RETINAL DISORDERS

Educational Objectives

Educational Objectives

The goal of this program is to improve the diagnosis and treatment of retinal disorders and visual complications of gi­ant cell arteritis. After hearing and assimilating this program, the clinician will be better able to:

1.   Summarize the data supporting the current treatment options for dry age-related macular degeneration and evaluate progress in the development of new therapies.

 

Summary

Statins: data do not support use of statins for AMD

AREDS II: will evaluate alternative supplements; lutein  —  presence in high concentration in retina suggests lutein may protect retina; AREDS II will evaluate addition of 10 mg lutein and 2 mg zeaxanthin; fish oil  —  Blue Moun­tain Study found that patients who ate ³1 servings of fish per month less likely to have advanced AMD; omega-3-fatty acids found in photoreceptors and retinal pigment epithelium (RPE) and may protect retinal cells and prevent endothelial cell dysfunction; AREDS II will evaluate addition of 1 g of combined docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA); speaker recommends supplements for patients at high risk

Laser for drusen: Choroidal Neovascularization Prevention Trial (CNVPT), Complications of Age-Related Macular Degeneration Prevention Trial (CAPT), and Prophylactic Treatment of AMD (PTAMD) study found no evidence that laser treatment applied to drusen or to fellow eye prevented choroidal neovascularization; laser treatment not recommended

Telescope: approved for treatment of dry AMD; similar to intraocular lens that sits on optic to enlarge images 2.2-fold to 2.7-fold; magnification allows paracentral projection of images onto healthier areas of retina; 3.6 mm in di­ameter and 4.4 mm in length; requires phakic eyes; not currently available

Investigational Treatments: rheotherapy  —  uses plasmapheresis to remove macromolecules and large proteins from blood; macroglobulin, fibrinogen, cholesterol, and immune complexes postulated to play role in macular degenera­tion; trials halted because of lack of funding; fenretinide  —  synthetic retinoid that decreases accumulation of lipo­fuscin in retina; phase II trial for GA in progress; retinol carried in blood bound to retinol binding protein (RBP) and transthyretin (TTR); fenretinide binds RBP and blocks binding of RBP to TTR; complex then eliminated from circulation; decreases delivery of retinol to RPE and accumulation of lipofuscin; oral agent; OT-551  —  eye drop with antioxidant, anti-inflammatory, and antiangiogenic activities; may protect against oxidative damage, light damage, and retinal degeneration; GSK-933776  —monoclonal antibody against amyloid; given by intravenous infusion for GA; Neurotech device  —  encapsulated cells placed surgically through pars plana; delivers ciliary neurotrophic factor; testing efficacy for macular degeneration and retinitis pigmentosa; in phase II studies; inflammation  —  new data suggest variants in complement component 3 and complement factor H increase risk for AMD; oxidative stress, ge­netic predisposition, and environment may lead to chronic, low-grade deposition of complement in Bruch membrane, RPE, and choroid, causing either low-grade inflammation with atrophy mediated by complement or expression of vas­cular endothelial growth factor (VEGF) and choroidal neovascularization; complement factor D also in phase I tri­als glatiramer (Copaxone)  —  approved for multiple sclerosis; given by subcutaneous injection; formation of drusen possibly similar to amyloid deposits; glatiramer reduced drusen in study; others  —Brimonidine Intravitreal Implants provide sustained release of neuroprotective agent; Geographic Atrophy Treatment Evaluation (GATE) evaluating AL-8309, which reduces retinal damage induced by blue light in rats

Readings

Suggested Reading

Abbate M et al: Prevention and treatment of diabetic retinopathy: evidence from clinical trials and perspectives. Curr Diabetes Rev 7:190, 2011; Augustin AJ: Upcoming therapeutic advances in diabetic macular edema: an intravitreal dexamethasone drug delivery system. Expert Opin Drug Deliv 8:271, 2011; Campochiaro PA et al: Long-term benefit of sustained-delivery fluocinolone aceton­ide vitreous inserts for diabetic macular edema. Ophthalmology 118:626, 2011; Elman MJ et al: Expanded 2-year follow-up of ra­nibizumab plus prompt or deferred laser or triamcinolone for diabetic macular edema. Ophthalmology 118:609, 2011; Gilles MC et al: Intravitreal triamcinolone prior to laser treatment of diabetic macular edema: 24-month results of a randomized controlled trial. Ophthalmology 118:866, 2011; Goslin BJ, Chung MH: Temporal artery biopsy as a means of diagnosing giant cell arteritis: is there over-utilization? Am Surg 77:1158, 2011; Hassan N et al: Giant cell arteritis. BMJ 342:d3019, 2011; Klingel R: RheoNet registry analysis of rheopheresis for microcirculatory disorders with a focus on age-related macular degeneration. Ther Apher Dial 14:276, 2010; Kuno N, Fujii S: Dry age-related macular degeneration: recent progress of therapeutic approaches. Curr Mol Pharmacol May 6, 2011 [Epub ahead of print]; Landa G et al: Qualitative spectral OCT/SLO analysis of drusen change in dry age-related macular degeneration patients treated with Copaxone. J Ocul Pharmacol Ther 27:77, 2011; Lugo JZ et al: Demographic and laboratory data may predict positive temporal artery biopsy. J Surg Res 170:332, 2011; Meisner RJ et al: How to diagnose giant cell arteritis. Int An­giol 30:58, 2011; Montero JA et al Intravitreal anti-VEGF drugs as adjuvant therapy in diabetic retinopathy surgery. Curr Diabetes Rev 7:176, 2011; Olson JH et al: Nutritional supplementation and age-related macular degeneration. Semin Ophthalmol 26:131, 2011; Pearson PA et al: Fluocinolone acetonide intravitreal implant for diabetic macular edema: a 3-year multicenter, randomized, controlled clinical trial. Ophthalmology 118:1580, 2011; Villa-Forte A: Giant cell arteritis: suspect it, treat it promptly.  Cleve Clin J Med 78:265, 2011; Witkin AJ, Brown GC: Update on nonsurgical therapy for diabetic macular edema. Curr Opin Ophthalmol 22:185, 2011; Yehoshua Z et al: Current clinical trials in dry AMD and the definition of appropriate clinical outcome measures. Semin Ophthalmol 26:167, 2011; Zhang K et al: Ciliary neurotrophic factor delivered by encapsulated cell intraocular implants for treatment of geographic atrophy in age-related macular degeneration. Proc Natl Acad Sci U S A 108:6241, 2011.

 

Disclosures

In adherence to ACCME Standards for Commercial Support, Audio-Digest requires all faculty and members of the plan­ning committee to disclose relevant financial relationships within the past 12 months that might create any personal con­flicts of interest. Any identified conflicts were resolved to ensure that this educational activity promotes quality in health care and not a proprietary business or commercial interest. For this program, members of the faculty and planning committee reported nothing to disclose. In this lecture, Dr. Baumal presents information related to off-label or investigational use of a product, therapy, or device.

Acknowledgements

Acknowledgements

Dr. Baumal spoke at 6th Annual Physician Education Conference “2011 Summit on Posterior Segment Dis­orders”, held September 10, 2011, in Cambridge, MA, and presented by the Ocular Immunology and Uveitis Foundation (to learn more about CME activities at the Ocular Immunology and Uveitis Foundation, visit www.uveitis.org). The Audio-Digest Founda­tion thanks Dr. Baumel and the Ocular Immunology and Uveitis Foundation for their cooperation in the production of this pro­gram.

CME/CE INFO

Accreditation:

The Audio- Digest Foundation is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Audio- Digest Foundation designates this enduring material for a maximum of 0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Audio Digest Foundation is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's (ANCC's) Commission on Accreditation. Audio Digest Foundation designates this activity for 0 CE contact hours.

Lecture ID:

OP492301

Expiration:

This CME course qualifies for AMA PRA Category 1 Credits™ for 3 years from the date of publication.

Instructions:

To earn CME/CE credit for this course, you must complete all the following components in the order recommended: (1) Review introductory course content, including Educational Objectives and Faculty/Planner Disclosures; (2) Listen to the audio program and review accompanying learning materials; (3) Complete posttest (only after completing Step 2) and earn a passing score of at least 80%. Taking the course Pretest and completing the Evaluation Survey are strongly recommended (but not mandatory) components of completing this CME/CE course.

Estimated time to complete this CME/CE course:

Approximately 2x the length of the recorded lecture to account for time spent studying accompanying learning materials and completing tests.

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