Caroline Helwick

November 15, 2013

NEW ORLEANS — Within virtually every subspecialty of ophthalmology, there are emerging trends and new technologies for clinicians to stay informed about. And with healthcare reform, practice and policy issues are becoming more important than ever to specialists.

The American Academy of Ophthalmology (AAO) will address these and other issues here at the 2013 Annual Meeting, which opens November 16. The conference will offer more than 280 instructional courses, nearly 100 skills transfer labs, 50 symposia and spotlight sessions as well as hundreds of scientific papers and posters.

AAO spokesperson Michael Repka, MD, from the Johns Hopkins School of Medicine, pointed out that attendees will be able to grapple with policy and practice issues up-close-and-personal with experts at the meeting. "Policy changes by the minute. We are all worried about what will happen with sequestration, the sustainable growth rate, and payment reform." The learning lounge is one innovative platform for these topics, where attendees can participate in informal conversations, he said.

Andrew Iwach, MD, executive director of the Glaucoma Center of San Francisco, also a spokesperson for AAO, told Medscape Medical News the meeting "is the preeminent platform for research, and draws the best of it."

For clinicians and researchers, "the academy is a unique organization where all aspects of eye care are addressed, including new regulations and practice tools in addition to clinical information," he said. "At the AAO meeting, these resources are available in the form of panels, courses, lectures, research presentations — everything the ophthalmologist needs to be a top-notch clinician," Dr. Iwach said.

With so many options, attendees can have a hard time choosing among the many educational events, but the option of purchasing a general pass for courses, without having to commit ahead of time, makes the educational process more organic, he noted.

"I can go to any course I want to on that particular day. I may have had a tough case just the week prior to the meeting, and there may be a session that would be informative on that. Attendees like to have that flexibility," Dr. Iwach said.

He singled out several presentations that may help advance the subspecialty of glaucoma.


Dr. Iwach pointed to a study of a 60-day travoprost punctum plug for reducing intraocular pressure (Abstract PO094). "The challenge in treating glaucoma is that it is a chronic disease, and medications must be dosed up to 3 times daily. There's been lots of interest in trying to design a delivery system that is more convenient for patients," Dr. Iwach said.

The study will evaluate a means of slowly releasing glaucoma medication, which will eliminate the big swings in dosing that can occur with eye drops. "This is exciting, demonstrating a new delivery mechanism for drugs that are already approved. It would be convenient, create better compliance, and offer better control of pressure," he noted.

The 2-year clinical experience of combined cataract surgery and supraciliary Micro-Stent implantation will also be presented (Abstract PO352). This will provide information for moving the combination treatment approach forward. "We hope this device has potential," Dr. Iwach said. "It is an example of a trend on the surgical management of glaucoma where we need better ways to help patients."

Because there is interest in measuring intraocular pressure during the 24-hour period, attendees will hear about how continuous nyctohemeral intraocular pressure pattern can identify glaucoma patients in comparison with healthy control indivduals (Abstract PA073).

Another study will explore the trend in online delivery of healthcare and will compare online perimetry and Humphrey visual field testing (Abstract PA075). "We now have opportunities to do things remotely, and if validated, this could be a potential tool, though we will have to put it into context with the clinical picture," Dr. Iwach explained.

Researchers will also present findings on primary angle-closure glaucoma (Abstract PO083). A new study has found increased risk among family members — a fact that needs to be emphasized to the general public, Dr. Iwach pointed out. "The study reminds us that by talking about family risk with our patients, we may find individuals with glaucoma who are not yet diagnosed."

Abdhish Bhavsar, MD, from the Retina Center Minnesota, told Medscape Medical News about some of the best abstracts in retinal disease.

Retinal Disease

He pointed to the Argus II retinal prosthesis, which helps blind people with outer retinal dystrophies identify common objects (Abstract PO181). "This involves a small number of patients, but deserves attention, which I believe it will get because this is the first artificial retina, and it's the farthest along in development," he said. "While the device is rudimentary, it can bring vision to the patient with no outer vision, and it's outstanding to be able to do that."

Several cutting-edge advances are anticipated to garner a lot attention. Early work in the area of genotyping will evaluate the impact of genes on predicting advanced macular degeneration (Abstract PO186). Although the clinical utility of genotyping is still in the future, understanding genetic predisposition is a first step.

The potential benefit of human umbilical tissue–derived cells delivered subretinally to patients with geographic atrophy will also be explored in a phase 1 study (Abstract PA058).

Of more clinical utility, investigators will try to settle the debate over the potential association between antibiotic use and retinal detachment and breaks through a population-based study of oral fluoroquinolones (Abstract PO488).

Dr. Bhavsar predicted that the case-based course on diabetic retinopathy, which is always popular, will help attendees apply the latest clinical trial results to their practices.

Dr. Repka also identified several newsworthy abstracts in his subspecialty of pediatric ophthalmology.

Pediatric Ophthalmology

A randomized trial is comparing part-time patching with observation for children with intermittent exotropia (Abstract PA056). "Ophthalmologists have been skeptical about this nonsurgical intervention, but a small benefit was shown in this study," he said. The approach will be "exciting" if long-term follow-up validates the results, he added.

Screening for strabismus is important, and new tools for this are always of interest. In a large, retrospective review, researchers evaluated the accuracy of the Plusoptix photoscreening device (Abstract PO414).

Also of note is a 10-year review that shows how the use of visors by athletes can greatly minimize the risk for eye injuries (Abstract PO072). Although conducted in hockey players, the study's results translate to other sports, Dr. Repka said.

Dr. Repka, Dr. Iwach, and Dr. Bhavsar report no relevant financial relationships.

American Academy of Ophthalmology (AAO) 2013 Annual Meeting: November 16 - 19, 2013.


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