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A C C R E D I T A T I O N A N D C R E D I T D E S I G N A T I O N

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of Beaumont Health, Medical Conference Planners, Inc. and the

Aspen Retinal Detachment Society. Beaumont Health is accredited by the ACCME to provide continuing medical education for physicians.

Beaumont Health designates this live activity for a maximum of 12.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

FEBRUARY 29-MARCH 4, 2020 • S N O W M A S S , C O L O R A D O

48th Annual

Aspen Retinal Detachment Society

Meeting

T H E A S P E N R E T I N A L D E T A C H M E N T S O C I E T Y

“Oh vitreous where is thy humor?”

ARDS 2020 • SNOWMASS, COLORADO 3

Guest Faculty

Program Directors Founders Meeting Planner

R.V. Paul Chan, MD, MSc, MBAIllinois Eye and Ear Infirmary Chicago, IL

Philip J. Ferrone, MD Long Island & Queens Vitreoretinal ConsultantsGreat Neck, NY

Jay S. Duker, MD New England Eye Center/Tufts University Boston, MA

Glenn J. Jaffe, MDDuke Eye CenterDurham, NC

FOUNDERS LECTURE

Carl D. Regillo, MDWills Eye HospitalPhiladelphia, PA

Baruch D. Kuppermann, MD, PhDUniversity of California, IrvineIrvine, CA

Carol L. Shields, MD Wills Eye HospitalPhiladelphia, PATAYLOR SMITH & VICTOR CURTIN LECTURE

Christina Y. Weng, MD, MBABaylor College of MedicineHouston, TX

Giovanni Staurenghi, MD University of MilanMilan, Italy

Donald J. D’Amico, MDWeill Cornell Medicine OphthalmologyNew York, NY

William O. Edward, MD1930-2012

Karen BaranickMedical Conference Planners Intl.Los Angeles, CA

Timothy G. Murray, MD, MBAMurray Ocular Oncology and RetinaMiami, FL

Ottiwell W. Jones, III, MDSpokane, WA

4 ARDS 2020 • SNOWMASS, COLORADO

FOUNDERS LECTUREMONDAY, MARCH 2, 2020 • 6:55 PM

Intraocular Drug Delivery - A Winding JourneyGLENN J. JAFFE, MD

Glenn J. Jaffe, MD is the Robert Machemer Professor of Ophthalmology and a member of the vitreoretinal faculty at Duke University Eye Center. He is chief of the Vitreoretinal Division, and founded and directs the Duke Reading Center. Dr. Jaffe received his medical degree and his ophthalmology residency training at the University of California, San Francisco. He completed a two-year combined clinical and research vitreoretinal fellowship at the Medical College of Wisconsin. He joined the faculty at Duke University in 1989. He has published over 285 articles in peer-reviewed journals and has an active clinical and basic science research program. Dr. Jaffe treats patients with a variety of medical and surgical vitreoretinal and uveitis diseases. His clinical research interests include the use of optical coherence tomography in clinical retinal treatment trials, novel medical and surgical therapies of uveitis and other posterior segment disorders. He has been a pioneer in the development of sustained drug delivery systems to treat ocular disease. He has participated in numerous clinical trials of new therapies for uveitis and vitreoretinal diseases. He directs a basic research program to investigate the mechanisms responsible for macular degeneration. Dr. Jaffe serves on the Editorial Board of the journals Retina, Current Opinions in Ophthalmology, and Ocular Surgery News and reviews manuscripts for a variety of clinical and investigative ophthalmology journals.

Founders Honorees

2012 Steve Charles, MD

2013 Joan W. Miller, MD

2014 Carl D. Regillo, MD

2015 Dean Eliott, MD

2016 Mark W. Johnson, MD

2017 Mark S. Humayun, MD, PhD

2018 Maria H. Berrocal, MD

2019 Allen C. Ho, MD


TAYLOR SMITH & VICTOR CURTIN LECTURETUESDAY, MARCH 3, 2020 • 6:50 PM

Intraocular Tumors - A Footprint into the FutureCAROL L. SHIELDS, MD

Carol L. Shields, MD is currently the Director of the Oncology Service, Wills Eye Hospital, and Professor of Ophthalmology at Thomas Jefferson University in Philadelphia.

Born in Sharon, Pennsylvania, Dr. Shields attended the University of Notre Dame for undergraduate pre-medical studies and played 4 years of Varsity basketball on the Women’s basketball team, serving as captain for 3 years. She completed her medical school at the University of Pittsburgh and residency in ophthalmology at Wills Eye Hospital in Philadelphia in 1987. She subsequently completed fellowship training in ocular oncology, oculoplastic surgery, and ophthalmic pathology.

Dr. Shields has authored or coauthored 12 textbooks, over 1800 articles in major peer-reviewed journals, over 330 textbook chapters, given over 900 lectureships, and has received numerous professional awards. Some of her awards include The Byron Kanaley Award (1979) given to the top student-athlete at the University of Notre Dame, (she was the first woman to receive this award) and The Donders Award (2003) given by the Netherlands Ophthalmological Society every 5 years to an ophthalmologist worldwide who has contributed extensively to the field of ophthalmology. She received an Honorary Doctorate of Science Degree from the University of Notre Dame (2005) and Catholic University (2011). She was bestowed the American Academy of

Ophthalmology Life Achievement Honor Award (2011) and induction into the Academic All-American Hall of Fame (2011) for lifetime success in athleticism and career. She was the President of the International Society of Ocular Oncology (2013-2015) – this is the largest international society for study of ocular tumors. She was the first elected President of this society. Dr. Shields has also been cited on the Ophthalmology Power List - nominated by peers as one of the top 100 leaders in the field of ophthalmology in 2014, 2016 and 2018. She is a member of numerous ocular oncology, pathology, and retina societies and has delivered 60 named lectures in America and abroad. She has been active in the American Academy of Ophthalmology. She serves on the editorial board of several journals including JAMA Ophthalmology, RETINA, Journal of Pediatric Ophthalmology and Strabismus, Ophthalmic Plastic and Reconstructive Surgery, and International Journal of Clinical Oncology.

Dr. Shields practices ocular oncology on a full time basis with her husband, Dr. Jerry Shields and associates on the Oncology Service at Wills Eye Hospital. She is an avid sportswoman with interest in basketball, tennis, downhill skiing, biking, hiking and others. She also enjoys watercolor and oil painting. She maintains farm hobbies of raising chickens, goats, dogs, and cats. She and her husband Jerry are the parents of 7 children, ranging from ages 19 to 31 years.

Taylor Smith & Victor Curtin Honorees*

1983 Thomas M. Aaberg, Sr., MD1984 Robert E. Morris, MD 1985 Michael Shea, MD 1986 Alexander Ray Irvine, Jr., MD1987 William H. Spencer, MD1988 Victor T. Curtin, MD 1989 Alan Bird, MD 1990 J. Donald M. Gass, MD1991 Robert J. Brockhurst, MD 1992 Stephen J. Ryan, MD

1993 Wayne E. Fung, MD 1994 Charles P. Wilkinson, MD1995 George W. Blankenship, MD1996 Mary Lou Lewis, MD 1997 Donald J. D’Amico, MD 1998 Stanley Chang, MD1999 Harry W. Flynn, Jr., MD 2000 Ian J. Constable, MD2001 Thomas R. Friberg, MD 2002 William S. Tasman, MD

2003 Evangelos S. Gragoudas, MD2004 Steve Charles, MD 2005 Thaddeus P. Dryja, MD 2006 Jerry A. Shields, MD2007 Mark S. Blumenkranz, MD2008 Allan E. Kreiger, MD 2009 Alexander R. Gaudio, MD 2010 Carmen A. Puliafito, MD, MBA2011 David W. Parke, II, MD2012 J. Brooks Crawford, MD

2013 Michael T. Trese, MD2014 Julia A. Haller, MD2015 George A. Williams, MD2016 Neil M. Bressler, MD2017 Gary W. Abrams, MD2018 Daniel F. Martin, MD2019 Yale L. Fisher, MD

*Prior to 2017, this lecture was known as the Taylor Smith Lecture.


PROGRAM AT A GLANCE

SaturdayFEBRUARY 29

4:00 – 9:00 PM

Registration

6:00 – 9:00 PM

Welcome Dinner

SundayMARCH 1

3:30 – 4:00 PM

Break

3:30 – 7:30 PM

Exhibits

4:00 – 4:20 PM

OCTA – What it is. What it is Good For.Jay S. Duker, MD

4:20 – 4:35 PM

Discussion

4:35 – 4:55 PM

Artificial Intelligence and Pediatric RetinaR.V. Paul Chan, MD, MSc, MBA

4:55 – 5:10 PM

Discussion

5:10 – 5:30 PM

Teleretinal Screening for Diabetic DiseaseChristina Y. Weng, MD, MBA

5:30 – 5:45 PM

Discussion

5:45 – 6:15 PM

Break

6:15 – 6:35 PM

OCTA: Are the Platforms All the Same?Giovanni Staurenghi, MD

6:35 – 6:50 PM

Discussion

6:50 – 7:30 PM

PANEL 1: Impact of Advanced Imaging and AI on RetinaModerator: Timothy G. Murray, MD, MBA

Panelists: R.V. Paul Chan, MD, MSc, MBA Jay S. Duker, MD Giovanni Staurenghi, MD Christina Y. Weng, MD, MBA

7:30 PM

Adjourn

MondayMARCH 2

7:30 – 9:30 AM

SATELLITE SYMPOSIA WITH BREAKFAST (non-CME)DARPin® Molecules: An Emerging Investigational Class of Binding ProteinAllergan, Inc.

3:30 – 4:00 PM

Break

3:30 – 7:30 PM

Exhibits

4:00 – 4:20 PM

Second Generation Anti-VEGF AgentsCarl D. Regillo, MD

4:20 – 4:35 PM

Discussion

4:35 – 4:55 PM

The Role of Neuroprotection in Retinal DiseasesBaruch D. Kuppermann, MD, PhD

4:55 – 5:10 PM

Discussion

5:10 – 5:30 PM

Subretinal Gene TherapyChristina Y. Weng, MD, MBA

5:30 – 5:45 PM

Discussion

5:45 – 6:15 PM

Break

6:15 – 6:55 PM

PANEL 2: Advanced Retinal TherapyModerator: Timothy G. Murray, MD, MBA

Panelists: Glenn J. Jaffe, MD Baruch D. Kuppermann, MD, PhD Carl D. Regillo, MD Christina Y. Weng, MD, MBA

6:55 – 7:00 PM

Introduction of Founders LectureTimothy G. Murray, MD, MBA

7:00 – 7:20 PM

FOUNDERS LECTURE Intraocular Drug Delivery A Winding JourneyGlenn J. Jaffe, MD

7:20 – 7:30 PM

Discussion

8:00 – 10:00 PM

Faculty Dinner


TuesdayMARCH 3

7:30 – 9:30 AM

SATELLITE SYMPOSIA WITH BREAKFAST (non-CME)Individualized Treatment in Wet AMD: A Patient Case-Based ApproachRegeneron Pharmaceuticals, Inc.

11:00 AM – 2:00 PM

NASTAR Ski Race and Lunch

3:30 – 4:00 PM

Break

3:30 – 7:30 PM

Exhibits

4:00 – 4:20 PM

SD-OCT and SS-OCT: What is the Impact?Giovanni Staurenghi, MD

4:20 – 4:35 PM

Discussion

4:35 – 4:55 PM

Pediatric Retinal ImagingR.V. Paul Chan, MD, MSc, MBA

4:55 – 5:10 PM

Discussion

5:10 – 5:30 PM

Best Approaches for Pediatric RDPhilip J. Ferrone, MD

5:30 – 5:45 PM

Discussion

5:45 – 6:15 PM

Break

6:15 – 6:35 PM

Perfluorocarbon Liquids: Pearls and PitfallsCarl D. Regillo, MD

6:35 – 6:50 PM

Discussion

6:50 – 6:55 PM

Introduction of Taylor Smith & Victor Curtin LectureTimothy G. Murray, MD, MBA

6:55 – 7:20 PM

TAYLOR SMITH & VICTOR CURTIN LECTURE Intraocular Tumors - A Footprint into the FutureCarol L. Shields, MD

7:20 – 7:30 PM

Discussion

8:00 – 10:00 PM

Closing DinnerViceroy SnowmassToro Kitchen & Lounge

WednesdayMARCH 4

3:30 – 4:00 PM

Break

3:30 – 7:30 PM

Exhibits

4:00 – 4:20 PM

Surgical RoundsGlenn J. Jaffe, MD

4:20 – 4:35 PM

Discussion

4:35 – 4:55 PM

Pediatric Macular HolesPhilip J. Ferrone, MD

4:55 – 5:10 PM

Discussion

5:10 – 5:30 PM

Diabetic Macular Edema in Cataract Surgery: The Role of InflammationBaruch D. Kuppermann, MD, PhD

5:30 – 5:45 PM

Discussion

5:45 – 6:15 PM

Break

6:15 – 6:35 PM

Unusual Causes of Peripheral Retinal ElevationsJay S. Duker, MD

6:35 – 6:50 PM

Discussion

6:50 – 7:30 PM

PANEL 3: Surgical Advances - The ARDS PerspectiveModerator: Timothy G. Murray, MD, MBA

Panelists: Donald J. D’Amico, MD Jay S. Duker, MD Philip J. Ferrone, MD Glenn J. Jaffe, MD Baruch D. Kuppermann, MD, PhD

7:30 PM

Adjourn

-


PROGRAM SUMMARIES

Sunday | MARCH 14:00 – 4:20 PM

OCTA – What it is. What it is Good For.JAY S. DUKER, MD

Optical Coherence Tomography Angiography (OCTA) is a relatively recent expansion of the capabilities of cross section, structural OCT. It is based on the measurement of the decorrelation signal between two OCT B scans done very close together temporally in the exact same location. If most, or all, of the motion artifact can be eliminated, the difference between the two scans represents motion of red blood cells. This can be three dimensionally reproduced into an en face flow image or, as a cross sectional anatomic B scan with pixel overlay showing areas of flow within the retina. At the present time, OCTA is an excellent diagnostic tool for determining if an eye harbors neovascularization. It is not yet a robust therapeutic decision making tool.

4:35 – 4:55 PM

Artificial Intelligence and Pediatric RetinaR.V. PAUL CHAN, MD, MSc, MBA

Artificial intelligence (AI) in Ophthalmology has demonstrated high diagnostic performance and has the potential to be incorporated into clinical practice to facilitate the management of ocular disease. In 2018 the first autonomous AI system, IDx-DR, for detecting diabetic retinopathy was FDA approved, and more recently the first AI system for retinopathy of prematurity (ROP), which was developed by the imaging and informatics for ROP (i-ROP) consortium, received breakthrough approval by the FDA. This deep learning algorithm (DeepROP) has been incorporated into a system termed “i-ROP DL”. This system has been shown to have very high accuracy for detecting plus disease from wide-angle posterior pole retinal images and may even perform better than expert human examiners in detecting plus disease. iROP DL, however, was initially trained only to recognize plus disease.

Although there is a trend toward widespread adoption of AI in many fields of medicine and an increasing interest to implement AI in Ophthalmology clinical practice, there are

still potential challenges to incorporation of AI in clinical decision making. Important factors to consider include effect on standard of care, the patient-physician relationship, and medicolegal liability. In a recent survey regarding physician perceptions of AI, our group found that (1) ophthalmologists felt that AI will improve the field of ophthalmology; (2) there are concerns regarding AI in ophthalmology, including AI replacing physicians and harming the patient-physician relationship; and (3) many ophthalmologists felt that an AI curriculum should be developed for medical school and residency.

5:10 – 5:30 PM

Teleretinal Screening for Diabetic DiseaseCHRISTINA Y. WENG, MD, MBA

Teleophthalmology screening programs are used in the detection of various diseases such as retinopathy of prematurity and glaucoma, but the most common application is for diabetic retinopathy (DR). Diabetic retinopathy is currently the leading cause of visual impairment amongst working-age Americans, and poor compliance with screening guidelines plays a key role in this public health crisis. Teleretinal screening may be beneficial in addressing this issue by increasing the capacity to screen large numbers of patients, improving access to care, and detecting disease at earlier stages. While the specific process can vary per the particular program, teleretinal screening starts with patient identification, often in the primary care setting. A standardized protocol is used to acquire images with a nonmydriatic fundus camera. Once the images are uploaded to a cloud-based server, image interpretation is performed, and a patient recommendation is determined.

Multiple studies support the diagnostic accuracy of teleretinal screening for DR and its effectiveness in improving screening compliance. Teleretinal screening has also been shown to be cost-efficient compared to conventional in-clinic screening. However, challenges still exist such as ensuring that patients who are detected with disease are able to receive timely treatment and addressing reimbursement rates for teleretinal screening so that these programs are sustainable. Nevertheless, progress continues to be made with efforts to integrate widefield imaging and optical coherence tomography into teleretinal DR screening. Additionally, the advent of home monitoring devices and emergence of artificial intelligence create new opportunities for how teleretinal screening might be implemented in the future.


6:15 – 6:35 PM

OCTA: Are the Platforms all the Same?GIOVANNI STAURENGHI, MD

OCT-angiography improved the possibility to diagnose retinal pathologies. OCT-A refers to a group of OCT imaging methods that facilitate visualization of blood flow in the retina and choroid. To detect this vascular flow information, there are different algorithms and average methods which generate images based on the motion signal between repeated OCT B-scans at the same position.

Software updates and lastly the introduction of Artificial Intelligence have significantly improved the quality of OCT-angiography (OCT-A).

However these images could be different between instruments. Several factors differentiate OCT-A from traditional fluorescein angiography (FA) and indocyanine green angiography (ICGA). is the possibility to identify and visualize different layers one by one. Paramount among these differences are OCT-A’s image segmentation possibilities. This allows for the separate visualization of individual layers of the retina and choroid. Segmentation can be based on structural OCT or flow signal. In the first case two layers are identifiable and in the second case three layer in the macular region and 4 layers in peripapillary region can be identify.

But this can create different images among different instruments.

In the presentation will be showed images which explain all the differences among all the instruments.

6:50 – 7:30 PM

Panel 1: Impact of Advanced Imaging and AI on RetinaMODERATOR: TIMOTHY G. MURRAY, MD, MBA

PANELISTS: R.V. PAUL CHAN, MD, MSc, MBA; JAY S. DUKER, MD; GIOVANNI STAURENGHI, MD; CHRISTINA Y. WENG, MD, MBA

The panel will present a case presentation/interactive discussion format to gain an overview on AI focused on RETINA. This panel will discuss the different approaches to AI, the unique application of AI in imaging, the current state of AI in the field of Retina. Panelists will also discuss the potential ethical impact of AI and BIG DATA. Finally, the structural role of AI in retina will be explored to define the role of the retinal specialist both in AI development and clinical practice.

Monday | MARCH 24:00 – 4:20 PM

Second Generation Anti-VEGF AgentsCARL D. REGILLO, MD

Most of the emerging therapies for neovascular AMD on the horizon are intravitreal anti-VEGF agents or delivery approaches aimed at extending the anti-VEGF durability while, at the same time, hoping to maintain the good efficacy and safety profile that is currently available with the first-generation anti-VEGF therapeutics. The recently approved brolucizumab, a single-chain anti-VEGF A antibody fragment, has been shown in phase 3 trials to have equivalent efficacy over 2 years to aflibercept with the former dosed in a variable q8-12 week fashion and the latter dosed in a fixed q8 week regimen. The study showed greater macular drying by OCT with brolucizumab but how much more durable it may be will only be answered with further study such as with the phase 3b Talon trial which is currently underway. Abicipar, the anti-VEGF DARP-in molecule, showed non-inferiority visual acuity gains to ranibizumab in phase 3 testing with the former dosed either q8 or q 12 weeks and the latter q4 weeks but had higher rates of intraocular inflammation which has been ameliorated to some degree with formulation refinements and is currently under FDA review. Conbercept, an anti-VEGF A/B/C fusion protein, recently completed phase 3 trial enrollment with a study design similar to abicipar, but being compared to aflibercept rather than ranibizumab. Faricimab, the dual acting (bispecific) antibody targeting both VEGF A and Ang-2, recently completed enrollment in its phase 3 studies being dosed in a flexible fashion up to q16 weeks compared to aflibercept q8 weeks. KSI-301, the anti-VEGF A antibody biopolymer conjugate, is showing promising extended durability in phase 1 testing to date and has started enrollment in a pivotal AMD trial against aflibercept with KSI-3-1 being dosed q12, q16 or q20 weeks. In addition, the ranibizumab port delivery system completed phase 3 testing with results pending later this year and aflibercept is now also being tested at a higher dose to examine the possibility of extending durability. Furthermore, OPT-302, a fusion protein that binds VEGF C and D, showed signs of augmenting the efficacy of anti-VEGF A with ranibizumab in phase 2 testing. Lastly, anti-VEGF in the form of gene therapy along with both topical and intravitreal tyrosine kinase inhibitor small molecules are all in earlier, phase 1 or 2 testing hoping to show sustained anti-VEGF-like maintenance therapy.


4:35 – 4:55 PM

The Role of Neuroprotection in Retinal DiseasesBARUCH D. KUPPERMANN, MD, PhD

Apoptosis is a normal process of genetically programmed cell death that destroys cells that are injured or unneeded. Excessive or uncontrolled apoptosis is implicated in the pathogenesis or poor outcome of many ocular diseases, including glaucomatous optic neuropathy, diabetic macular ischemia, chronic macular edema, retinitis pigmentosa, retinal detachments, and geographic atrophy. Apoptosis is also implicated in CNS diseases such as Alzheimer’s and Parkinson’s diseases.

Stopping retinal neuronal cell death is a balancing act. In normal eyes, various factors promote either the survival or death of retinal neurons and photoreceptors. Retinal cell viability depends on the balance between cell survival and cell death signals. The goal of neuroprotective (and neuroenhancement) therapy is to tip the balance in favor of cell survival by blocking cell death signals and/or enhancement of cell survival signals. The principal distinction between neuroprotection and neuroenhancement is that neuroenhancement attempts to not only stop cells from dying but to improve the function of the remaining cells.

Neuroprotection/neuroenhancement is a significant unmet need in posterior segment diseases. Multiple potential pathways have been explored as targets for neuroprotection including Brimonidine (a selective α-2 receptor agonist), CNTF (ciliary neurotrophic factor), Memantine (NMDA antagonist), Corticosteroids, Complement inhibition, Integrin Peptide regulation, Stem cell neurotrophic products, and Mitochondrial membrane stabilizers such as elamipretide. A detailed review of the science and status of clinical retinal neuroenhancement and neuroprotection will be provided.

5:10 – 5:30 PM

Subretinal Gene TherapyCHRISTINA Y. WENG, MD, MBA

Subretinal gene therapy holds tremendous promise in the treatment of both rare inherited retinal diseases as well as more common conditions such as age-related macular degeneration (ARMD). While intravitreal- and suprachoroidal-based therapies have been explored,

subretinal gene therapy offers advantages including penetration to deeper retinal layers and relative drug compartmentalization. Voretigene neparvovec-rzyl (Spark Therapeutics) is a subretinal gene therapy for patients with a biallelic RPE65 mutation, and became the first Food and Drug Administration-approved gene therapy in 2017. Subretinal gene therapy can also be used to induce production of non-native proteins. RGX-314 (REGENXBIO) is a therapeutic candidate that encodes a monoclonal anti-vascular endothelial growth factor antibody fragment and is currently in Phase II clinical studies for patients with neovascular ARMD.

The surgical approach to subretinal gene therapy may require some modifications compared to that for routine cases. For example, pre-operative genetic confirmation is necessary for gene replacement therapies such as voretigene neparvovec-rzyl. Corticosteroid pre-treatment is used in some genetic therapy protocols. Following a core vitrectomy with hyaloid elevation, either manual or pedal-assisted injection can be utilized to deliver the product through a 41-gauge cannula into the subretinal space. Bleb localization target depends on the specific gene therapy product, but typically involves the macula; intraoperative optical coherence tomography may aid in this process. Air-fluid exchange is often performed at the case conclusion.

While questions remain regarding how to optimize the effectiveness, safety, and feasibility of subretinal gene therapy, it has the potential to revolutionize how we manage certain retinal diseases.

6:15 – 6:55 PM

Panel 2: Advanced Retinal TherapyMODERATOR: TIMOTHY G. MURRAY, MD, MBA

PANELISTS: GLENN J. JAFFE, MD; BARUCH D. KUPPERMANN, MD, PhD; CARL D. REGILLO, MD; CHRISTINA Y. WENG, MD, MBA

The panel will review case based presentations highlighting advances in retinal imaging and pharmacological therapy. The impact of widefield viewing, OCTa, and extended duration pharmacotherapies will be explored. Particular attention will be paid to deploying and employing these advanced therapeutic approaches within a “real world” clinical setting. The discussion will explore cost based analysis of existing and future therapies along with a discussion of the impact of evolving health policy.


7:00 – 7:20 PM

FOUNDERS LECTURE

Intraocular Drug Delivery - A Winding JourneyGLENN J. JAFFE, MD

Intraocular sustained drug delivery has increasingly become available to treat retinal and ocular inflammatory diseases. Sustained drug delivery systems include transcleral delivery techniques, Intravitreal implants, intravitreal Injection, suprachoroidal infusion, subretinal implants, and refillable reservoirs. The US FDA has approved specific intravitreal Implants. Approved non-biodegradable implants that release drug over 2.5-3 years include the surgically implanted fluocinolone acetonide implant, approved for uveitis affecting the posterior segment and injectable fluocinolone acetonide implants approved for chronic DME and uveitis.

A biodegradable injectable dexamethasone implant that releases over 6 wks-3 months is approved to treat macular edema and uveitis.

There are several new implants that are under development. Examples include encapsulated cell technology tested in a successful phase 2 study of a CNTF implant to treat MacTel 2.

Refillable implants include a refillable posterior micropump that can deliver small molecules and proteins for multiple ocular indications and the port delivery system, a refillable implant that is surgically placed through the pars plana and secured without scleral sutures. Recently, favorable phase 2 study results were reported that demonstrated prolonged drug delivery for nAMD. A suprachoroidal delivery system has also been developed. Favorable phase 3 study results have been reported in patients with uveitic macular edema.

In conclusion, the future is very bright for intraocular sustained drug delivery. In the near future, it is likely that additional implants will be approved by regulatory agencies, that the clinician can use to treat ocular and inflammatory eye diseases.

Tuesday | MARCH 34:00 – 4:20 PM

SD-OCT and SS-OCT: What is the Impact?GIOVANNI STAURENGHI, MD

OCTs is probably the most innovative and used tool for retinal imaging. There are a series of different approaches such as time domain, frequency domain (spectral domain SD-OCT and swept source SS-OCT domain), full field or line filed domain. In ophthalmology the frequency domain is widely used in the two possibilities SD-OCT and SS-OCT. Both technologies have advantages and disadvantages.

Advantages of SS-OCT imaging include the faster scanning speed, its use of a longer wavelength and its reduced sensitivity roll-off. The use of a longer wavelength and its results in enhanced light penetration; the reduced sensitivity roll-off allow to have a larger window of acquisition with the consequence to image a wider field of view particularly useful for myopic eyes and to obtain a wide field OCT-A.

However the signal to noise ratio is higher with SD-OCT particularly for the inner retina allowing much more contrast and visualization for these layers.

In the presentation will be showed images of the same patient acquired using different OCTs. For SSOCT we use Topcon and Zeiss and for SDOCT Heidelberg Spectralis OCT2 with or without Enhanced depth imaging modality (EDI).

4:35 – 4:55 PM

Pediatric Retinal ImagingR.V. PAUL CHAN, MD, MSc, MBA

Over the past decade, multimodal imaging for the evaluation of pediatric retinal disease has become more accessible as new imaging systems have facilitated imaging in the pediatric population. Although we have had significant experience with fundus imaging and fluorescein angiography (FA) for pediatric retinal disease, a number of studies have now demonstrated the utility of optical coherence tomography (OCT) and OCT-Angiography (OCTA) in pediatric patients. In addition, with the need for improved access to care, telemedicine and artificial intelligence have gained increasing interest in the delivery of care for pediatric patients.

(continued)


FA continues to have an important role in the diagnosis and management of pediatric vasoproliferative disorders of the retina. In the late 1960s, Flynn and colleagues introduced FA for the evaluation of pediatric retinal disease. Initially, FA was utilized as a method to evaluate and understand retrolental fibroplasia. These early investigations revealed the presence of retinal changes seen on FA that were not visible on clinical examination, demonstrating its unique role in the evaluation of pediatric retinal disease. Subsequently, FA was also applied to evaluate the peripheral retina in greater detail. Nevertheless, challenges in obtaining fundus images in neonates and children limited further investigation and adoption of the technology. Currently, FA has been described to be of increased importance in retinopathy of prematurity (ROP), Coats’ disease, sickle cell retinopathy, choroidal neovascular membranes, ocular tumors, and other diseases.

5:10 – 5:30 PM

Best Approaches for Pediatric RDPHILIP J. FERRONE, MD

Pediatric rhegmatogenous retinal detachments have an annual incidence of approximately 0.53 per 100,000 population.1 Adult rhegmatogenous retinal detachments have an annual incidence of approximately 12 cases per 100,000 population.2 Traction retinal detachments are even less common and arise from a myriad of diseases seen in children.

These detachments in children also often present late due to children not voicing to their parent or caretaker that something is wrong with their vision whether due to them being pre-verbal or not noticing the change in their vision initially.

The approach to the examination and knowing when to perform an exam under anesthesia (EUA) in these patients is critical to detecting early pathology and treating in an optimal time frame. Once pathology is detected knowing what testing to perform and determining which disease is underlying the condition is also critical for future management.

Rhegmatogenous retinal detachments are usually treated with a scleral buckle alone in most of these eyes. Even eyes with subretinal strands usually respond well to this approach. In very young children there are concerns of eye growth with uninterrupted encircling scleral buckles and induced high myopia in these patients. Additionally, if the patient is younger than 6 years old amblyopia concerns have to be treated with proper refractive error correction and patching if necessary.

References

1. Haimann MH, Burton TC, Brown CK. Epidemiology of retinal detachment. Arch Ophthalmol. 1982;100(2): 289–292.

2. Fivgas GD, Capone A., Jr Pediatric rhegmatogenous retinal detachment. Retina. 2001;21(2):101–106.

6:15 – 6:35 PM

Perfluorocarbon Liquids: Pearls and PitfallsCARL D. REGILLO, MD

Perfluorocarbon liquid (PFCL) is a valuable intraocular tool for displacement of subretinal fluid in both primary and complicated retinal detachment repair. PFCL use may be considered for certain types of uncomplicated retinal detachments and is often the preferred way to reattach retinas with giant retinal tears or large retinectomies. Problems associated with its use include droplets being retained under the retina or in the vitreous cavity and displacement of subretinal fluid in the macula which can contribute to macular distortion or fold formation. These are all avoidable issues. Small amounts of subretinal PFCL may be tolerated if outside the center of the macula but is detrimental to vision if it is in the subfoveal location, in which case it needs to be removed surgically. Retained PFLC in the vitreous cavity is technically well tolerated by the eye but can be symptomatic. Displacement of subretinal fluid into the macula during PFLC-air exchange may occurs when there is excessive trapped fluid anterior to the retinal break with PFCL in the eye. Surgical pearls that help to prevent these PFCL issues will be discussed. Such pearls include the use of valved cannulas, techniques to minimize break-up of the PFLC bubble in the eye, best ways to instill and remove PFCL, enlarging and anteriorizing the peripheral retinal break to minimize anterior trapped subretinal fluid, and rinse maneuvers with venting at the end of the surgery to facilitate complete removal of PFCL.


6:55 – 7:20 PM

TAYLOR SMITH & VICTOR CURTIN LECTURE

Intraocular Tumors - A Footprint into the FutureCAROL L. SHIELDS, MD

In honor of Taylor Smith MD and Victor Curtin MD and their interest in intraocular tumors, we will explore new information on 3 important topics relative to uveal melanoma, uveal metastasis, and retinoblastoma.

Regarding uveal melanoma, we will review tumor imaging, The Cancer Genome Atlas (TCGA) classification, nanoparticle therapy for small melanoma, and novel observations with immunotherapy for metastatic melanoma.

From an imaging standpoint, new risk factors have been identified based on multimodal imaging, predictive of choroidal nevus transformation into melanoma. These can be remembered by the mnemonic “To Find Small Ocular Melanoma Doing Imaging” (TFSOM-DIM) representing

• Thickness >2 mm (by ultrasonography), • Fluid subretinal (by OCT), • Symptoms vision loss (by Snellen VA), • Orange pigment (by autofluorescence), • Melanoma hollow (by ultrasonography), and • Diameter >5mm (by photography).

The 5-year rate of growth was 1% for those with 0 risk factor, 11% with 1 factor, 22% with 2 factors, 34% with 3 factors, and >50% with 4, 5, or 6 factors.

A new classification for melanoma, TCGA, based on genetic markers, was recently published. In a cohort of 658 patients with uveal melanoma, TCGA was robust for prognostication. The more advanced TCGA class demonstrating increased 5-year risk for metastasis (4% vs. 20% vs. 33% vs. 63%, p<0.001).

Regarding uveal metastasis, recent publications on 1111 patients with uveal metastatic disease revealed overall 24% 5-year survival. The most common primary cancer sites were breast (37%) and lung (26%). Younger patients and males fared worse than older patients and females.

Regarding retinoblastoma, there has been immense accomplishment in saving lives and eyes using intravenous, intra-arterial, and intravitreal chemotherapy.

The field of ocular oncology is making great headway in the early diagnosis and management of intraocular malignancies.

Wednesday | MARCH 44:00 – 4:20 PM

Surgical RoundsGLENN J. JAFFE, MD

Saturday Morning Surgical Rounds at Duke University were started by Robert Machemer nearly four decades ago. The format has changed over the years, from examination of live patients on the first postoperative day, to a video-based format that is now held on Wednesday mornings. The foundational principles of these rounds have, nonetheless remained the same. The rounds have been designed to be highly interactive whereby the presentations serve as a jumping off point to highly interactive discussions among vitreoretinal faculty and trainees. The goals of the rounds are not only to enhance the knowledge of the participants, but also to generate ideas that can lead to new and better approaches to common and not-so-common surgical problems. In the current presentation, I will present several different retinal detachment surgical cases ranging from relatively straightforward to complex, using the video case presentation format that we use at the Duke morning surgical rounds. My goal will be to demonstrate the surgical approach we have taken to manage these cases, and to solicit input from ARDS participants to challenge these approaches, and to determine potential alternative surgical techniques to treat these retinal detachments.

4:35 – 4:55 PM

Pediatric Macular HolesPHILIP J. FERRONE, MD

Pediatric macular holes are very uncommon, and there are no firm numbers regarding their incidence. If we look at the overall incidence of macular holes from a retrospective longitudinal study which included claims data from 600,000 patients based on CPT codes, 144 (0.02%) developed new macular holes requiring vitrectomy. The overall incidence of macular holes was 4 cases per 10,000 people per year. The average age of patients requiring vitrectomy for macular hole in this series was 63 years old, and 73% were female.1 This leads one to believe that there were very few children involved in these cases reported.

Pediatric macular holes are often related to direct, blunt, globe trauma, as opposed to a spontaneous occurrence. As a rare sequela of trauma, macular holes occur in only 1.4% of closed-globe injuries in the overall population.2

(continued)


In this talk, we will review several presentations of pediatric macular holes and their management. Management options include observation for a period of time, something that one would not usually elect for in age-related macular holes. When surgery is indicated, we will review some of the options that are helpful in treating these macular holes in the pediatric population.

References

1. Joseph T Nezgoda, MD MBA, Jay M Stewart MD. Incidence and Risk Factors of Idiopathic Macular Hole. ASRS Annual Meeting, 2017

2. Kuhn F, Morris R, Witherspoon CD, Mann L. Epidemiology of blinding trauma in the United States Eye Injury Registry. Ophthalmic Epidemiol. 2006;13(3):209-216. doi:10.1080/ 09286580600665886

5:10 – 5:30 PM

Diabetic Macular Edema in Cataract Surgery: The Role of InflammationBARUCH D. KUPPERMANN, MD, PhD

Cataract is an important clinical problem affecting diabetic patients. The diabetic population is large and growing, especially in western countries. Cataract surgery has been shown to double the progression rate of diabetic retinopathy in a study 12 months after surgery (28% vs. 14%). Cataract surgery in diabetic patients has a greater incidence of complications than the general population. The complications of cataract surgery in diabetic patients include accelerated progression of retinopathy, DME, CME, fibrinous uveitis, posterior capsule opacification, and anterior segment neovascularization.

Why does cataract surgery in eyes with DME carry more risk? In a word: inflammation. Cataract surgery results in a transient increase in VEGF and different cytokines. A high VEGF level in the aqueous humor has been shown to predict a significant risk for the postoperative exacerbation of macular edema. Vitreous fluid levels of VEGF and other cytokines were significantly higher in patients with DME than in nondiabetic patients or diabetic patients without retinopathy. VEGF-A and other cytokine levels in the anterior chamber have been shown to increase with DR

progression and may be of prognostic value in evaluating the potential risk of further neovascularization after cataract surgery. Given the role of cytokines in DME, how best to handle the increased risk of cataract surgery in patients with DME? Studies have shown that intraoperative injection of anti-VEGF or triamcinolone or dexamethasone implant resulted in decreased incidence of macular edema after cataract surgery. A few tips and tricks in managing cataract surgery and DME will be discussed.

6:15 – 6:35 PM

Unusual Causes of Peripheral Retinal ElevationsJAY S. DUKER, MD

Common causes of peripheral elevation include retinal detachment, retinoschisis and benign intraocular tumors. For the most part, these are easily distinguishable by most retinal specialists. Malignant intraocular tumors, retinal vascular diseases, extraocular vascular disease and even orbital disease can result in unusual elevations of the peripheral retina. Judicious use of ancillary testing along with honed observational skills for the most part will guide clinicians to the proper diagnosis.

6:50 – 7:30 PM

Panel 3: Surgical Advances - The ARDS PerspectiveMODERATOR: TIMOTHY G. MURRAY, MD, MBA

PANELISTS: DONALD J. D’AMICO, MD; JAY S. DUKER, MD; PHILIP J. FERRONE, MD; GLENN J. JAFFE, MD; BARUCH D. KUPPERMANN, MD, PhD

The panel will focus on evolving surgical approaches using the broad history of ARDS. Transition points in care will be discussed evaluating scleral buckling surgery, evolving micro -ncisional vitrectomy, and the impact of advancing technology platforms. Heads up surgery, ultrafast cutting, and advances in surgical imaging will be reviewed. Recent surgical deliveries for pharmacotherapy will be discussed including subretinal and suprachoroidal drug delivery. Discussions focused on translating surgical clinical data into clinical practice will focus on key strategies to minimize surgical complications.

ExhibitorsThe Aspen Retinal Detachment Society gratefully

acknowledges the following companies for their support:

BLACK DIAMOND

Genentech, Inc. DIAMOND

Alcon Vision, LLC. Novartis

GOLD

Allergan, Inc. Bausch + Lomb

Regeneron Pharmaceuticals, Inc.

SILVER

Dutch Ophthalmic USA EyePoint Pharmaceuticals

MedOne Surgical, Inc. OCULUS Surgical, Inc.

Optos, Inc. Quantel Medical

REGENXBIO, Inc.

MEDICAL CONFERENCE PLANNERS INTL. [email protected]

www.medconfs.com • www.aspenretina.com

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