Keep Up With Evolving Trends in Retina Care

Treatment targets and modalities for retinal vascular diseases are rapidly changing, with research goals targeted towards improving patient quality of life. Jessica Steen, OD, assistant professor at the Nova Southeastern University College of Optometry in Fort Lauderdale, Florida, provides an overview of evolving trends in retinal vascular disease, at the 2021 Southeastern Educational Congress of Optometry (SECO), held April 28 to May 2 in Atlanta, Georgia.

Dr Steen’s presentation includes a pathophysiology review, covering the era of anti-VEGF therapies, and an overview of imaging strategies, treatment trends, and other developments in diabetic retinopathy (DR), exudative macular degeneration, and retinal vein occlusion. 

Oxygen is delivered via the retinal and choroidal vasculature; each of these are complex networks comprised of multiple systems within the eye. Vascular responses to diseases — such as DR, macular degeneration, and retinal vein occlusion — include exudation, ischemia, or both. 

In both type 1 and type 2 diabetes, there is a high likelihood for DR. Recently, data emerged showing that a patient’s risk for myocardial infarction, cerebrovascular accident, and death increases at each stage of DR, even after controlling for confounding factors such as smoking status, hypertension history, lipid profile, and age, sex, BMI, insulin use, and HbA1c. DR often leads to vision loss secondary to diabetic macular edema (DME), macular ischemia, and proliferative DR. 

The current first-line treatment for DR is anti-vascular endothelial growth factor (VEGF) agents; ranibizumab, bevacizumab, and aflibercept are the currently available treatment options for DR. Other pharmacologic options include injectable steroids such as ozurdex-dexamethasone 0.7 mg, Iluvien® (Alimera Sciences), and Triesence™ (Alcon Pharmaceuticals). 

Brolucizumab (Beovu®, Novartis) was approved in October 2019 by the US Food and Drug Administration (FDA) as a treatment option for age-related macular degeneration based on top-line results from phase 3 trials. Brolucizumab is one of the most expensive anti-VGEF agents; bevacizumab is the least expensive and is therefore the typical first-line anti-VEGF agent. 

In exudative AMD, protocol includes OCT and a once-monthly clinical examination. According to Dr Steen, injections typically occur only with recurrent fluid or hemorrhage. Following the clearing of macular fluid, the treatment interval can be extended, typically, by 2-week intervals. 

Although anti-VEGF agents are the top-line treatment, they are associated with some adverse events. These include increased intravitreal volume and increased intraocular pressure and risk of endophthalmitis, vitreous hemorrhage, and/or cerebrovascular events. 

Future developments in retinal vascular disease aim to reduce the number of required injections, increase intervals between treatment, develop alternative administration routes for medications, reduce cost, and improve patient quality of life. 

Reference

Steen J. Evolving trends in retinal vascular disease. Presented at: Presented at: Southeastern Educational Congress of Optometry (SECO) 2021 Annual Meeting; April 28-May 2, 2021; Atlanta, GA. Course 114.