The 2016 annual meeting of the American Academy of Ophthalmology (AAO) was held in Chicago in mid-October. The Subspecialty Days provided updates on a vast array of topics, and as always, the general program was overwhelming in its breadth of offerings including spotlight sessions, scientific symposia, original papers, instructional courses, scientific posters, skills transfer programs, videos, technology pavilion learning lounge, and breakfast with the experts.
For those who were unable to make it to the meeting or would like to investigate some of the material further, additional resources are available on the AAO website.
Some of the presentations I found most interesting are briefly highlighted below.
Cataract
- Dr. Mary Atia compared the functional results of bifocal, trifocal, and extended depth of focus IOLs. In the 88 eyes studied, no IOL was better in all aspects, and the investigators concluded the IOL must be matched to the patient’s lifestyle.
- Dr. Jonathan Davidorf evaluated the benefit of intraoperative aberrometry during cataract surgery in eyes with prior myopic LASIK. In 52 percent of cases, the IOL power was changed based on the aberrometry, and the change improved the accuracy in half of these cases and reduced the accuracy in the other half.
- Dr. Soosan Jacob presented a new device, the glued capsular hook, for sutureless fixation of the capsular bag to the scleral wall. The device produces good centration and stability to the IOL.
- Dr. Mario Rojas compared the predicted residual astigmatism after toric IOL implantation using three different methods — Barrett toric calculator, Koch toric nomogram, and Cassini LED topographer. Results of this study of 200 eyes showed that the best predictor of residual astigmatism was the Cassini, followed by Barrett, and then Koch methods.
- Dr. William Wiley investigated the efficacy of corneal astigmatism treatment at the time of cataract surgery using aberrometry-guided limbal relaxing incisions versus topography-guided femto arcuate incisions. Both methods achieved similar results.
Refractive Surgery
- Dr. Karl Stonecipher assessed satisfaction in patients undergoing presbyopia correction with bilateral VisAbility implants. At three years, 95 percent of patients described their improvement in near vision as significantly better or better.
- Dr. Jesus Cabral-Macias compared outcomes of small-incision lenticule extraction to the implantable collamer lens in high myopes and found better visual acuity at day one in the ICL group but similar vision for both groups after one week.
- Dr. Seyed Hashemian evaluated long-term outcomes and complications of posterior chamber phakic IOLs for high myopia and astigmatism. At five years, the implants were effective, predictable, and safe. Forty-two of 66 eyes gained at least one line of vision, average endothelial cell loss was 11 percent, four eyes required lens realignment, and the crystalline lens remained clear in all eyes.
- Dr. Miguel Teus presented data from OCT evaluation of femtosecond LASIK flaps created with two platforms: Victus vs. IntraLase. The study showed differences in flap thickness homogeneity, which had refractive implications.
Cornea
- Dr. Marco Lombardo reported the one-year results of transepithelial corneal crosslinking using iontophoresis versus standard crosslinking for the treatment of keratoconus. Patients who underwent iontophoresis had better visual outcomes although the average corneal flattening was less than that observed with standard crosslinking.
- Dr. Rana Mady evaluated the subjective and objective effects of single thermal pulsation (LipiFlow) treatment in patients with Meibomian gland dysfunction. Only 57 percent of patients were satisfied despite improvement in signs and symptoms. This underscores the importance of patient expectation on perceived success of treatment.
- Dr. Satish Shet presented a new sutureless, glue-free surgical approach to primary pterygium surgery without a conjunctival autograft, in which the healthy conjunctival tissue overlying the pterygium is excised and placed over autologous blood on the scleral bed. In 72 eyes, there were no recurrences at one year.
- Dr. Cynthia Matossian discussed the safety and efficacy results of the OPUS-2 and OPUS-3 Phase 3 studies of lifitegrast 5.0% vs. placebo for dry eye disease. Lifitegrast was well tolerated and significantly improved symptoms of dry eye as early as day 14.
- Dr. John Sheppard evaluated the safety and efficacy of Dextenza, a 30-day sustained-release dexamethasone depot, compared to placebo when placed in the canaliculus of patients with dry eye. Dextenza was safe and effective in reducing the signs (corneal and conjunctival staining) of dry eye disease.
Glaucoma
- Dr. Rebecca Chen investigated the relationship of anterior chamber depth (ACD) with IOP reduction after cataract surgery. The study found that ACD is a predictor of IOP reduction, and shallow anterior chambers are associated with a larger IOP reduction after cataract surgery.
- Dr. Yoko Ikeda evaluated the safety and efficacy of a Rho kinase inhibitor, ripasudil, for reducing IOP in patients with glaucoma. During the one-year study, the drug significantly reduced IOP, but 17 percent of patients discontinued the drop because of adverse events or eye surgery.
- Dr. Young Kook Kim reported on the clinical significance of optic disc microhemorrhage in glaucoma. In 68 percent of the study eyes, the micro disc hemorrhage was detected prior to gross disc hemorrhage with a median lag time of 13.6 months. Eyes with microhemorrhage had visual field progression earlier.
- Dr. Shi Zhuan Tan discussed five-year results and cost analysis of combined phaco-iStent surgery in open-angle glaucoma patients. The study showed that the procedure is an effective treatment, and the cost effectiveness depends upon the health care system (UK vs. US) and whether branded or generic glaucoma eye drops are prescribed.
- Dr. Steven Vold reviewed three-year results of a supraciliary microstent for lowering IOP in glaucoma patients undergoing cataract surgery. The combined surgery was safe and effective compared to cataract surgery alone.
Retina
- Dr. Arshad Khanani reported on ORBIT — a Phase 4 study of the efficacy and safety of ocriplasmin intravitreal injection for patients with symptomatic vitreomacular traction. Results of this study showed better efficacy than in the MIVI-TRUST study with comparable safety profile.
- Dr. Daniel Schwartz studied the effect of bevacizumab, ranibizumab, and aflibercept injections on retinal nerve fiber layer thickness in patients with diabetic macular edema. The anti-VEGF agents significantly reduce RNFL thickness in a dose-response fashion.
- Dr. Preethi Sridharan investigated the role of sub-threshold diode micropulse laser for acute central serous chorioretinopathy compared to observation, and found that the laser treatment is beneficial in these cases by producing faster visual recovery with no complications.
- Dr. Michael Fielden shared five pearls from the BRIGHTER and CRYSTAL studies for treating ischemic retinal vein occlusion patients. The studies demonstrated that flexible administration of ranibizumab is effective in the treatment of ischemic BRVO and CRVO.
- Dr. Andrew Moshfeghi presented the visual and anatomic outcomes before and after cataract surgery in patients treated for diabetic macular edema with aflibercept injections or laser in the VISTA and VIVID studies. The BCVA gains were higher in patients treated with injection vs. laser despite a modest increase in central retinal thickness.
Later this week, we continue our review of the AAO 2016 meeting with a look at some of the newest products and trends from exhibitors.