2017 Will Shape How We Treat Patients in the Future

The 2017 American Academy of Ophthalmology meeting was a culmination of many clinical trials and debates that will shape how we care for patients in the future. One of the cornerstones of the AAO Retina Subspecialty Day programs has been the “Hot Topic” debates. Is optical coherence tomography angiography (OCTA) ready for prime time? “No” was the response from the majority of audience members. I tend to disagree as I’ve used OCT to ferret out situations in my own patients when a fluorescein angiography wasn’t possible or was equivocal.

Is 3D heads-up surgery ready for “prime time”?  Again, the audience response was an overwhelming “No.” And again, I disagree as I’ve migrated fully to 3D surgery and love the encapsulating experience and well as being able to have everyone in the room follow along.

Is intraoperative OCT ready for prime time?  The answer was again a “no.” I don’t use intraoperative OCT routinely, but in select cases I can definitely say that it has improved my decision making ability.  

The late breaking sessions in particular were full of first presentations of data in assorted disorders such as diabetic macular edema, geographic atrophy (GA) and exudative age related macular degeneration.  One of the most impactful presentations was Protocol AA study from the DRCR.net.  In this study, patients were imaged with the 7 standard photographic fields versus and ultra widefield image capable of a 200 degree field of view.  The study found that grading with a single shot ultra widefield device was equivalent to the 7 standard fields. But those 7 standard fields are more time consuming and required significant effort on the part of the photographer to complete.

More impressive was the finding that peripheral retinal lesions helped to drive the risk of retinopathy progression higher and were especially seen on these wide field photographs.

In addition, we received data from the Apellis Filly study, which suggests that the inhibition of the complement pathway at the level of C3 does result in a reduction of progression of GA in patients. Inhibition higher in the alternative pathway at the level of factor D did not have any benefit.

The takeaway from these two studies suggests that we are finally understanding GA better from a mechanistic point of view, but still have achieved all of the understanding we need to about this complex disease.

Lastly we saw some compelling data from Novartis on the developed on the brolucizumab drug demonstrating that 50% of patients achieved q3 month dosing.  We hope to see other studies in the near future on abicipar and other mechanisms of action to see if we might decrease the frequency between injections and potentially achieve better adherence to established protocols.

- Rishi P. Singh, MD