Ophthalmology

The European Medicines Agency publishes a full scientific assessment report called a European public assessment report (EPAR) for every medicine granted a central marketing authorization by the European Commission. A few months ago, the EPAR evaluation of the VIEW trials stated, “The number of cerebrovascular events was higher in the VEGF Trap-Eye groups (35) compared with ranibizumab (two cases), especially in the subgroup greater than or equal to 85 years (20 vs. one case).”

Ask a retina specialist how she treats patients with diabetic macular edema, and more than likely she will reply that she follows the DRCR.net Protocol I. Really? How many retina specialists know that to follow Protocol I, patients are seen not monthly but every 4 weeks for more than a year? Or that the first opportunity to not treat the patient with ranibizumab on an every-4-week basis was at week 16? Approximately 25% of patients met the criteria not to be treated at week 16; however, more than 90% of these patients recurred and had to be re-treated. How many retina specialists know that in Protocol I the first opportunity to not see the patient and thereby decrease the treatment burden of being seen on an every-4-week basis was after week 60? And the bottom line is that as important a study as Protocol I is, it is largely a hypothetical study and rarely, if ever, is it followed in clinical practice because it is simply not sustainable. Remember that patients with diabetic macular edema are often young patients in the workforce who are historically noncompliant.

I think duty cycle control is the most misunderstood of our recent surgical parameters. The definition of duty cycle is the percentage of time that the cutter remains open in a given cut cycle. As far as I know, the only surgical device to have duty cycle control is the Alcon Constellation machine. I need to disclose herein that I am a consultant for Alcon and I use the Constellation.

The news that Eylea (aflibercept, Regeneron) 2 mg every 4 weeks has been approved by the U.S. Food and Drug Administration for the treatment of macular edema following central retinal vein occlusion is welcome news to the retina community.

The treatment of dry age-related macular degeneration is the holy grail for a retina specialist.

The degree of metabolism that occurs in the photoreceptor choriocapillaris retinal pigment epithelium (RPE) interface is unsurpassed in the body. It is thought that this results in toxic by-products that accumulate, resulting in macular degeneration. Therefore, a natural strategy to treat dry macular degeneration is to slow down this entire metabolic process.

Anti-VEGF monotherapy will go down in medical history as a treatment model that was both insurmountable and unsustainable.

It was insurmountable because of the historic gains that were seen in a disease, neovascular macular degeneration, that had miserable treatment results earlier. We went from essentially not being able to treat our patients at all and watching them go blind to being able to maintain vision in 90% of our patients with exudative macular degeneration. We were able to actually improve vision in 30% to 40% of our patients with neovascular macular degeneration with anti-VEGF monotherapy.

The editors of Ocular Surgery News and OSN Retina would like to welcome our first blogger in the retina subspecialty, Pravin U. Dugel, MD, managing partner of Retina Consultants of Arizona, who will focus on putting the latest news and clinical trials into practical perspective for the busy retina specialist. The long-awaited and often controversial CATT 2-year results were presented at the recent ARVO meeting in Ft. Lauderdale. Most people think of the CATT as simply a comparison of Avastin (...