The last day of AAO 2020 Virtual featured a round-up of sorts — a discussion of some of the hot topics that have raised eyebrows and perked up ears across the ophthalmic industry. It was fitting that this discussion was saved for the last day, as it gives attendees a chance to think about the major trends of the last year and consider possible trends for the future.
Similarly, some valuable questions were answered regarding some of the year’s more pressing topics. Had the discussion been allowed to continue past the hour mark, the panelists would have had no shortage of conversation fodder.
Extended-release glaucoma implants
Dr. Randy Craven discussed a long-awaited treatment option: an extended-release glaucoma implant. The reasons driving the desire for such an option are many, but they all revolve around improving patient adherence to treatment. An implant guarantees a patient gets the treatment they need to manage IOP and makes forgetfulness obsolete.
Bimatoprost intracameral, also known as DURYSTA (Allergan, Dublin, Ireland) became available in the United States on June 23 of this year — so it’s hot off the presses. Dr. Craven indicated the implant can be inserted either via slit-lamp or in a minor surgical room, so both physicians and patients have options.
Immediately following the implant, data shows that the patient will experience a strong drop in IOP to below target IOP. That level will rebound and reach a steady level within the target IOP — around 16-17mmHg, according to the Artemis study — at about 4 months, and will slowly but steadily increase as the implant dissolves.
Dr. Craven also pointed out the safety of bimatoprost, noting that corneal endothelial cell loss at 24 months was only 3%, very similar to the 1% shown in the control group.
Other implants in the pipeline are Travoprost XR (Envisia Therapeutics, North Carolina, USA) and iDose (Glaukos, California, USA), both currently in phase II studies.
Immunotherapy for Ocular Cancer
Yale’s Dr. Rinelle P. Lim introduced some fascinating research demonstrating the viability of immune checkpoint inhibitors. It’s worth noting that the first immunotherapy was approved by the FDA in 2011, and seven varieties have been further approved since then.
Dr. Lim discussed ways to keep cancer-fighting T cells in their active state. B7 proteins keep T cells active, and Dr. Lim noted two important receptors that interact with B7: CTLA4 and CD28. Essentially, CTLA4 acts like a brake on the interaction between B7 and T cells, reducing the activity of T cells. CD28 acts in the opposite way, as an accelerant, increasing the activity of T cells.
Preventing the binding of CTLA4 and B7 can help keep T cells active, says Dr. Lim. This leads to the immunotherapies mentioned above. Combinations of Ipi and Nivo therapies, for example, can lead to a 63% survival rate of metastatic melanoma according to data presented.
Overall, Dr. Lim recommends considering immune checkpoint inhibitors for treating aggressive primary or metastatic periocular or orbital tumors.
Treating ocular tumors requires a multidisciplinary approach, and in the question and answer section panelists asked Dr. Lim if there were any complications in collaborations. For example, an ophthalmologist would have to work with an oncologist and an ENT specialist for many of these treatments.
Dr. Lim indicated she’d encountered no difficulties working with other specialists. Simply put, they’re all working together with the patient’s best interest in mind. To wit, she had no problems acquiring medicine or agreeing on therapeutic treatments with her colleagues. That’s good news across the board, and something doctors can be proud of.
