Highlights from Hawaiian Eye and Retina 2022

The Hawaiian Eye and Retina 2022 meeting was held in Waikoloa Village, Hawaii, from January 15 to 21. Meeting attendees were updated on the latest developments in ophthalmology, with the expert faculty covering a broad range of topics, including recommendations for best practice.

Dr Peter Kaiser provided an update on emerging therapies for the treatment of dry age-related macular degeneration (AMD), explaining that several pathways are currently under investigation.¹ For example, both elamipretide (a drug that helps to repair mitochondrial dysfunction) and risuteganib (a synthetic RGD-class oligopeptide that boasts antiangiogenic and anti-inflammatory effects) have shown promise in clinical trials, with more studies ongoing.¹ In addition, the phase II ARCHER study will investigate ANX007, an anti-C1q antibody fragment that is formulated for intravitreal administration.¹ Dr Carl Regillo also discussed the exciting new treatment options that are in development for patients with wet AMD, including those that utilise alternative drug delivery routes to facilitate the sustained release of anti-vascular endothelial growth factor (anti-VEGF) agents, as well as novel anti-VEGF treatments.²

Another focus of the meeting was the prevention of endophthalmitis in patients receiving intravitreal injections. As explained by Dr Sunir Garg, the COVID-19 pandemic presented researchers with a unique opportunity to investigate whether face mask use can reduce the incidence of endophthalmitis. In a retrospective review of 505,968 injections that were carried out at 12 centres between October 2019 and July 2020, the incidence of endophthalmitis dropped from approximately 1 in 3,500 to 1 in 4,700 when a universal face mask policy was put in place.³ Although this was not statistically significant, there was a significant drop in the incidence of culture-positive endophthalmitis following the introduction of universal face mask use (approximately 1 in 10,000 to 1 in 25,000).³ In a separate presentation, Dr Garg reported the results of a prospective, double-armed interventional study that compared povidone-iodine 5% with aqueous chlorhexidine 0.1% as ocular antisepsis in patients undergoing same-day bilateral intravitreal injections.⁴ Among those patients experiencing pain following injection, the majority (79%) had greater pain in the eye treated with povidone-iodine.⁴

The landscape of ocular oncology is also evolving rapidly. Dr Basil K Williams explained how the introduction of new imaging technologies can benefit clinical practice, although he cautioned that anterior segment optical coherence tomography (OCT) should be used as an adjunct to clinical examinations, and not a replacement for them.⁵ Anterior segment OCT can be used to help physicians differentiate between different lesions, and can also be used to assess response to treatment or to identify early progression.⁵ Dr Williams also highlighted potential treatments for retinoblastoma – such as laser therapy, cryotherapy or chemotherapy (systemic, ophthalmic artery infusion or intravitreal) – and for uveal melanoma – such as diode laser transpupillary thermotherapy, proton beam radiotherapy, local resection and enucleation.⁵

Several presentations discussed cataract surgery, with a focus on matching the right intraocular lens (IOL) to the right patient. Dr Julie Schallhorn emphasised that monofocal IOLs remain important in cataract surgery, with high satisfaction rates despite the compromises; it is therefore important that physicians are familiar with the pros and cons of this type of lens so that they can understand how well they match their patients’ goals.⁶ Similarly, Dr Jack T Holladay discussed the compromises that are associated with multifocal IOLs, such as increased glare and halo effects, and emphasised the importance of choosing the right IOL for the right patient when using premium lenses.⁷ In addition to this, Dr Michael Greenwood presented the results of a retrospective chart review of patients who underwent LASIK or PRK enhancement after cataract extraction, showing that a greater number of patients achieved 20/20 uncorrected distance visual acuity following LASIK compared with PRK (67.2% versus 42.9%).⁸

Emerging treatments for diabetic macular oedema and diabetic retinopathy were also highlighted at the meeting. Dr Michael S Ip summarised the results of the KESTREL, KITE and KINGFISHER studies, which have shown that the anti-VEGF-A antibody brolucizumab has a favourable risk-benefit profile in patients with diabetic macular oedema.⁹ In a separate presentation, Dr Ip reported that RGX-314, a novel gene-based therapy designed to neutralise VEGF activity, was well-tolerated in the first cohort of patients with diabetic retinopathy who were treated in the phase II ALTITUDE study.¹⁰ RGX-314 is advantageous over current therapies as it involves a single suprachoroidal administration rather than multiple injections.¹⁰

Finally, several speakers discussed the importance of co-managing other diseases when treating eye disorders. For example, Dr Jeffrey Goldberg explained that ophthalmologists should consider other diseases that put the optic nerve at risk when treating patients for progressive glaucoma.¹¹ For example, physicians should check that hypertension is under control, encourage the use of a continuous positive airway pressure machine in patients who have obstructive sleep apnoea, and ensure that any inflammatory disorders have been treated.¹¹ Similarly, Dr Marjan Farid emphasised the importance of diagnosing and treating ocular surface disease preoperatively in patients who come in for cataract surgery, in order to improve postoperative outcomes.¹²

Visit the touchOPHTHALMOLOGY Conference Hub to see our full coverage of Hawaiian Eye and Retina 2022.

Support and Acknowledgements: Medical writing assistance was provided by Katharine Williams, supported by Touch Medical Media Ltd.

References

1. Kaiser PK. Update on emerging treatments for dry age-related macular degeneration. Presented at: Retina 2022; Jan. 15–21, 2022; Waikoloa, Hawaii.
2. Balatsoukas DD, Tsaousis KT, Boboridis KG, et al. Emerging treatment modalities for neovascular age-related macular degeneration: a systematic overview. Adv Ther. 2022;39:5–32
3. Garg SJ. What intravitreal injections have taught us about endophthalmitis. Presented at: Hawaiian Eye; Jan. 15-21, 2022; Waikoloa, Hawaii.
4. Garg SJ. Endophthalmitis projects during the pandemic. Presented at: Retina 2022; Jan. 15–21, 2022; Waikoloa, Hawaii.
5. Williams Jr. BK. What’s new in the world of ocular oncology? Presented at: Hawaiian Eye; Jan. 15–21, 2022; Waikoloa, Hawaii.
6. Schallhorn J. Monovision vs multifocal vs EDOF: Very important considerations. Presented at: Hawaiian Eye 2022; Jan. 15–21, 2022; Waikoloa, Hawaii.
7. Holladay JT. Optics and clinical performance: Mono, EDOF, pinhole, diff/ref, bifocal & trifocal IOLs. Presented at: Hawaiian Eye; Jan. 15–21, 2022; Waikoloa, Hawaii.
8. Greenwood M. Strategy and timing of refractive enhancements following cataract surgery. Presented at: Hawaiian Eye 2022; Jan. 15–21, 2022; Waikoloa, Hawaii.
9. Ip MS. Brolucizumab for the treatment of diabetic macular edema: Update from the KESTREL, KITE & KINGFISHER studies. Presented at: Retina 2022; Jan. 15–21, 2022; Waikoloa, Hawaii.
10. Ip MS. Update on gene therapy for diabetic retinopathy. Presented at: Retina 2022; Jan. 15–21, 2022; Waikoloa, Hawaii.