Macular Degeneration Watch Time: 53 mins

touchCONGRESS The personalized patient experience in nAMD: What do the latest data tell us about optimizing clinical management?

Stay abreast of the latest research on the clinical management of neovascular age-related macular degeneration (nAMD) for individual patients by watching a webinar and interviews with international experts reviewing data from the virtual proceedings of the World Ophthalmology Congress 2020 (WOC2020 Virtual).

Part 1: Watch internationally renowned expert Prof. Pravin Dugel review key data from WOC2020 Virtual

Part 2: Choose from leading experts who discuss what the data findings mean for global and regional practice

 

  • Part 1: Webinar
CME ACCREDITED
Introduction: WOC2020 Virtual®
Watch Time: 00:00
Symposia highlights: Novel therapies and retinal fluid management
Watch Time: 03:20
Symposia highlights: Home monitoring and novel delivery systems
Watch Time: 12:30
Congress abstracts on novel treatments for nAMD
Watch Time: 21:42
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Overview

Watch Pravin Dugal review key data and congress highlights from WOC2020 Virtual and consider:

  • How does the latest evidence inform the management of retinal fluid in nAMD?
  • What do assessments of anti-VEGF therapies tell us about optimal dosing schedules in nAMD?
  • Can novel therapies and drug delivery systems reduce treatment burden in nAMD?
  • Is there a central role for home monitoring in nAMD?
About Prof. Pravin Dugel

Prof. Pravin Dugel is Clinical Professor at the USC Roski Eye Institute, Keck School of Medicine, University of Southern California, USA.

Prof. Dugel is internationally recognized as a major clinical researcher and has been a primary investigator in over 100 multicentre clinical trials. His research and educational contributions have earned him the prestigious Senior Honor Award from the American Academy of Ophthalmology (AAO).

Prof. Pravin Dugel discloses: Advisory boards for Acucela, Aerpio, Alcon Pharmaceutical, Alcon Surgical (RACII), Alimera Sciences, Abbott Medical Optics Incs, Annidis, ArticDX, ASRS Board, Avalanche, Bausch, Beyeonics, CDR-Life Inc., Clearside Biomedical, Digisight, DOSE Medical, Euretina Board, Gemini Pharmaceutical, Genentech, Graybug Vision, Lutronic, LUX BioScience, MacuSight, NeoVista, Neurotech, Novartis, Oculis, Omeros, Opthea, Ophthotech, Orbis International, Oxurion, Regenxbio, Reneuron, Retina World Congress, Roche, Santen, Inc, Shire Human Genetics, Stealth Biotherapeutics, Thrombogenics and TrueVision. Consultant for Acucela, Aerie Pharmaceutical, Aerpio, Alcon Pharmaceutical, Alcon Surgical, Allergan, Alimera Sciences, Amgen, Annidis, ArticDX, Arctic Vision, AsclepiX Therapeutics Inc., Bausch & Lomb Pharma, BeyeOnics, BioBridge/Retinagenix, Boehringer Ingelheim, Chengdu Kanghong Biotechnology, Clearside Biomedical, Daiichi Sankyo, DigiSight, DOSE Medical, FoxKiser, Gemini Pharmaceutical, Genentech, Glaukos, Graybug Vision, Kodiak Sciences, Irenix, jCyte, Ionis, Lutronic, LUX BioScience, MacuSight, Merck, Nan Fung Group, NeoVista, Neurotech, Novartis, Oculis SA, Omeros, Opthea, Ophthotech, Optovue, ORA, PanOptica, Pentavision, Pieris Pharmaceutical, pSiveda/Eyepoint, RegenexBio, Reneuron. Roche, Santen, Inc., SciFluor Life Sciences, Shire Human Genetics, Spark Therapeutics, Stealth Biotherapeutics, Thrombogenics, TopCon and Zeiss Group. Minor stockholder with Aerpio, Allegro, ArctixDx, Arctic Vision, Clearside Biomedical, Digisight/Verana, FoxKiser, Graybug, Irenix, Nan Fung Group, Oculis, Ophthotech, PanOptica, SciFluor and TrueVision. Employee and shareholder at IVERIC Bio.

  • Part 2: Expert Interviews
NON-CME ACCREDITED CONTENT
Prof. Frank G Holz
Watch Time: 08:00
University of Bonn, Germany

Prof. Frank G Holz, Professor and Chair of the Department of Ophthalmology at the University of Bonn, Germany, provides his expert insights into the key data from WOC2020 Virtual on the management of nAMD in a post-COVID-19 era.

 
 
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Interview Questions

In this interview, Frank G Holz answers the following questions:

  • How might treatment schedules for approved anti-VEGF agents be adapted due to the ongoing COVID-19 pandemic?
  • How will the ongoing COVID-19 pandemic affect the uptake of recently approved novel anti-VEGF agents and technologies for the treatment of nAMD?
  • Compared with the period before the COVID-19 pandemic, do you intend to change your approach to the treatment of nAMD?
  • How will the ongoing COVID-19 pandemic affect the assessment and monitoring of patients with nAMD, including the use of home monitoring?
About Prof. Frank G Holz

Prof. Frank G Holz is Professor and Chairman of the Department of Ophthalmology at the University of Bonn, Germany. Prof. Holz’s major clinical interest is surgical and medical retina. His scientific interests include pathogenesis, prognostic factors, biomarkers and treatment of macular and retinal diseases, and innovative retinal imaging technologies. He trained at the University of Chicago Pritzker School of Medicine, IL, USA, and completed a fellowship at Moorfields Eye Hospital, London, UK with Prof. Alan C Bird.

Prof. Holz was a co-founder of the German Research Foundation Priority Program for AMD (DFG) and the GRADE Reading Center in Bonn. He is project lead of the MACUSTAR study funded by the European Union Innovative Medicines Initiative 2 (IMI2 EU) programme.

He is a board member of the German Ophthalmological Society and EURETINA; a member of the European Academy of Ophthalmology, the Macula Society, the Club Jules Gonin, and the Gass Club; Editor-in-Chief of Der Ophthalmologe; and serves as a reviewer for many peer-reviewed journals.

Prof.Holz has received numerous awards, including the Leonhard Klein Award for Ocular Surgery, the Alcon Research Institute Award, the Senior Achievement Award from the AAO, and the Jules Gonin Award.

Prof. Frank  G Holz discloses: Consultancy for Acucela, Alcon/Novartis, Allergan, Bayer, Boehringer-Ingelheim, Genentech/Roche, LIN Bioscience and Pixium. Research grants from Allergan, Bayer, Carl Zeiss Meditec, Nightstar Therapeutics, Optos, Roche/Genentech and Pixium. Speaker honoraria from Alcon/Novartis, Bayer, Heidelberg Engineering. Roche/Genentech and Zeiss.

Prof. Pravin Dugel
Watch Time: 04:44
USC Roski Eye Institute, Keck School of Medicine, University of Southern California, CA, USA

Prof. Pravin Dugel, a leading retinal specialist from Phoenix, AZ, USA, provides his expert insights into the key data from WOC2020 Virtual on the management of nAMD in a post-COVID-19 era.

 
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Interview Questions

In this interview, Pravin Dugal answers the following questions:

  • How might treatment schedules for approved anti-VEGF agents be adapted due to the ongoing COVID-19 pandemic?
  • How will the ongoing COVID-19 pandemic affect the uptake of recently approved novel anti-VEGF agents and technologies for the treatment of nAMD?
  • Compared with the period before the COVID-19 pandemic, do you intend to change your approach to the treatment of nAMD?
  • How will the ongoing COVID-19 pandemic affect the assessment and monitoring of patients with nAMD, including the use of home monitoring?
About Prof. Pravin Dugel

Prof. Pravin Dugel is Clinical Professor at the USC Roski Eye Institute, Keck School of Medicine, University of Southern California, USA.

Prof. Dugel is internationally recognized as a major clinical researcher and has been a primary investigator in over 100 multicentre clinical trials. His research and educational contributions have earned him the prestigious Senior Honor Award from the American Academy of Ophthalmology (AAO).

Prof. Pravin Dugal discloses: Advisory boards for Acucela, Aerpio, Alcon Pharmaceutical, Alcon Surgical (RACII), Alimera Sciences, Abbott Medical Optics Incs, Annidis, ArticDX, ASRS Board, Avalanche, Bausch, Beyeonics, CDR-Life Inc., Clearside Biomedical, Digisight, DOSE Medical, Euretina Board, Gemini Pharmaceutical, Genentech, Graybug Vision, Lutronic, LUX BioScience, MacuSight, NeoVista, Neurotech, Novartis, Oculis, Omeros, Opthea, Ophthotech, Orbis International, Oxurion, Regenxbio, Reneuron, Retina World Congress, Roche, Santen, Inc, Shire Human Genetics, Stealth Biotherapeutics, Thrombogenics and TrueVision. Consultant for Acucela, Aerie Pharmaceutical, Aerpio, Alcon Pharmaceutical, Alcon Surgical, Allergan, Alimera Sciences, Amgen, Annidis, ArticDX, Arctic Vision, AsclepiX Therapeutics Inc., Bausch & Lomb Pharma, BeyeOnics, BioBridge/Retinagenix, Boehringer Ingelheim, Chengdu Kanghong Biotechnology, Clearside Biomedical, Daiichi Sankyo, DigiSight, DOSE Medical, FoxKiser, Gemini Pharmaceutical, Genentech, Glaukos, Graybug Vision, Kodiak Sciences, Irenix, jCyte, Ionis, Lutronic, LUX BioScience, MacuSight, Merck, Nan Fung Group, NeoVista, Neurotech, Novartis, Oculis SA, Omeros, Opthea, Ophthotech, Optovue, ORA, PanOptica, Pentavision, Pieris Pharmaceutical, pSiveda/Eyepoint, RegenexBio, Reneuron. Roche, Santen, Inc., SciFluor Life Sciences, Shire Human Genetics, Spark Therapeutics, Stealth Biotherapeutics, Thrombogenics, TopCon and Zeiss Group. Minor stockholder with Aerpio, Allegro, ArctixDx, Arctic Vision, Clearside Biomedical, Digisight/Verana, FoxKiser, Graybug, Irenix, Nan Fung Group, Oculis, Ophthotech, PanOptica, SciFluor and TrueVision. Employee and shareholder at IVERIC Bio.

Dr Kelvin Teo
Watch Time: 07:00
Singapore National Eye Centre, Singapore

Dr Kelvin Teo from the Medical Retina Department, Singapore National Eye Centre, Singapore, provides his expert insights into the key data from WOC2020 Virtual on the management of nAMD in a post-COVID-19 era.

 
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Interview Questions

In this interview, Kelvin Teo answers the following questions:

  • How might treatment schedules for approved anti-VEGF agents be adapted due to the ongoing COVID-19 pandemic?
  • How will the ongoing COVID-19 pandemic affect the uptake of recently approved novel anti-VEGF agents and technologies for the treatment of nAMD?
  • Compared with the period before the COVID-19 pandemic, do you intend to change your approach to the treatment of nAMD?
  • Compared with the period before the COVID-19 pandemic, do you intend to change your approach to the treatment of nAMD?
About Dr Kelvin Teo

Dr Kelvin Teo is a consultant ophthalmologist in the Medical Retina Department at the Singapore National Eye Centre. He has a strong interest in clinical research in the field of medical retina. In particular, his focus is on real-world outcomes and how imaging techniques help to advance the pathophysiology and therapy of nAMD.

Dr Kelvin Teo discloses no financial interests/relationships or affiliations in relation to this activity.

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Overview & Learning Objectives
Overview

In this activity, internationally recognized experts in ophthalmology discuss the latest data on the clinical management of nAMD, including the importance of regular monitoring, application of optimal dosing regimens for individual patients and role of novel drug delivery systems and agents.

This activity has been jointly provided by Oakstone and touchIME. Oakstone Publishing is accredited by the ACCME to provide continuing medical education to physicians.

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Target Audience

This activity is designed to meet the educational needs of ophthalmologists and retinal disease specialists worldwide.

Disclosures

Oakstone Publishing has assessed conflict of interest with its faculty, authors, editors, and any individuals who were in a position to control the content of this CME activity. Any identified relevant conflicts of interest were resolved for fair balance and scientific objectivity of studies utilized in this activity. Oakstone Publishing’s planners, content reviewers, and editorial staff disclose no relevant commercial interests.

Faculty

Prof. Pravin Dugal Discloses:  Advisory board member: Acucela, Aerpio, Alcon Pharmaceutical, Alcon Surgical (RACII), Alimera Sciences, Abbott Medical Optics Incs, Annidis, ArticDX, ASRS Board, Avalanche, Bausch, Beyeonics, CDR-Life Inc., Clearside Biomedical, Digisight, DOSE Medical, Euretina Board, Gemini Pharmaceutical, Genentech, Graybug Vision, Lutronic, LUX BioScience, MacuSight, NeoVista, Neurotech, Novartis, Oculis, Omeros, Opthea, Ophthotech, Orbis International, Oxurion, Regenxbio, Reneuron, Retina World Congress, Roche, Santen, Inc, Shire Human Genetics, Stealth Biotherapeutics, Thrombogenics and TrueVision; Consultant for, Acucela, Aerie Pharmaceutical, Aerpio, Alcon Pharmaceutical, Alcon Surgical, Allergan, Alimera Sciences, Amgen, Annidis, ArticDX, Arctic Vision, AsclepiX Therapeutics Inc., Bausch & Lomb Pharma, BeyeOnics, BioBridge/Retinagenix, Boehringer Ingelheim, Chengdu Kanghong Biotechnology, Clearside Biomedical, Daiichi Sankyo, DigiSight, DOSE Medical, FoxKiser, Gemini Pharmaceutical, Genentech, Glaukos, Graybug Vision, Kodiak Sciences, Irenix, jCyte, Ionis, Lutronic, LUX BioScience, MacuSight, Merck, Nan Fung Group, NeoVista, Neurotech, Novartis, Oculis SA, Omeros, Opthea, Ophthotech, Optovue, ORA, PanOptica, Pentavision, Pieris Pharmaceutical, pSiveda/Eyepoint, RegenexBio, Reneuron. Roche, Santen, Inc., SciFluor Life Sciences, Shire Human Genetics, Spark Therapeutics, Stealth Biotherapeutics, Thrombogenics, TopCon and Zeiss Group; Minor stockholder with: Aerpio, Allegro, ArctixDx, Arctic Vision, Clearside Biomedical, Digisight/Verana, FoxKiser, Graybug, Irenix, Nan Fung Group, Oculis, Ophthotech, PanOptica, SciFluor and TrueVision. Employee and shareholder: IVERIC Bio.

Content Reviewer

Walter Murray Yarbrough, MD, FACP, has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Director

Kathy Day has no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Oakstone Publishing and touchIME. Oakstone Publishing is accredited by the ACCME to provide continuing medical education for physicians.

The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 Credit™ into European CME credit (ECMEC) should contact the UEMS (www.uems.eu)

Oakstone Publishing designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

In order to receive credit for this activity, participants must review and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

Date of original release: 22 July 2020. Date credits expire: 22 July 2021.

Learning Objectives

After watching this touchCONGRESS, you should be able to:

  • Evaluate strategies for the management of retinal fluid in nAMD
  • Interpret results from clinical trials and real-world experience to inform on optimal dosing of anti-VEGF in nAMD
  • Recall factors that contribute to optimization of clinical management and reduction in treatment burden for patients with nAMD

This content is intended for healthcare professionals only. Please confirm that you are a healthcare professional.

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Question 1/4
Which of the following statements best describe the relationship between retinal fluid and vision in nAMD?
Correct

Undertreatment of nAMD consistently results in sub-optimal outcomes and the best evidence supports maintaining a dry retina. Data from the HAWK and HARRIER clinical trials showed that, compared with aflibercept, patients treated with brolucizumab had less intra-retinal fluid, sub-retinal fluid and sub-RPE fluid at weeks 16, 48 and 96. In addition, a treatment-agnostic analysis of data from HAWK and HARRIER demonstrated that higher CST variability was associated with vision loss and worse NEI VFQ-25 scores. Although intra-retinal fluid is usually associated with poorer long-term visual outcomes, the presence of sub-retinal fluid does not prevent patients achieving good visual outcomes.

 

CST, central subfield thickness; nAMD, neovascular age-related macular degeneration; NEI VFQ-25 National Eye Institute vision function questionnaire.

References
Sadda S. Brolucizumab in the current management of nAMD. Presented at WOC2020 Virtual
Dugel P, et al. Abstract presented at WOC2020 Virtual, 26–29 June 2020. [Abstract OP-092].
Sadda S. Fluid management in neovascular AMD. Presented at WOC2020 Virtual

Question 2/4
Should the Portal Delivery System with ranibizumab be approved, which of the following patient groups could it be most suitable for?
Correct

The Port Delivery System with ranibizumab is a refillable intraocular drug delivery reservoir that is being developed with a customized formulation of ranibizumab for the treatment of nAMD. It is most suitable for patients who need anti-VEGF treatment every 4-6 weeks.

 

nAMD, neovascular age-related macular degeneration; VEGF, vascular endothelial growth factor

References
Pieramici D. Towards a more durable anti-VEGF therapy for neovascular AMD. Presented at WOC2020 Virtual

Question 3/4
Which of the following options could you suggest exploring as a way of optimizing clinical management and care for patients with nAMD in a post-COVID-19 era?
Correct

A smartphone and web-based app has been successfully used to monitor patients with nAMD during the COVID-19 lockdown by Moorfields Eye Hospital, London, UK. The app allows thresholding, monitoring and instant feedback to patients and scores can be monitored by physicians.

nAMD, neovascular age-related macular degeneration; VEGF, vascular endothelial growth factor

References
Sims D. We are ready for home monitoring of NVAMD patients on follow up. Presented at WOC2020 Virtual

Question 4/4
Your patient is a 68-year old female with a new diagnosis of nAMD in her right eye. Your patient is needle-phobic and very concerned about the experience of intravitreal injections. Based on the results of the HAWK and HARRIER clinical trials, what options could you consider to reduce the burden of therapy for your patient whilst optimizing visual function?
Correct

In the HAWK and HARRIER clinical trials patients were randomized equally to receive brolucizumab or aflibercept. Dosing of aflibercept was fixed at Q8W after the loading doses. After three monthly loading doses patients received brolucizumab Q12W unless disease activity was detected; presence of disease activity resulted in permanent Q8W dosing. In HAWK and HARRIER 82–85% patients who completed their first Q12W interval successfully remained on a Q12W interval until Week 48. Patients treated with brolucizumab had a lower risk of disease activity occurrence and therefore better disease control compared with aflibercept.

nAMD, neovascular age-related macular degeneration; PRN, pro re nata, as needed; Q12W, every 12 weeks.

References
Hamilton R, et al. Abstract presented at WOC2020 Virtual, 26–29 June 2020. [Abstract OP-094].

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