Quick Hits

Cataract surgery education, straight up

‘Most interesting meeting’ on planet in fifth year.

By René Luthe, Senior Editor

Cataract Surgery: Telling It Like It Is!” has always sold out, warns Robert H. Osher, MD, regarding the cataract surgery meeting he started in 2010. He attributes its success to the glowing reviews past attendees have given it, describing the meeting as intensely educational and entertaining, with an experienced faculty dedicated to making each attendee a better and more confident cataract surgery. “It has been rewarding to see that our candid, unrestricted approach has attracted so many young as well as experienced cataract surgeons,” he says.

The number of attendees — 500 — may be surprising, considering the Sarasota, Fla. meeting doesn’t offer CME credits, but Dr. Osher says the sacrifice is worth it so that presenters can “teach the way teachers should.

“Because this meeting allows presenters to speak freely and without restrictions, it was not difficult to recruit renowned surgeons such as Richard Makool, MD, Ike Ahmed, MD, Warren Hill, MD, Mike Snyder, MD, and other gifted teachers to join the faculty,” he says.

Each day features symposia (challenging cases and complication management); wet labs (intraocular devices, advanced suturing, anterior vitrectomy, and more); tutorials (IOL selection and IOL exchange); and videos. “I’m serving beer and pretzels to ophthalmologists around midnight,” Dr. Osher says. Experts teach their specialties — such as a wet lab taught by Boris Malyugin, MD, on how to use his eponymous pupil expander ring.

Boris Malyugin, MD, creator of the Malyugin Ring, seen here, will be the meeting’s international guest of honor.

At this year’s meeting, running from Jan. 15 to 18, presenters include Sunil K. Srivastava, MD, of the Cleveland Clinic, who will give the keynote address on cataracts and uveitis. Dr. Malyugin is back as the meeting’s international guest of honor. Dr. Osher has expanded the topics to include updates in retina, glaucoma, refractive surgery, cornea and neuro-ophthalmology, as well as an OMIC Risk Management session. The AAO will organize the meeting.

Ophthalmology Management’s medical editor, Larry Patterson, MD, will team with consultant John Pinto on a session devoted to practice management issues. Those who want to get started early can register for “Wednesday Night at the Movies,” scheduled before the meeting officially kicks off on Thursday morning, to see Dr. Osher’s picks for best videos from the video journal. For further information about this meeting, go to www.CSTELLINGITLIKEITIS.com.

DME implants gain approvals from FDA

New sustained-release treatments to become available in U.S.

By Bill Kekevian, Senior Associate Editor

The FDA has recently approved both a new intravitreal implant for the treatment of DME and a revised indication for an existing intravitreal implant. The two implants are Iluvien (0.19 mg fluocinolone acetonide intravitreal implant) (Alimera) and Ozurdex (0.7 mg dexamethasone intravitreal implant) (Allergan).

Ozurdex

In late September, the FDA expanded the approval for Ozurdex for use in the general DME patient population.

Ozurdex, a biodegradable implant that delivers an extended release of corticosteroid, was initially approved for the treatment of macular edema following retinal vein occlusion. It was first approved for treatment of DME in June, but only for adult patients who either have an artificial lens implant or are scheduled for cataract surgery.

Iluvien

Earlier in September, Iluvien received approval for the treatment of DME in patients who have previously been treated with a course of corticosteroids and did not have a clinically significant rise in IOP, according to parent company Alimera. Iluvien is a sustained-release intravitreal implant injected into the back of the eye with an applicator that uses a 25-gauge needle.

The implant is designed to deliver small amounts of the corticosteroid for 36 months. The 25-gauge needle allows for a self-sealing wound, according to a statement from Alimera.

Alimera has previously received marketing approval for Iluvien in 10 EU countries for the treatment of vision impairment associated with chronic DME considered insufficiently responsive to available therapies.

The FDA approval was based on clinical trial data in which patients treated with Iluvien experienced and maintained a statistically significant improvement in visual acuity.

The company expects to begin selling Iluvien in the United States during the first quarter of 2015.

Second Sight’s Argus II restores visual function for retinitis pigmentosa patients

Success of the “bionic eye” could pave the way for other vision restoration technology.

By Zack Tertel, Senior Associate Editor

Fran Fulton, a 66-year-old blind patient with retinitis pigmentosa (RP), presented to Wills Eye Hospital in Philadelphia interested in restoring her vision any way possible.

“She is someone who isn’t going to take any of life’s challenges lying down,” says Julia A. Haller, MD, Wills Eye ophthalmologist-in-chief. “She’s feisty, courageous, and she’s there fighting the whole way.”

A team of surgeons led by Retina Research Director Allen C. Ho, MD, successfully implanted the recently FDA-approved Argus II Retinal Prosthesis System (Second Sight) in Fulton, one of the first procedures of its kind in the United States.

Commonly described as a “bionic eye,” Argus II partially restores functional vision in patients with RP who are blind and have little to no light perception. The device uses a pair of glasses with an attached camera to wirelessly transmit images to the brain. Implanted in the patient is a ray of electrodes that processes the images into low-resolution, pixilated images. While the implant does not restore 20/20 vision, the patient sees visual perceptions of light patterns, an improvement that Dr. Haller compares to early cochlear implants that restored hearing in deaf individuals.

“Patients have to understand how the little objects they suddenly start seeing are translated into a door or a pathway,” she says.

Dr. Haller describes this adjustment period as a lengthy process, which is a reason she says the patient’s personality is a major factor in identifying potential candidates for the operation

“The patients who I’ve seen do best and really flourish are the ones with inquiring minds and strength of character that make them love challenges and want to adapt,” Dr. Haller says.

Wills Eye implanted some of the first Argus II devices in the United States during the clinical trials, and Dr. Haller was present on the FDA-presenting panel, an experience she says nearly brought her to tears as she listened to patient testimony.

“One question that came up was, ‘is it worth it just to get back the ability to see shapes and to navigate a little better?’” Dr. Haller says. “And actual patients came and spoke very compellingly about how it totally changes [their] life to go from living in darkness to living in a world where [they] can see motions and shapes.”

Dr. Haller says the Argus II parallels other types of vision restoration in development, such as stem cell restoration that harnesses cellular and regenerative capabilities. Similar to other forms of technology, Dr. Haller expects the vision restoration field to evolve and grow.

While she admits it is far down the pipeline, she is optimistic that other patients, beyond those diagnosed with RP, will also be able to receive replacement therapy solutions.

“It all points to the fact that there’s a whole new world of hope out there with blinding eye disease.”

How to deal with low vision and depression

Comorbid mental health issues are associated with conditions such as AMD, but what can eye-care professionals do about it?

By Bill Kekevian, Senior Associate Editor

Recent studies into the prevalence of depression among patients with low vision as a result of AMD come as no surprise to Barry Rovner, MD, professor of psychiatry and neurology in Philadelphia. Dr. Rovner has researched the link between AMD and depression for 23 years and his work includes the results of the Low Vision Depression Prevention Trial (VITAL), published in June.¹ Dr. Rovner started noticing a correlation between AMD and depression working at Wills Eye Hospital. “We started doing small epidemiological studies and we showed that in this population there are high rates of depression that weren’t being recognized or treated,” he says.

Supporting this work, a British study about the prevalence of depression in AMD found that people with AMD were more likely to experience symptoms of depression compared with those without AMD.²

Treating the whole person

“Wills Eye is leading the way in emphasizing the importance of ‘treating the whole patient’ and screening for depression in various populations,” Dr. Rovner says.

With better opportunities and need to treat AMD on an ongoing basis, ophthalmologists, particularly vitreoretinal specialists, have seen their patient loads increase quite dramatically, says Melissa Brown, MD, CEO of the Center for Value-Based Medicine in Philadelphia. “There’s no question that schedules are packed. However, time must be made to address these quality of life issues with our patients, regardless of how uncomfortable or unusual it is to do so. Depression is a problem commonly associated with low vision. To serve our patients well, we can and must address it.”

Addressing depression

“We don’t have to do anything extraordinary in terms of evaluation,” Dr. Brown says, “All we have to do is ask patients, ‘have you felt sad or depressed?’” Simply asking has been shown to have a 78% sensitivity and a specificity of 80%.³ In other words, patients will usually talk to ophthalmologists about depression they experience as a result of vision loss.

“When patients say they feel depressed most days of the week, that’s a problem that needs to be addressed,” says Dr. Rovner. He says the ophthalmologist should encourage patients to contact a low-vision optometrist who specializes in dealing with low-vision issues. If depression doesn’t improve, more specific mental health treatment is necessary. Using this approach, according to the VITAL study, depression in AMD patients can be halved.¹

Within a quality of life discussion, patients should be made aware that depression often accompanies vision problems and that doctors can provide helpful treatments, according to Dr. Brown. “I would tell them, ‘if you’re feeling that way, this is what I would like you to do’ and then encourage them to seek care with their primary care doctor. Following up on these quality of life issues at the next visit are key.”

References:

Online presence affects your practice

tip of the month

Websites don’t define your ability to practice, but Cynthia Matossian, MD, warns of what an out-of-date website can mean to patient perception. “Doctors without a website, or with websites that are old or out of style, or haven’t been updated in a long time, are damaging their credibility. That could be a reflection of the practice, be it real or perceived. They may be cutting- edge surgeons, but if they’ve neglected to update their website the patient may perceive them as being outdated. The content on the Internet and the way it’s presented has to reflect the practice and its vitality.”

To submit your own practice tip e-mail: william.kekevian@pentavisionmedia.com.

OWL to host events at AAO

Ophthalmic Women Leaders (OWL) will be attending and hosting several events at the 2014 AAO meeting in Chicago. The events will features speakers such as Mildred Olivier, MD, Lisa Arbisser, MD, and OWL president Marsha Link, PhD. All events will be hosted at the Hyatt McCormick Place, S400B, except the Monday event, which will be in the Hyatt McCormick Place, Jackson Park Room. Admission to the reception is free for OWL members and $25 for non-members.

Registration is available online at www.owlsite.org or at the door.