American Academy of Ophthalmology, Nov. 12-15

The annual meeting of the American Academy of Ophthalmology was held from Nov. 12 to 15 in New Orleans and attracted participants from around the world, including ophthalmologists, optometrists, opticians, and other eye health care professionals. The conference featured presentations focusing on the latest advances in comprehensive eye care, including medical, surgical, and optical care.

As part of the HORIZON pivotal trial, Iqbal Ahmed, M.D., of Massachusetts General Hospital and Harvard Medical School in Boston, and colleagues found that cataract surgery combined with the Hydrus Microstent device lowers the rate of visual field loss by 47 percent compared with cataract surgery alone in patients with mild-to-moderate open-angle glaucoma with cataract.

The authors performed a retrospective analysis on all visual field follow-ups from baseline through five years. At three years, the researchers found that use of the Hydrus Microstent had a positive impact on the rate of invasive secondary surgery, which was also observed at five years and resulted in a 47 percent reduction in visual field loss.

"This is tremendous news for glaucoma patients because it is well documented that each decibel reduction in visual field loss from glaucoma has a dramatic impact on patient quality of life and health care costs," Ahmed said. "Even a slight loss of vision can create a cascade of medical costs, from increased glaucoma medications to additional surgeries to hospitalizations from fractures and falls."

One author disclosed financial ties to pharmaceutical and biotechnology companies, including Ivantis, the manufacturer of the Hydrus Microstent device.

Abstract No. PA001

In another study, Carol Shields, M.D., of the Wills Eye Hospital in Philadelphia, and colleagues found that a novel treatment, a virus-like drug conjugate (AU-011), is promising as an alternative treatment for choroidal melanoma and indeterminate choroidal tumors.

The authors evaluated the efficacy and safety of AU-011, which was injected into the eye and stimulated by laser light to induce tumor cell necrosis. Single ascending doses and multiple ascending doses were studied, as were expansion cohorts using intravitreous injection of AU-011 combined with laser light. The safety study revealed AU-011 was well tolerated and produced intraocular inflammation, which was controllable with topical, oral, or periocular corticosteroids. Patients tolerated the medication with minimal pain and vision loss of 3.6 percent. Regarding tumor control, of those with actively growing small choroidal melanoma, the researchers found that the growth rate was significantly reduced. For patients with actively growing small choroidal melanoma who received the full therapeutic regimen, tumor control at 12 months was 64 percent.

"Certainly, there will be an impact in the management of small choroidal melanoma and indeterminate lesions. Up to now, small melanoma has been treated with plaque radiotherapy with favorable tumor control but with anticipated severe loss of vision, so AU-011 offers a potential alternative therapy for tumor control with preservation of vision," Shields said. "Indeterminate choroidal lesions have been managed by cautious observation, but at some risk to the patient if the tumor shows rapid growth, but now AU-011 offers a potential alternative for earlier intervention."

One author disclosed financial ties to Aura Biosciences, the manufacturer of AU-011.

Abstract No. PA054

Jordan Leo Hamburger, of the Wills Eye Hospital in Philadelphia, and colleagues found that children can experience acute eye symptoms that are statistically significant from just one session of virtual school.

The authors recruited 110 healthy children from the community between the ages of 10 and 17 years. These children were enrolled in at least one day of virtual learning a week and were instructed to fill out the two symptom surveys before and after school. The researchers found that during the course of one virtual school day, children exhibited a significant rise in eye symptoms. Specifically, 61 percent of healthy children had complaints directly related to their binocularity and 53 percent had complaints related to ocular surface discomfort.

"It was also surprising to us that the binocularity complaints were directly proportional to the number of hours spent with digital learning," Hamburger said. "The results are important because we know that digital technology is here to stay and will likely remain a part of the educational curriculum even postpandemic."

Abstract No. PA016

Philip Ferrone, M.D., of Vitreoretinal Consultants in Great Neck, New York, and colleagues found that according to the results of two randomized phase III trials (YOSEMITE and RHINE), injections of faricimab up to every 16 weeks for diabetic macular edema (DME) offer durable efficacy.

In YOSEMITE and RHINE, researchers investigated the efficacy of faricimab every eight weeks or per personalized treatment interval (PTI) protocol, including dosing up to every 16 weeks, compared with aflibercept 2 mg every eight weeks (as per label dosing) for patients with center-involving DME (central subfield thickness [CST] ≥ 325 µm) and best corrected visual acuity (BCVA) 25 to 73 ETDRS letters (Snellen [BCVA] ~20/320 to 20/40). YOSEMITE and RHINE both met their primary end point for mean best corrected visual acuity gains at one year, with faricimab either every eight weeks or PTI protocol up to every 16 weeks both being noninferior to aflibercept every eight weeks. At week 52, durable vision gains were achieved in more than 50 percent of patients in the faricimab PTI arms with dosing every 16 weeks. More than 80 percent of the faricimab PTI arms achieved absence of DME at week 52.

"There was early disease control with faricimab with greater reductions in CST, and more patients achieved absence of intraretinal fluid, versus aflibercept through week 56. Also, more patients treated with faricimab achieved absence of DME (CST < 325 µm) compared with aflibercept through week 56," Ferrone said. "Faricimab was well tolerated, with low rates of ocular and nonocular adverse events through week 56, and no signs of retinal vasculitis or occlusive retinitis."

One author disclosed financial ties to pharmaceutical and biotechnology companies, including Genentech, the manufacturer of faricimab.

Abstract No. PA043