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Clinical

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Idiopathic macular telangiectasia (MacTel) is bilateral condition characterised by ectatic capillaries of the macula and atrophy of the neurosensory retina. Familiarity with the distinctive intraretinal cavitation on SD-OCT in type 2, the most common type, is key for correct diagnosis.

Diagnosing and treating MacTel degenerative retinal disease

The American Academy of Ophthalmology (AAO) is holding its annual meeting October 18 to 21 at McCormick Place in Chicago, Illinois, featuring symposia, instruction courses, clinical sessions, original papers, skills transfer lectures, videos and posters, and the Expo.

According to Debra Rosencrance, vice president of meetings and exhibits at the AAO, the theme for AAO 2024 is “elevate.”

“The academy’s annual meeting helps attendees elevate their skills, knowledge, and the profession,” she explained. “We encourage physicians to bring their entire team to the annual meeting as there are sessions and networking opportunities that can elevate one’s entire practice.”

A new addition this year is the Saturday Night Celebration, being held from 7:30 PM to 10:30 PM on October 19. Rosencrance noted that it is a new meetingwide event supporting the academy’s education initiatives. Attendees can buy tickets through registration.

Rosencrance added that more educational opportunities are now available in the AAO 2024 Expo.

“In addition to the sessions taking place in the Learning Lounge and Poster Theater, industry will talk about products and trends in the Showcase Theater,” she pointed out. “Exhibitors from early-stage and start-up companies will speak in the new Innovation Theater, and academy education, advocacy, and research initiatives will be highlighted in the new Academy Theater.”

During the meeting there will be a range of educational opportunities available, including hands-on workshops and certification courses, with an educational opportunity for everyone, regardless of their learning style. Rosencrance noted that these include the following:

Small-group learning at the Learning Lounge, Academy Café, Poster Theater, Poster Discussions, new Innovation Hub, and more.

Hands-on surgical labs allow attendees to practice a new technique or brush up on an old one.

Symposia rooms allow attendees to listen to ophthalmology’s key opinion leaders on the latest research and then immediately discuss with nearby colleagues during the breaks.

There are several keynote speakers lined up for the event, including the following:

Jasmine H. Francis, MD, will deliver the Jackson Memorial Lecture. The title of her presentation is “Histiocytosis Advancements Parallel Ophthalmic Innovation.”

Mary Street Alinder will deliver the Michael F. Marmor Lecture in Ophthalmology and the Arts with a presentation titled “Ansel Adams: The Development of Vision.”

Rosencrance pointed out that there are several must-attend sessions on the schedule this year. New sessions and hot topics include Office-Based Surgery; Ophthalmology Mythbreakers; The Year in Literature: Editor’s Choice Highlights From the Ophthalmology Journal Family; Artificial Intelligence in Ophthalmology; Geographic Atrophy; New Retinal Therapies; and New Therapies for Corneal Endothelial Diseases.

“We encourage attendees to stay for Cataract Monday, the academy’s must-attend Spotlight on Cataract Complications,” she added.

The primary objectives for planners this year, according to Rosencrance, have been to provide more networking and educational opportunities in the Expo and to develop programs for the entire practice team.

“We continue to look for ways to make the meeting more comfortable for attendees,” she added. “One way we are addressing this at this year’s meeting is the introduction of a quiet room. We’ll be providing a room away from the action where attendees who may be feeling a little overwhelmed can sit quietly to read, work, or relax.”

Each year, the academy sets out to make the event a little different.

“AAO attendees will find something different every year because the program is based on what is hot in ophthalmology right now,” Rosencrance explained. “We are continually tweaking the educational opportunities to continue offering value to all attendees.”

Rosencrance also pointed out that Chicago remains a favorite destination for the academy.

“It is easy to travel to and from the city, and there is always something new to see, hear, and experience,” Rosencrance said. “It is known for its cutting-edge theater, breathtaking architecture, world-renowned museums, and inventive chefs.”

The academy will also provide myriad ways for ophthalmologists to network during the annual meeting.

“We have been creating more and more business-ready networking lounges designed for attendees to conduct meetings and interviews, charge devices, check in with the office, focus, and relax,” Rosencrance pointed out. “We’ve added more educational opportunities to interact and discuss in small groups—Learning Lounge, Academy Café, poster discussions, and introducing ‘continue the conversation’ areas in selected session rooms.”

Rosencrance added that attendees are encouraged to take advantage of regularly scheduled breaks in the scientific program to meet up with colleagues and mentors, visit affinity group lounges, and explore the AAO 2024 Expo.

“The new Saturday Night Celebration is a great place to connect with friends and colleagues, meet academy leadership, and just have fun at one of Chicago’s hottest nightclubs, TAO,” she added.

The academy also will offer both in-person and virtual options for AAO 2024 and Subspecialty Day.

American Academy of Ophthalmology offers in-person and virtual options for annual meeting, Subspecialty Day.

AAO 2024 to “elevate” in Windy City

Treatment with a subretinal injection of voretigene neparvovec (Luxturna, Spark Therapeutics) resulted in a significant increase in visual function at the 12 months evaluation in most treated pediatric patients with 

mediated inherited retinal dystrophy (IRD),

 according to first author Alejandra Daruich, MD, PhD. She is from the Ophthalmology Department, Necker-Enfants Malades University Hospital, Paris Cité University, and INSERM, UMRS1138, Team 17, Sorbonne Paris Cité University, Centre de Recherche des Cordeliers, both in Paris.

Previous research has shown that voretigene neparvovec administered subretinally early in childhood for 

-mediated inherited retinal dystrophy achieved encouraging efficacious results,

 the authors explained. However, perifoveal chorioretinal atrophy developed in children who underwent post-market treatment.

Daruich and colleagues conducted a retrospective study to determine the main outcomes and complications in pediatric patients after treatment with voretigene neparvovec. They reviewed the records of patients younger than 17 years who had undergone subretinal administration of voretigene neparvovec for confirmed biallelic 

-mediated IRD. Twelve months after treatment, the best-corrected visual acuity (BCVA) was measured, spectral-domain optical coherence tomography (SD-OCT) and ultra-wide-field fundus images were reviewed, and the Goldmann visual fields were analyzed.

The study included 12 eyes (6 patients; mean age, 7.8 years). The investigators reported, “No intraoperative complications occurred. The BCVA significantly improved at the 12-month follow-up (mean logarithm of the minimal angle of resolution BCVA, 1.0±0.8 at baseline vs. 0.6±0.3 at 12 months, p=0.001). The mean central macular thickness and central outer nuclear layer thickness did not change at 12 months follow-up. The visual field V4e isopter did not show significant changes.”

Regarding complications, 1 patient had elevated intraocular pressure bilaterally. The most common complication was atrophy on the injection site. The atrophy on the injection site was limited in all patients except 1, in whom the atrophy increased considerably.

Daruich and colleagues concluded, “…the majority of pediatric patients treated with voretigene neparvovec exhibited a significant increase in visual function at the 12-month follow-up. This improvement was not associated with structural changes in SD-OCT or intraoperative foveal detachment. The most common complication was atrophy at the injection site. None of the observed postoperative complications prevented gains in visual function. Long-term studies are expected to evaluate the evolution of retinal thickness and chorioretinal atrophy.”

The investigators also pointed out that no consensus has yet been reached regarding the indications for treatment with voretigene neparvovec in children. Long-term studies are expected to evaluate the evolution of VA and chorioretinal atrophy in these patients.

Daruich A, Rateaux M, Batté E, et al. 12-Month outcomes after voretigene neparvovec gene therapy in paediatric patients with 

HauswirthWW, AlemanTS, KaushalS, et al. Treatment of Leber congenital amaurosis due to RPE65 mutations by ocular subretinal injection of adeno-associated virus gene vector: short-term results of a phase I trial.Hum Gene Ther. 2008;19:979–90. 

MaguireAM,SimonelliF, PierceEA, et al. Safety and efficacy of gene transfer for Leber’s congenital amaurosis.N Engl J Med. 2008;358:2240–8. 

BennettJ, WellmanJ, MarshallKA, et al. Safety and durability of effect of contralateral-eye administration of AAV2 gene therapy in patients with childhood-onset blindness caused by RPE65 mutations: a follow-on phase 1 trial.Lancet. 2016;388:661–72. 

Le MeurG, LebranchuP, BillaudF, et al. Safety and long-term efficacy of AAV4 gene therapy in patients with RPE65 Leber congenital amaurosis.Mol Ther. 2018;26:256–68. 

BainbridgeJWB, SmithAJ, BarkerSS, et al. Effect of gene therapy on visual function in Leber’s congenital amaurosis. N Engl J Med. 2008;358:2231–9. 

. Perifoveal chorioretinal atrophy after subretinal voretigene neparvovec-rzyl for RPE65-mediated leber congenital amaurosis.Ophthalmol Retina. 2022;6:58–64. 

Previous research has shown that voretigene neparvovec administered subretinally early in childhood for RPE65-mediated inherited retinal dystrophy achieved encouraging efficacious results.

clinical

Successful treatment of RPE65-mediated inherited retinal dystrophy with voretigene neparvovec

Considerations for surgical implant of the port delivery device and refill process

Video content above is prompted by the following:

What are the key considerations for the surgical implantation of the PDS?

Can you explain the refill process for the PDS and how it differs from standard intravitreal injections in terms of procedure and patient experience?

Panelists discuss how successful implementation of the port delivery system requires careful attention to surgical technique during both initial implantation and subsequent refill procedures, with specialized training and protocols that differ significantly from standard intravitreal injections in terms of procedural steps, sterility requirements, and patient preparation.

Video Series

Retinal Disease 

Considerations for Surgical Implant of the Port Delivery System and Refill Process

Panelists discuss how patients experiencing a high treatment burden with frequent anti-VEGF injections every 4-8 weeks are optimal candidates for the port delivery system, which can help reduce their number of clinic visits while maintaining therapeutic effectiveness.

Patient Selection For Port Delivery Device

Video content above is prompted by the following: 

Which patients are ideal candidates for this anti-VEGF delivery method?

Patients with frequent anti-VEGF treatment burden (4-8 weeks)

Patient Selection For Port Delivery System

Panelists discuss how the port delivery system (PDS) with ranibizumab represents a paradigm shift in neovascular AMD treatment by utilizing a surgically implanted refillable device that provides continuous medication delivery for 6 months, offering patients a preferred alternative to frequent intravitreal injections while ensuring consistent therapeutic levels.

Overview and Benefits of Port Delivery Device with Ranibizumab

Can you provide an overview of the port delivery system with ranibizumab approved for treating neovascular AMD?

What are the benefits of using the port delivery system with ranibizumab?

Certainty of 6 months of continuous anti-VEGF delivery

Patients in clinical trials prefer PDS over intravitreal injections

Overview and Benefits of Port Delivery System with Ranibizumab

Overview of Novel Treatments for Retinal Vascular Diseases

Video content above is prompted by the following: 


Could you briefly provide an overview of the new treatments available for retinal vascular diseases?

A panelist discusses novel treatments for retinal vascular diseases, including faricimab, aflibercept, and port delivery system with ranibizumab.

Dr Peter Karth

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