD, and colleagues sought to measure the rates of retinal detachment (RD) after both penetrating keratoplasty (PK) and endothelial keratoplasty (EK). Rates of RD were 2.4% and 0.5% after PK and EK, respectively. Visual acuity was found to be worse after PK-associated RD compared to EK. Not surprisingly, patients undergoing anterior or pars plana vitrectomy at the time of corneal transplant had a higher odds of developing RD.²

To Peel Or Not To Peel? 

Matthew Starr, MD, and co-authors performed a subgroup analysis from the Primary Retinal Detachment Outcomes (PRO) study to assess if prophylactic internal limiting membrane (ILM) peeling reduces epiretinal membrane formation following repair of rhegmatogenous retinal detachments (RRD). Although they saw higher rates of anatomic success in patients who underwent concurrent ILM peeling at the time of RRD repair, they did not note any statistically significant difference in postoperative ERM formation or final visual acuity. The authors posit that removing ILM within the arcades may remove enough posterior cortical gel to prevent posterior proliferative vitreoretinopathy and traction on the retina.³

Impact of COVID-19 on Ophthalmic Practice

Researchers at the Edward S. Harkness Eye Institute of Columbia University presented outcomes of teleophthalmology initiatives during the 2020 coronavirus disease 2019 (COVID-19) pandemic. The study analyzed 143 televisits during the first month of the pandemic in New York City. From their study, televisits lasted approximately 12.5 minutes and only 13% of patients utilizing telehealth would ultimately require an in-office visit. The most common telehealth complaints were red eye, dry eye, foreign body sensation, and eye pain. The authors conclude that telehealth is adequate for ocular surface and eyelid issues, but in-person visits may be needed in cases of vision loss and post-operative issues. All vision-threatening conditions were successfully treated in the studied cohort. 

Another interesting presentation addressed characteristics of ocular trauma during the COVID-19 stay-at-home orders. Connie Wu MD and co-authors looked at patients with severe ocular trauma presenting to the Wills Eye Emergency Room between March and April 2020, in comparison with patients during the same season 1 year prior in 2019. Their study showed convincing data suggesting patients with severe ocular trauma during the pandemic were more likely to be uninsured, travel a greater distance, and present a longer amount of time after their injury. The mechanism of injury was more commonly related to home improvement projects during this time period as well.⁴

Paradigm Shift In Screening Protocols For Suspected Sarcoidosis Uveitis

Andrew Zheng, MD, and colleagues reviewed serology and radiologic studies of 158 patients with biopsy-proven sarcoidosis after presentation with uveitis. CT scans of the chest were the most sensitive screening test, followed by serum angiotensin converting enzyme (ACE) level, and chest X-ray (74%, 59% and 39%, respectively). Lymphadenopathy severity on CT chest was the strongest predictor of a positive sarcoidosis biopsy in binary logistic regression models. Given the relatively low sensitivity of chest X-rays, the authors recommend considering combined serum ACE level and CT chest as the initial screening tests for suspected sarcoidosis in uveitis clinics.⁵

Retinal Gene Therapy on the Horizon 

Glenn Yiu, MD, PhD, initiated the ‘Gene and Cell-Based Therapy’ session with a thorough review of recent gene therapy advances. Topics covered included the genetic heterogeneity of inherited retinal disease, pros and cons of various viral vectors, administration strategies for gene therapy, and ongoing clinical trials. He ended his talk focusing on the very promising CRISPR gene editing technology which will have broad applications, particularly to autosomal dominant disease such as CEP290-associated retinal degeneration.⁶

Albert Maguire, MD, and colleagues which included Jean Bennett, MD, PhD, and Stephen Russell, MD, presented the 5-year update on Phase III voretigene neparvovec-rzyl gene therapy for RPE65-associated inherited retinal disease. Safety profiles of gene therapy administration were consistent with that expected of vitrectomy and subretinal injection. Improvements in ambulatory navigation, light sensitivity, and visual field were maintained for 5 years in most patients who received the original intervention.⁷

Retinal advances continue to thrust ophthalmology forward and offer physicians better odds of managing disease, maintaining vision, and preserving patients’ quality of life. The AAO, virtual or otherwise, offers hours worth of research showcasing cutting edge technologies, surgical techniques and pharmaceutical applications. Slides and recordings of presentations from the virtual conference can be accessed at the AAO website.

References

1. Zarbin, Basavarajaiah, Yu, et al. Profiles and Early Outcomes of Patients Who Initiated Brolucizumab for Neovascular (Wet) AMD in the IRIS® Registry.  Presented at: American Academy of Ophthalmology 2020 Annual Meeting; November 13-15, 2020. Abstract PO395.

2. Borkar DS, Levin HJ, Wibbelsman TD, et al. RD rates and clinical outcomes following PK and EK. Presented at: American Academy of Ophthalmology 2020 Annual Meeting; November 13-15, 2020. Abstract PO437.

3. Starr M, Ryan E, Shah G, et al. Prophylactic ilm peeling during rrd surgery. Presented at: American Academy of Ophthalmology 2020 Annual Meeting; November 13-15, 2020. Abstract PO495.

4. Wu C, Patel S, Jenkins T, Obeid A, Ho A, Yonekawa Y. Ocular trauma during COVID-19 stay-at-home orders. Presented at: American Academy of Ophthalmology 2020 Annual Meeting; November 13-15, 2020. Abstract PO230.

5. Zheng A, Arshad J, Sharma S, Baynes K, Lowder C, Srivastava S. Diagnostic performance and utility of serum ace level and chest radiography in sarcoid uveitis. Presented at: American Academy of Ophthalmology 2020 Annual Meeting; November 13-15, 2020. Abstract PO515.

6. Yiu G. Gene- and cell-based therapies: overview of gene therapy. Presented at: American Academy of Ophthalmology 2020 Annual Meeting; November 13-15, 2020. Session: RET07V. 

7. Maguire A, Bennett J, Drack A. Phase 3 trial update of voretigene neparvovec-rzyl in biallelic RPE65 mutation–associated inherited retinal disease.  Presented at: American Academy of Ophthalmology 2020 Annual Meeting; November 13-15, 2020. Session: PO405