EURETINA 2024: Boris Stanzel, MD, shares research on fluid monitoring and fixation clouds

At this year's European Society of Retina Specialists (EURETINA) meeting, Boris Stanzel, MD, visited the Ophthalmology Times Europe booth. He spoke about a wide range of topics, including central subfield thickness (CST) measurements in age-related macular degeneration (AMD) and diabetic macular oedema (DME), picking the right intraocular lenses for patients with geographic atrophy (GA), and interesting symposia from the congress, including in-office applications of artificial intelligence (AI).

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

Boris Stanzel, MD: Hello. My name is Boris Stanzel. I'm a professor of ophthalmology with a teaching affiliation at the University of Bonn, but my main practice is at the Eye Clinic Sulzbach Germany. Nobody knows Sulzbach—that's the sort of the underdog statement that we have all the time. Sulzbach is sort of at the Southwest border, at the border to France and Luxembourg, so it's a very good wine region! But okay, jokes aside, we are the largest surgical retina centre in Germany, and we're sort of top three in medical retina practice in Germany as well.
So, for me, several contributions at the EURETINA. So one that I spoke about was fluid quantification with the RetInSight Fluid Monitor in the VABYSMO [faricimab-svoa] patients in a real-life cohort. And we found that basically, when you look at CST measurements compared to fluid quantification in AMD, CST underestimates the drying with VABYSMO by two-fold in DME; it's a four-fold underestimation of CST. Translated, say, in a switcher population, basically patients with AMD, when you load them with VABYSMO, get an additional up to 40% drying. Patients with DME get an up to 60% drying with VABYSMO up-load. So this is first-time quantification of these data. It's a small cohort, but it appeared to be reproducible among many sort of incremental data acquisitions that we had.
The other contribution that we made at this meeting was that we had looked at a kind of new intraocular lens, which was a monofocal lens that has a hyperspheric design. And that is very interesting for patients who have some form of macular atrophy. Obviously, geographic atrophy is a big buzzword at this moment, and so a lot of these patients who have a macular atrophy have a lost fixation. And so, fixation is something that you can quantify with microperimetry. In other words, when you first turn on microperimetry devices, they do something what is called a fixation cloud. So, the bigger the fixation cloud, the lesser the ability of a patient to fixate. Our theory was that if you put in a regular lens, then the IOL is basically [shining] the optical path onto the macular scar, which makes no sense. But by using a lens that has a wider viewing angle, you can actually look at the somewhat healthier areas at the edges of the scar, and thereby perhaps shrink that fixation cloud. And turns out, this is exactly what happened in a smaller cohort of patients. Were basically independent of the sort of approval and transparency. We also had a shrinkage of the fixation. And so that perhaps is, at the moment, an unexplored niche in sort of visual rehabilitation of patients. And so, I should add a caveat that basically, we don't have a control group. So this is really just exploratory at the moment, but I think this is a very interesting technology that, I think, once you get sort of the hang of this lens and what it can do, you start seeing so many patients who have macular disease we can put it in.

What else did I sort of get excited about at this meeting? Well, you know, AI is everywhere. And so we all have this problem of, "I saw these patients back then, then I saw another patient, then you need to go to your clinic manager. Can you make me a list of that?" And, and so recently, I came across a pitch presentation at the EURETINA Innovation Symposium, where [the] result was, "Well, it's kind of like Chat GPT, this technology, and you tell it what you want, and it will go into your medical record and pull those patients for you." Fantastic! I mean, I'm not saying AI is replacing people, but this idea is just very close to it.