Eye care is advancing at a rapid pace, and the Ophthalmology Times® EyeCon 2022 is the best place to discover opportunities in the field to bring home to your practice. 

Ophthalmology EyeCon 2022

A handheld, standalone device provides easy, fast, and comfortable remote monitoring for patients with dry age-related macular degeneration. 

Reviewed by Angela Christine Yim, BA; and Yannis Mantas Paulus, MD, FACS

A handheld, standalone device provides easy, fast, and comfortable remote monitoring for patients with dry age-related macular degeneration (AMD), according to Angela Yim, BA; and Yannis Mantas Paulus, MD, FACS. Yim is a student at the University of Michigan Medical School in Ann Arbor. Paulus is the Helmut F. Stern Career Development Professor of Ophthalmology and Visual Sciences and an associate professor in the Department of Ophthalmology and Visual Sciences and Biomedical Engineering at University of Michigan Health Kellogg Eye Center. The investigators tested the device in a clinical setting.

Patients with AMD who were 50 years or older participated in a trial of the device at the Kellogg Eye Center outpatient retina clinic following Investigational Review Board approval by the University of Michigan.

After using the device, patients completed a device survey and the System Usability Scale survey. The primary outcome was the testing duration, and the secondary outcome was the patient-reported usability and comfort while engaged with the device, the investigators said.

Thirty-one patients (mean age, 77.4 years) completed the study and 1 patient withdrew after completing the study. The patients were evenly divided by gender (50% men, 50% women).

Yim reported that the mean total testing time was just above 2 minutes (126 seconds with a standard deviation [SD] of 56 seconds) and the mean System Usability Scale score was 77.7 (SD, 11.9), indicating the device had easy usability.

An image taken from the handheld device. 

The vast majority of the patients, 97%, reported that both the time required to use the device and the ease of use of the device were acceptable; 90% of patients said the device was comfortable to use.

Based on the surveys, this device seems to have a promising future for home monitoring of AMD. Being handheld makes it rapid, easy, and comfortable for patients to use to monitor their AMD. The investigators believe that the usability demonstrated by the device supports further clinical trials to demonstrate the reliable detection of AMD progression.

AMD is a leading cause of blindness in the world, Paulus said, noting that the majority of vision loss occurs at the transition from dry to wet AMD. Timely identification of this transition is critical to initiate anti-VEGF treatment.

“This novel, handheld device using shape discrimination hyperacuity is comfortable, easy, and quick to use, requiring only 2 minutes in this clinical validation among dry AMD patients.” Paulus concluded.

Yim has no financial interest in this technology. She is a medical student at the University of Michigan Medical School.

Paulus is an inventor on a submitted University of Michigan patent application (42904767) titled “Apparatus for testing age-related macular degeneration and method of using the same.”

He is the Helmut F. Stern Career Development Professor of Ophthalmology and Visual Sciences and an associate professor in the Department of Ophthalmology and Visual Sciences and Biomedical Engineering at Kellogg Eye Center, University of Michigan Health, Ann Arbor.

Articles

Patients surveyed say the handheld tool proved to be comfortable and easy to use. 

Remote monitoring device detects AMD progression

Reviewed by Jed Lusthaus, MBBS, MPH, FRANZCO

An example of hemoglobin video imaging showing improved aqueous outflow 4 weeks after trabecular bypass surgery with iStent inject. An aqueous column becomes clearly visible postoperatively, and the black arrow demonstrates the direction of flow. (Image courtesy of Jed Lusthaus, MBBS, MPH, FRANZCO)

Contrary to what one might expect, the highest IOP spikes can occur 1 week after implantation of the iStent device (Glaukos) viatrabecular bypass surgery, not on postoperative day 1.

In addition, investigators have found that hemoglobin video imaging (HVI) may enhance our understanding of IOP control and aqueous outflow after trabecular bypass surgery with implantation of iStent Inject, Jed Lusthaus, aglaucoma pecialist and clinical researcher at Sydney Eye Hospital and The University of Sydney, told 

The ocular response to trabecular bypass surgery can vary greatly, from unpredictable IOP reductions to sharp IOP elevations, anywhere between 1 day and 2 weeks postoperatively.

However, Lusthaus cautioned that sudden IOP spikes after trabecular bypass surgery can pose safety concerns, especially in cases of advanced glaucoma. On the other hand, such events allow surgeons to study the pathophysiologic response of the aqueous outflow system.

Cohort study of open-angle glaucoma patients

Lusthaus and his team conducted a study of the short-term IOP fluctuations in 105 consecutive eyes during the 4 weeks after surgery.

Twenty patients underwent HVI preoperatively to assess changes in aqueous outflow, and another 5 eyes underwent HVI after cataract extraction and intraocular lens implantation. One nasal vein and 1 temporal aqueous vein were the imaging targets for aqueous outflow analysis.

All patients were evaluated preoperatively, on postoperative day 1, and at postoperative weeks 1 and 4.

The results indicated that IOP peaked 1 week after stent implantation and stabilized by week 4 (

 < 0.0001). Greater than 30% IOP elevations from baseline occurred in 13% of the patients.

The evaluation at week 1 showed that 46.7% of patients had more than a 30% IOP increase at week 1 compared with day 1.

The aqueous outflow, represented by aqueous column cross-sectional area, showed inconsistent responses on imaging of targeted veins after trabecular bypass surgery; however, the eyes with the lowest outflow preoperatively experienced an increase at week 4.

Three outflow patterns were observed: recovered and improved laminar flow, in which 2 of 10 eyes had an IOP spike; preoperative laminar flow with a reduced or lost aqueous column at weeks 1 and 4, in which 3 of 6 eyes had an IOP spike; and redirected flow into adjacent vessels at week 1, in which 3 of 4 eyes developed an IOP spike.

Based on these results, investigators recommended that the IOP be monitored more frequently after trabecular bypass surgery and that prophylaxis should be considered in patients with advanced glaucoma. In addition, they noted that eyes with very low preoperative aqueous column cross-sectional areas are likely to have significant blockage of the trabecular meshwork and may benefit from trabecular bypass surgery.

“Understanding the significance of different aqueous outflow responses to trabecular bypass surgery may advance our understanding of glaucoma pathophysiology and improve perioperative decision-making,” Lusthaus concluded.

The Sydney Eye Hospital Foundation, Glaukos Corporation, and Carl Zeiss Meditec provided equipment grants for this study.

The procedures may result in temporary pressure spikes later than expected. 

Getting a better handle on IOP control

Investigators conducted a dose-escalation trial of AAV5-RPGR that included low, intermediate, and high doses of the gene therapy administered to 3, 4, and 3 adults, respectively.


A gene therapy for a common and severe form of retinitis pigmentosa (RP), 

-associated X-linked RP, botaretigene sparoparvovec (MeiraGTx Holdings plc and Janssen Pharmaceuticals), demonstrated improvements in retinal sensitivity and visual function compared with controls and had a manageable adverse event profile, according to Michel Michaelides, MD, from the UCL Institute of Ophthalmology and Moorfields Eye Hospital, London, UK.

In their multicenter phase 1/2 safety study conducted in the US and UK, Michaelides and colleagues conducted a dose-escalation trial of AAV5-RPGR that included low, intermediate, and high doses of the gene therapy administered to 3, 4, and 3 adults, respectively.

An intermediate dose was administered to 3 children. The study design also included an expansion phase once the dosing was confirmed; the expansion cohort included low- and intermediate-dose arms with 8 and 11 patients, respectively, and a concurrent control arm in which a low- or intermediate dose was deferred for 6 months in 13 patients.

All patients in the study were male 5 years and older and all had RP resulting from a disease-causing variant in RPGR. In addition, optical coherence tomography showed relative preservation of central retinal structure.

Michaelides reported that AAV5-RPGR gene therapy demonstrated an adverse events profile that was anticipated and manageable. Most events were associated with the surgery to deliver the vector and resolved without intervention.

During the dose-escalation phase, 1 retinal detachment developed and resolved with treatment and 1 case of panuveitis associated with the low dose; in the dose-expansion phase, the intraocular pressure increased in 1 patient and resolved with treatment. When an additional steroid regimen was used during the expansion phase, the adverse events related to inflammation decreased, he explained.

Pooling of the data from the low- and intermediate-dose groups showed an improvement in the mean retinal sensitivity in adults at 6 months compared with the untreated controls. The treatment showed a 2-decibel improvement seen with static perimetry compared with controls and 1 decibel by microperimetry.

A sensitivity analysis based on phase 3 criteria results in exclusion of 2 patients each from the treatment and control groups. Once they were excluded, a greater significance (

A pointwise responder analysis of the static perimetry of the pooled data from the adults treated with low and intermediate doses showed improvement with both doses compared with untreated controls. Michaelides defined a responder as a patient with at least a 7-decibel improvement compared with baseline at 5 or more loci and the same 5 loci showed improvement at 2 evaluations after treatment.

At week 26 after treatment, 26% of patients in the pooled data group satisfied the definition and that increased to 48% at week 52; in the control group, 20% were responders at week 26 and no additional data for week 52 (as patients in the control group receive treatment after the week 26 assessments), he reported.

The sensitivity analysis using phase 3 criteria applied to the pooled data showed 24% and 48%, respectively, at the same time points. In the control group the responder rate was 0%.

Patients were exposed to a mobility maze 9 months after treatment to determine just what the visual improvements might contribute to their ability to negotiate in a real-world setting.

Michaelides outlined that the results achieved in the maze with a light level of 1 lux by a patient treated with the intermediate dose. When he went through the maze at baseline before treatment, the patient completed the maze in 61.7 seconds with 2 errors; at 9 months, the patient traversed the maze in 16.4 seconds with no errors.

“This is a dramatic representation of the impact this gene therapy can have,” Michaelides explained.

When considering all treated patients, the investigators observed significant reductions in walk time at week 26 compared with baseline and compared to untreated controls. When phase 3 criteria were applied, the results were significant at lux levels of 1, 2, and 16.

“We found a good safety profile and have seen improvements in retinal sensitivity and functional vision compared to the control group at 6 months,” Michaelides concluded. “Importantly, all domains in the low-luminance questionnaire trended positively, with the extreme lighting domain nominally significant. Considering these strong findings, a phase 3 study is underway.”

Michel Michaelides, MD
E: michel.michaelides@ucl.ac.uk

Michaelides is a consultant to and owns equity in MeiraGTx.

The therapy offers improved retinal sensitivity, visual function, as well as improvements in mobility.

Gene therapy trial highlights RPGR-associated X-linked RP 

When treating diabetic retinopathy (DR), the current approach for physicians remains medical management, specifically maintaining control of blood sugar, blood pressure, and lipids and encouraging smoking cessation.

Remarkably, for each 1% decrease in hemoglobin A1C, the risk of complications decreases by 28% to 35%, David S. Boyer, MD, an adjunct clinical professor of ophthalmology at the University of Southern California Keck School of Medicine in Los Angeles, outlined in a presentation at the American Academy of Ophthalmology’s annual meeting in Chicago.

So why are additional treatments needed for patients with diabetic eye diseases? The answer is that despite the latest advances in anti-VEGF therapy, a small group of patients do not achieve improved vision. Boyer pointed out that 40% of eyes have a suboptimal response to monthly intravitreal VEGF injections.

Numerous intravitreally injected anti-VEGF drugs for DR with different mechanisms of action are undergoing investigation. These include aflibercept (Regeneron/Bayer), OPT-302 (Opthea), THR-149 (Oxurion), KSI (Kodiak), and PDS/ranibizumab (Genentech), as well as multiple biosimilar drugs that work on controlling VEGF-A and VEGF-B.

Orally administered drugs for diabetic eye disease also are under study. These include APX3330 (Ocuphire), an REF-1 inhibitor; BAY1101042 (Bayer), a guanylate cyclase activator; AKST4290 (Alkahest), a CCR3 eotaxin inhibitor; RG7774 (Roche), a CB2 receptor; and HCB 1019 (InflammX), connexin 43, all of which are for treating DR; and RZ402 (Rezolute), plasma kallikrein for diabetic macular edema (DME). 

The hope, according to Boyer, is that the oral agents will reduce the number of injections administered and provide visual improvements.

Topical therapies are also in the pipeline: SFO-166 (OcuTerra), an integrin in a phase 2 study; and OCS-01 (Oculis), a steroid in a phase 1 study (NCT05409235). 

Pharmaceuticals further along the pipeline

High-dose (8 mg) aflibercept, currently in a phase 3 trial, may be active for a longer duration and provide better drying. The drug demonstrated excellent safety without toxicity. The treatments were extended out to 12 and 16 weeks with 8.8 and 7.9 letter gains, respectively, with decreased frequency of injections.

Regenix Bio’s RGX-314, a gene therapy injected into the suprachoroid, provides a long duration of action and a 2-step or greater improvement in the Diabetic Retinopathy Severity Score (DRSS) in 33% of patients at month 3 and in 47% of patients at month 6. These improvements were achieved with 1 injection. The therapy works by reducing blood vessel formation by providing ocular cells with the ability to produce an anti-VEGF fab and has not demonstrated any inflammation. “This is one of the most exciting treatments available for [patients with] DR,” Boyer stated.

Opthea’s OPT-302 is an intravitreally injection combination therapy targeting DME by inhibiting VEGF-C and VEGF-D. When used in combination with an anti–VEGF-A therapy, VEGFR-2 and VEGFR-3 signaling are blocked completely. In a small post hoc analysis, the mean change in the best-corrected visual acuity (BCVA) from baseline to week 12 was 6.4 letters when OPT-302 was injected with 2 mg of aflibercept compared with 3.4 letters with aflibercept alone. In addition, the number of patients who gained 10 or more letters with the combination therapy was much higher than with aflibercept alone, 27.3% versus 0%, respectively.

Genentech’s PDSinsert is a long-acting drug. In the phase 3 noninferiority PAGODA study (NCT04108156), 550 patients with DME were randomly sassigned to PDS 100 mg/mL that was refilled at 6-month intervals or ranibizumab 0.5 mg. The change in the BCVA at week 64 compared with baseline is the primary end point. These results are forthcoming. “This approach decreases the treatment burden tremendously,” Boyer said.

PAVILION (NCT04503551), a second study of the efficacy and safety of PDS is also under way in patients with moderately severe or severe nonproliferative DR without DME. The primary end point is the percentage of patients with a marked improvement of more than 2 steps in the DRSS at 1 year of treatment. Patients will be treated once every 6 months and hopefully disease progression will be reduced . [Editor’s note: Following this presentation, Genentech put their diabetic trials on hold because of failure of the insert.]

Kallikreins, which are serin proteases, also may provide better drying and visual improvements and may be used alone or in combination with anti-VEGF therapy. They are currently being evaluated as an intravitreal injection and also as oral agents.

“Diabetic retinopathy is a multifactorial disease. I am hoping that these new agents that are in clinical testing will be able to improve vision, decrease frequency of injections, allow easier routes of administration or improve diabetic retinopathy severity allowing us to take better care of our patients with diabetic eye disease,” Boyer concluded.

Boyer is a consultant to Regeneron, Opthea, Oxurion, and Genente.

Despite the latest advances in anti-VEGF therapy, a small group of patients do not achieve improved vision. Ophthalmologists are looking for options. 

Pipeline reveals bright future for combating diabetic eye disease

Videos

Drs Andrew S. Morgenstern and Francis S. Mah provide insight on the functionality of ocular accommodation as an autofocus lens and how this is affected in patients with presbyopia.

Impact of Presbyopia on Mechanism of Ocular Accommodation

Francis S. Mah, MD, and Andrew S. Morgenstern, OD, FAAO, FNAP, review the impact of presbyopia on quality of life as well as current treatment options and unmet needs for disease management.

Overview of Presbyopia

The investigators considered the therapy to be well tolerated out to 3 years after the gene therapy was administered.

An optogenetic treatment, GS030-MD (GenSight Biologics), which combines gene therapy and a medical device, demonstrated a good safety profile in the phase 1/2 PIONEER trial (NCT03326336) n patients with end-stage retinitis pigmentosa (RP), according to José-Alain Sahel, MD.

RP, a genetic disease that results from mutations in more than 100 genes, causes slowly progressive photoreceptor degeneration and blindness.

In the multicenter, open-label safety study, the gene therapy vector delivered the light-sensitive protein, ChrimsonR, to the participants’ retinal ganglion cells. The optoelectronic device includes goggles that encode the visual scene and project corresponding light pulses onto the retina to activate the retinal ganglion cells.

The patients were divided into 3 cohorts of 3 patients each, receiving escalating doses. In cohort 1, the dose was 5× 1010 vg/eye; cohort 2, 1.5 × 1011 vg/eye; and cohort 3, 5 × 1011 vg/eye; 1 intravitreal dose was injection into the eye with the worse vision. An extension cohort will receive the highest dose administered; participants are currently being enrolled.

All patients had end-stage disease with visual acuity of counting fingers or worse. Patients will be followed for 5 years. The primary end point was safety at 1 year.

Intraocular inflammation developed in 5 (56%) patients, with 8 episodes reported that resolved without sequalae with corticosteroid treatment. Anterior uveitis developed in 3 patients—2 had received the low dose and 1 had received the medium dose.

One episode each of hyalitis with retrocorneal precipitates and anterior uveitis with retrocorneal precipitates developed in association with the high dose, Sahel reported. He is chairman of the Department of Ophthalmology at The University of Pittsburgh School of Medicine in Pennsylvania and a professor at the Sorbonne Université in Paris, France.

Two patients reported light sensitivity, and 1 patient had increased IOP.

Two patients achieved a significant improvement in vision over the course of 1 year. The patients, according to Sahel, were barely able to perceive light before treatment and at 1 year were able to locate and count objects.

One of these patients, who had a 40-year history of RP, responded to the lowest of the 3 doses. A second patient had RP for 20 years and responded to the intermediate dose of gene therapy.

The training with the device began 4 months after the injection. The light-stimulating goggles were well tolerated by the patients.

The PIONEER study was the first clinical trial for patients with RP that combined the simultaneous action of gene therapy and a medical device. It is a therapeutic approach that is independent of underlying genetic defects.

The investigators considered the therapy to be well tolerated out to 3 years after the gene therapy was administered. The preliminary efficacy assessment showed partial functional recovery in 2 patients.

“While we are now observing the benefits of this first-in-human therapeutic approach in more patients, we are optimizing the stimulation system and enrolling patents for the extension cohort. Optogenetics certainly holds strong promises for our most affected patients,” Sahel concluded.

Dr Sahel is a founder of and unpaid consultant for GenSight Biologics.

Investigators who are examining end-stage disease see significant visual recovery in 2 patients. 

Combining gene therapy and medical device makes progress in RP

 This transcript has been lightly edited for clarity.

.® Dr. Patricia Piers, head of R&D, Ophthalmic Implants at Johnson & Johnson Surgical Vision, recently received the 2022 Women in Ophthalmology Scientific Contribution Award. This award recognizes a physician or non-physician scientist who has made significant contribution in the field of ophthalmology. Thank you for joining us today. Can you tell us a little bit about some of the contributions you made to ophthalmology that have led to this recognition?

 Thank you for the question. Yeah, I've been involved in, in as many as 20 new product launches. There are always several that stand out. Twice, I've been lucky enough to work on IOLs that were the first in the category. And, you know, the first of this was actually the very first project that I got to work on as a new employee. And that was the Tecnis lens, that that was the first ashperic lens on the market. Last year, 2021, was the 20th anniversary of the Tecnis IOL. So I guess that kind of dates me a little bit, tells you how long I've been working here. But in that, that lens actually evolved into the platform that we have today, that delivers high quality of vision, due to its design, and its unique materials. And all of the lenses in the Tecnis family of products are built on that platform that we created 20 years ago.

The second category creator that I got to work on was the Tecnis Symfony lens, which was the first of its kind, extended depth of focus lens, that that was also really special. As we were part of the creation of a category it with that one of lenses for presbyopia correcting. You know, like with anything else, it's always the ones that that you have to fight the hardest for, that are the ones that that you're most proud of.

In discussions of products that I'm most proud of the one that immediately springs to mind is the is a is one of our current, most current, most innovative products. That's the Tecnis Eyhance IOL that slightly extends the depth of focus for patients in the reimburse category. You know, it's, it's strange to say that I worked on these right, because as you know, I'm not responsible for anything alone, right? That that would definitely not be fair to say. Science is very rarely done, alone. And I'm really blessed to work with very special group of scientists and engineers. And actually, that's probably the thing that I'm most proud of is the group of really extremely competent, talented individuals that that I get to work with every day. So that's it.

 What does this recognition mean to you?

 I feel tremendously honored to represent Johnson and Johnson Vision, leadership in R&D and Surgical Vision. And especially with the WIO, this is a very special group that's extremely welcoming. And really setting the example of women helping women lead. I got the privilege of presenting this award to last year's winner and she was such an impressive individual that I don't really feel like I'm remotely in the same league. I'm excited to leave any imprint within Women in Ophthalmology that I can, as we really work together, to pave the way for more women in ophthalmology as well as STEM and supporting women in underrepresented areas of science and technology, which I'm also extremely passionate about.

 Looking to what's going on right now, what are some of the latest developments going on that you're seeing that will impact ophthalmology?

 Okay, so, what's going on in ophthalmology? It's, it's actually the best thing about this field, right? As a scientist and innovator, it's it, it's a field that truly gets completely under your skin because innovation moves very, at a very, very fast pace in this industry. You know, 2021 was a very exciting year for J&J Surgical Vision where we launched two very exciting products in the US market, the Tecnis Synergy IOL, a high-performance hybrid lens that's designed for spectacle, independence, and the Tecnis Eyhance IOL, that slightly extends the depth of focus for those patients in the monofocal category. And this year, J&J vision announced the Tecnis Symfony, OptiBlue IOL, the extended depth of focus lens that expands presbyopia correction to more patients and includes the InteliLight technology.

 What can these lenses, how can they help ophthalmologists provide better outcomes for their patients?

 Yeah, you know, as we as we go through new editions of technology, what we're what we're really looking for, is higher is higher quality of vision. And, you know, there's always a balance in everything we do, between providing a range of vision, providing a high quality of vision and providing reduced symptoms. And so as we as we continue to innovate in presbyopia correcting lenses, what we're looking for, is really a better balance. The Tecnis Symfony, OptiBlue, what we what we've provided with that lens is actually looking forward to the best contrast and low light performance in the presbyopia-correcting IOL category. So, every time we're innovating, we're striking a better and better balance between those three things, especially in the presbyopia correcting category that helps surgeons when we're reducing symptoms, it helps them to have to deal with less chair time, have less complaints from patients. Higher contrast vision is making patients safer. And having a larger range of motion is providing them with increased spectacle independence, or enabling them to do things that they otherwise wouldn't be able to do without spectacles.

 You mentioned having a great 2021. Are we still seeing any residual impacts from the pandemic on research and development?

 Yeah, we are. And you know, most of it comes from comes from what is trickling down from what we see with the in areas of the supply chain issues that we see worldwide, you know, that that affects us also on the front end of innovation as well. So, I think that's mostly where we're, we're seeing the effects, at least in industry. That as well as talent and staffing. And making sure that that you're able to, to work with the best possible people and it's really taking a lot more time to ensure that you're getting the same caliber of scientists and engineers that you really want to drive innovation forward.

 Are we seeing artificial intelligence being integrated into research and development efforts?

 Yes, definitely. It's being integrated in many, many areas. It's being integrated in diagnosis, it's being integrated in calculations, it's being integrated in design … all throughout the process. I's not taking, taking away from what people need to do, but it's making our lives easier.

 And looking forward. What's your outlook for research and development efforts in ophthalmology in 2023? And beyond?

 Oh, gosh, you know, there's just so much to be done, right. Billions of people during their lifetimes will have eye health needs. And the numbers are increasing every year. We all have our work cut out for us to raise the standards of care and improve outcomes for all those patients, as well as improving accessibility to care and improve solutions for all. And in cataract R&D, we're faced with aging populations and increased comorbidities. These are really exciting problems to work on. As I described earlier, we'll continue to develop new IOLs that will continue to improve and evolve and allow patients to have better outcomes and range of vision. The other thing, bringing it back to Women and Ophthalmology, as a member and advocate for Women in Ophthalmology, we continue to strive to elevate women and I think diversity in ophthalmology in R&D. This is through the actions of things like sponsorships and speaking engagements and clinical trials and R&D engagements to ensure that we really have a diverse group of people helping to solve all these problems that we, that I that I just mentioned. In order to ensure that we are providing the best solutions.

In a two-decade career as a researcher at Johnson & Johnson Surgical Vision, Piers has been a part of teams at the forefront of a number of innovations in IOLs. She discusses her career and the outlook for research and development in ophthalmology. 

Patricia Piers, PhD, discusses a career of innovation in ophthalmology, looks to future

Investigators who are examining end-stage disease see significant visual recovery in 2 patients.  

Combinining gene therapy and medical device makes progress in RP

Dropless cataract surgery is gaining in popularity with anterior segment surgeons to ease the treatment burden following cataract surgery, but it is associated with a greater incidence and longer duration of postoperative steroid response.

Annie Mao Wu, MD, and colleagues from the Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, assessed the risks of that prolonged steroid response developing.

The investigators retrospectively reviewed consecutive cataract surgeries performed from January 1, 2020, to September 30, 2021, to identify steroid responses in these patients. A steroid response was defined as an IOP that was 50% higher than the baseline levels or an IOP that exceeded 24 mm Hg following cataract surgery excluding the first 72 hours after the surgery.

The patients who underwent dropless cataract surgery were treated with 2 mg to 40 mg of subconjunctival triamcinolone at the end of surgery and those in the conventional group instilled topical prednisolone in the postoperative period.

During the study period, 368 cataract surgeries were reviewed, of which 150 were dropless cases and the remaining 218 cases were performed conventionally. A steroid response developed in 26 cases, 15 in the dropless cases, and 11 in the conventional cases, Wu reported. 

The mean patient ages at the time of surgery differed significantly between the groups (69.9 years vs 66.5 years in the dropless and conventional groups, respectively; 

The analysis indicated that the dropless cataract surgery was associated with a significantly longer duration of a steroid response (

 = .008). In 9 eyes in the dropless group, the steroid response lasted 30 days or longer compared with that same response in the conventional group.

 < .001) analyses also found that a history of a glaucoma diagnosis also predicted a steroid response, as did the dropless procedure (

Patient age at the time of surgery, axial length, baseline IOP, and suspected glaucoma were not significant risk factors in the development of a steroid response.

A 70-year-old male patient who was highly myopic and had undergone bilateral LASIK underwent emergency bilateral trabeculectomies to bring the IOP under control. The IOPs following cataract surgery were 23 to 38 mm Hg in the right eye and 21 to 36 mm Hg in the left eye and remained uncontrolled despite medication.

Dr. Wu has no financial interest in this subject matter.

Investigators find a link with a postoperative prolonged steroid response.

Patricia Piers, PhD, discusses a career of innovation in ophthalmology, looks to future

Combinining gene therapy and medical device makes progress in RP

Study examines dropless cataract surgery

Ophthalmology EyeCon 2022

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