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Cover Focus | Sept/Oct '21

On the Radar

At the 2021 Women in Ophthalmology (WIO) Summer Symposium, several ophthalmic experts reviewed innovations with potential to fill unmet needs within their subspecialties. Below are some key highlights from those presentations.1


NEW RETINA SURGICAL TECHNIQUES

Given the burden associated with standard anti-VEGF injection regimens, several new retina surgical options are in development to provide increased durability or sustained-release treatment. Lejla Vajzovic, MD, highlighted two of these options: the Port Delivery System with ranibizumab (PDS; Genentech) and RGX-314 (RegenXBio).

  • PDS with ranibizumab provides continuous intravitreal delivery of a customized formulation of ranibizumab (Lucentis, Genentech). This platform is being investigated for the treatment of wet age-related macular degeneration (AMD), diabetic macular edema, and diabetic retinopathy without diabetic macular edema.
  • RGX-314 is a subretinal gene therapy in development for exudative AMD and diabetic retinopathy. Several clinical trial programs investigating both subretinal and suprachoroidal use are underway.

NEW OCULOPLASTIC SURGICAL TECHNIQUES

Corneal nerves are essential for corneal health, as emphasized by Cat Burkat, MD, and Andrea Kossler, MD. Drs. Burkat and Kossler discussed the promise of corneal neurotization, an effective new surgical procedure that can restore sensory innervation to a neurotrophic cornea. This approach involves the surgical transfer of sensory donor nerve fibers to the cornea and can be done via direct or indirect transfer.

NEW OPTIONS FOR CATARACT SURGERY

Novel IOL technologies continue to be developed, and staying up to date on the available options helps to inform the clinical decision-making process. Priyanka Sood, MD, overviewed some of the lens options that are newer to the cataract surgery scene.

  • The Tecnis Eyhance (Johnson & Johnson Vision), which received FDA approval in February 2021, is a UV-blocking hydrophobic acrylic monofocal IOL with an aspheric anterior surface and extended depth of focus (EDOF)-like qualities.
  • The Clareon (Alcon), which received FDA approval in 2020, is a UV-blocking hydrophobic acrylic IOL that is made of a patented optic polymer material and features a precision-edge design to decrease photic phenomenon.
  • The Light Adjustable Lens (RxSight), which received FDA approval in 2017, is a three-piece, photoreactive, UV-absorbing silicone lens that can be adjusted postoperatively using light treatments.
  • The AcrySof IQ Vivity (Alcon), which received FDA approval in 2020, is an aspheric UV-blocking hydrophobic acrylic IOL with a nondiffractive EDOF design.
  • The AcrySof IQ PanOptix Trifocal IOL (Alcon), which received FDA approval in 2019, is a trifocal lens with diffractive rings in the central 4.5 mm. It splits light for distance, intermediate, and near, and its anterior surface is designed with negative spherical aberration.
  • The Tecnis Synergy IOL (Johnson & Johnson Vision), which received FDA approved in May 2021, is a UV-blocking hydrophobic acrylic lens that features elements of EDOF technology and diffractive multifocal optics.

NEW Therapeutic Innovations in Neuro-Ophthalmology

New therapeutic options for various neuro-ophthalmic conditions are becoming available, offering neuro-ophthalmologists and their patients options beyond steroids, explained Kimberly Winges, MD. Some of the new approaches include the following.

  • Tocilizumab (Actemra, Genentech) received FDA approval in 2017, becoming the first approved therapy for giant cell arteritis, the most common vasculitis among adults older than 50 years. Tocilizumab is an anti-IL 6 receptor antibody that reduces B cell activation, acute phase reactants, and differentiation of helper cells.
  • Teprotumumab (Tepezza, Horizon Therapeutics) received FDA approval in 2020, becoming the first approved therapy for thyroid eye disease. Teprotumumab blocks the IGF-1R antibody of the TSHR/IGF1 receptor complex and prevents stimulation of fibroblasts.
  • Antibody testing is now being utilized for atypical optic neuritis, including for myelin oligodendrocyte glycoprotein IgG-associated disorder (MOGAD) and neuromyelitis optica (NMO). The anti-MOG antibody test is available for MOGAD, a condition that is typically more bilateral, presents with disc edema and longitudinal optic nerve enhancement, and is more common in children. Additionally, the aquaporin-4 chloride channel antibody test is available for NMO, a condition that is typically bilateral, presents with longitudinal optic nerve enhancement, can involve the chiasm or other central nervous system structures, and affects more women than men.
  • Oral megadose steroids have been shown to be as effective as intravenous steroids for typical optic neuritis. The key, however, is administering a bioequivalent dose.
  • Stroke screening (and treatment as needed) for central retinal artery occlusion (RAO) is now recommended, as an RAO is considered an embolic stroke based on a new classification from the American Heart Association and American Stroke Association. A stroke workup should be performed in patients who present with CRAO.

1. Hot topics: clinical and therapeutic innovations. Women in Ophthalmology Summer Symposium; August 27, 2021; Amelia Island, FL.

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