American Academy of Ophthalmology – 2022 Annual Meeting

Zaina Al-Mohtaseh, MD, whom I met years ago when I was interviewing at Baylor for ophthalmology residency, discussed various surgical methods of fixating intraocular lenses (IOL) without the use of sutures. As a retina specialist, I occasionally am referred patients needing a scleral-fixated IOL, and will definitely incorporate some of the surgical techniques taught by Dr. Al-Mohtaseh and her colleagues.

I attended several sessions discussing several different techniques for using scleral buckle surgeries for the repair of retinal detachments. These techniques are used less frequently than vitrectomy for the repair of retinal detachments, but it is critical to be comfortable and confident in scleral buckling, as this type of surgery is a slam dunk for the right patient at the right time. I am grateful that my residency and fellowship both taught this “old-school” surgical technique, and I am grateful to be able to offer this type of surgery to my patients in Castle Rock and throughout Colorado’s Front Range.

On Sunday morning I volunteered to help with a session featuring several very interesting and recently-published papers involving the vitreoretinal disease. My responsibility was nothing more than running the stopwatch to help the speakers stay on time, but I enjoyed having a front row seat listening to these very interesting presentations.

Christine Nichols Kay, MD discussed the TEASE Study, which is a randomized, placebo-controlled clinical trial using the investigational drug, ALK-001 for the treatment of Stargardt disease. Stargardt disease is the most prevalent macular dystrophy and results from defects in the ABCA4 gene that cause accelerated formation of vitamin A dimers in the retina. Each year I see a handful of patients with Stargardt disease, and I am encouraged by Dr. Kay’s recent findings, which demonstrated a slowed progression of the atrophic retinal damage that is the main cause of permanent, center-involving, vision-loss in patients with Stargardt disease. I am hoping that I will soon be able to offer my patients with Stargardt disease a medication that can help them maintain their central vision for much longer than has been possible previously.

Catherine Creuzot-Garcher, MD, PHD gave a very interesting presentation discussing the STAR trial, which involves the very challenging clinical scenario of subretinal/submacular bleeding due to choroidal neovascularization and wet age-related macular degeneration. Her study sought to determine if there was a significant difference in visual acuity at 3 and 6 months following the treatment of submacular hemorrhage with either vitrectomy and subretinal treatment with tissue plasminogen activator (which we refer to as “TPA”) or with pneumatic displacement of the subretinal hemorrhage via a clinic-based procedure involving the injection of SF6 gas into the back of the eye to try and displace the blood from beneath the macula (blood underneath the retina in the macula causes considerable damage and vision-loss). Her study found that while both groups demonstrated improvement in visual acuity, there was no significant difference in the 3 and 6 month visual acuities between the surgical (vitrectomy with TPA) and non-surgical  (intravitreal SF6 gas displacement) options. A different-but-related study, called the TIGER Study, is on-going and will be looking for a difference in visual outcomes between treating submacular hemorrhage with intravitreal aflibercept (Eylea) alone compared to vitrectomy, subretinal TPA, SF6 gas, and intravitreal aflibercept. Hopefully these studies will continue to provide an evidence-based approach to the treatment of this very challenging, and potentially blinding condition.