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2019 American Society of Retina Specialists Annual Meeting

 offers balanced lectures, symposia, and courses with an ample amount of social events.

Beyond the welcome receptions and fundraisers to networking lunches and dinners, the event also is offering expanded educational opportunities.

The event will be held July 26-30 at the Hyatt Regency Chicago, offering a forum on the latest developments in retina.


	
	ASRS is debuting an ambitious live surgery symposium on Tuesday, July 30. Attendees will watch three hours of live vitreoretinal surgery beamed into the auditorium from three surgery sites in the United States, Europe and the Middle East.

The session will be moderated by Kourous Rezaei, MD, and a panel of expert surgeons in Chicago. A surgeon moderator in each operating room will offer their expertise as the surgeries unfold.

In response to requests for more discussion on presented papers, 

 has shortened the presentation time to allow for more moderated question-and-answer sessions after every four to six talks.

ASRS will now conclude each major area with a take-home panel discussion in which experts will “discuss topics of current clinical relevance to provide information you can put to immediate use in the office or in the OR.”

The LAST WORD will be the final session of the meeting, where selected authors, determined during the meeting, will be invited to present a two-minute summary of their work, followed by audience and expert panel discussion. 

“Sometimes a topic deserves more time… the most controversial, the most fascinating, the most important, the most memorable presentations,” said ASRS Program Chairman Carl C. Awh, MD.

OCT and OCTA: Seeing deeper into sickle cell retinopathy 


	The annual meeting kicks off Friday with instructional courses in the afternoon.

All registered attendees and guests are invited to the Welcome Reception, being held this year at 

, where ASRS will take over the entire 60,000 square foot area for an evening of food and drink.

The Women in Retina group will host a luncheon (complete with keynote speaker) and a dinner meeting to hear about unique retina cases.

The Fellow-in-Training Section reception is scheduled for Saturday, and is open to all members.

At 6 a.m. Sunday, the Foundation of the ASRS will host its 

 in Lincoln Park. Outlook Therapeutics has supported this charity event this year.

Registration continues until Saturday, with a $50 donation. For more information, contact Chayal Patel.


	The Early Career Section is hosting its annual luncheon symposium on Sunday. It will feature the 2019 Crystal Apple Award winner Seenu Hariprasad, MD.

For those on the other side of the employment spectrum, John T. Thompson, MD, will moderate an expert panel discussion on strategies to prepare for retirement. Speakers include Jerry Bovino, MD, Brian Conway, MD, Richard Garfinkel, MD, Alan Verne, MD, and David Williams, MD.

Attendees should be prepared with questions for an interactive audience question/comment period.

The annual black tie gala dinner will be held Sunday night at the Field Museum of Natural History.

The International Members and Delegates Breakfast is scheduled for Monday morning.

Festivities will culminate on Monday evening, when ASRS invites all attendees to its foundation fundraiser, a  Chicago architecture tour and river cruise.

Rated by TripAdvisor as the “top tour in Chicago and one of the top 10 tours in the U.S.,” the 90-minute tour on the Chicago River will be filled with Chicago’s 100-year coming-of-age story, as told through its architecture.

Proceeds from the event will help the foundation provide enhanced patient education materials on SavingVision.org.

Tickets are $60 per person and will include one drink ticket.
	 

Articles

Beyond the sessions, this year’s conference offers multiple events for attendees.

ASRS 2019 offers expanded education, social opportunities

 are a common postoperative complication after cataract and refractive surgery and can have an adverse impact on visual recovery and outcomes.

 surgery, common complaints (95% of patients) are of dry eye symptoms such as a gritty sensation, general ocular discomfort and fatigue, vision fluctuation, and ocular redness early in the postoperative period.

Dry eye symptoms tend to lessen over time in LASIK patients, with 20% to 40% of patients still experiencing dry eye six months after surgery.

Although usually transient, the postop symptoms can negatively impact perceived satisfaction with the surgery and overall quality of life.

The postoperative dry eye rate is less in cataract patients but still experienced by the majority. Upwards of 87% of cataract patients use artificial tears one month postop.

 The type of cataract surgery may also impact the severity of dry eye symptoms experienced.

Diagnostic tools can put causes of dry eye in focus


	
	In 2015, Yu et al. reported that patients undergoing femtosecond laser-assisted cataract surgery were at a higher risk for staining and dry eye symptoms than patients undergoing conventional cataract surgery.

 The PHACO study re-emphasized that close to 20% of patients may not have a diagnosis of dry eye when presenting for cataract surgery, but do have clinical signs and that one diagnostic preop test may not be enough to rule out the diagnosis.{Trattler, 2017 #20627}

The type of intraocular lens (IOLs) selected can impact dry eye rates as well. Patients receiving multifocal

IOLs may be at particular risk of dry eye development, leading to IOL exchange in extreme cases.

Preoperative dry eye is also a potential cause of postoperative complications after pterygium surgery.

Turkyilmaz et al. found that the presence of pterygium seems to cause dry eye, and although tear osmolarity signs improve after surgical removal of the pterygium, they deteriorate with recurrance.

Resources offer dry eye clarity for patients


	Many cataract and refractive surgery patients have undiagnosed dry eye. The PHACO study found the majority of patients screened for cataract surgery did not complain of dry eye symptoms, yet up to 80% showed conjunctival or corneal staining.

For physicians, this can present a challenge as cataract surgery can increase the severity of dry eye by about one level and LASIK will increase the severity by two levels.

Postoperative outcomes are also worse in patients with existing dry eye than in patients without.

For LASIK, existing dry eye will impact wavefront and topography readings, leading to residual refractive error.

In cataract surgery, dry eye will lead to inaccurate IOL calculations and axis and magnitude of astigmatism.

 now considers uncontrolled dry eye a contraindication for refractive surgery. It is therefore critical that clinicians evaluate the ocular surface and treat any disease before referring the patient to surgery.

Diagnostic tools include patient-reported symptom questionnaires such as SPEED and tests such as Schirmer’s, phenol red thread, tear break-up time, and ocular surface staining.


	There are certain steps physicians can take to minimize the impact of dry eye during refractive surgery, including creating smaller, thinner flaps during LASIK will reduce the number of nerves cut.

The depth of laser ablation also impacts dry eye development. The deeper the ablation, the more likely the patient will develop dry eye. Hyperopic LASIK also increases the risk of dry eye development, due to the larger flap and treatment zone.

Although the data are inconclusive, some studies have found that the 

small incision lenticule extraction (SMILE)

 refractive procedure is less invasive than LASIK and reduces the incidence of postoperative dry eye because it is a flapless procedure. The vertical side cut to the cornea is shorter with

SMILE than femtosecond LASIK, which preserves the nerves.

SMILE could be appropriate for contact lens wearers with dry eye who are not good candidates for LASIK or who are particularly concerned about exasperating dry eye effects postop.  

For cataract surgery patients, it is more about resolving any existing dry eye symptoms before proceeding with surgery. Patients with aqueous deficient dry eye should be prescribed Restasis (cyclosporine ophthalmic emulsion 0.05%) two to four weeks before cataract surgery. Physicians should see enough improvement to take accurate IOL calculations after that timeframe.

 (MGD) or blepharitis should use hot compresses, lid hygiene, and oral supplements such as flaxseed oil and fish oils to improve the health of their glands before proceeding with surgery. 

1. Trattler WB, Majmudar PA, Donnenfeld ED, et al. The Prospective Health Assessment of Cataract Patients' Ocular Surface (PHACO) study: the effect of dry eye. 

 2017;11:1423-30.
	2. Shtein RM. Post-LASIK dry eye. Expert Rev 

 2011;6(5):575-82.
	3. Roberts CW, Elie ER. Dry eye symptoms following cataract surgery. 

 2007;32(1):14-21; quiz 2-3.
	4. Yu Y, Chen X, Hua H, et al. Comparative outcomes of femtosecond laser-assisted cataract surgery and manual phacoemusification: a six-month follow-up. 

2016;44(6):472-80.
	5. Hovanesian JA. Pterygium: Techniques and Technologies for Surgical Success. Thorofare, NJ: 

, 2012.
	6. Turkyilmaz K, Oner V, Sevim MS, et al. Effect of pterygium surgery on tear osmolarity. 

 2013;2013:863498.
	7. De Paiva CS, Chen Z, Koch DD, et al. The incidence and risk factors for developing dry eye after myopic LASIK. 

2006;141(3):438-45.
	8. Kobashi H, Kamiya K, Shimizu K. Dry Eye After Small Incision Lenticule Extraction and Femtosecond Laser-Assisted LASIK: Meta-Analysis. 

A common symptom, dry eye can have an adverse impact on visual recovery and outcomes

Managing dry eye key to patient satisfaction after cataract, refractive surgeries

Originally believed to be primarily a disease of postmenopausal women with or without autoimmune disorders, it is now recognized that 

(DED) affects patients of both sexes at younger ages.

DED is a chronic condition, and although pharmacological and procedural treatments can improve clinical signs, there is no cure.
	

 generates close to $540 million in annual sales globally,

 and the U.S. spends more than $2 billion yearly on pharmaceuticals to treat DED.

 dry eye spend 78% more on western medicine than those without the autoimmune disorder DED.

 There continues to be an unmet need for more effective treatments for DED, as is evidenced from the multitude of clinical studies listed in 

 that are under way or not yet recruiting.

Here is a brief overview of studies that’s are nearing completion and some products that have been filed for regulatory approval.

Understanding prevalence, demographics of dry eye disease


	Kala Pharmaceuticals has submitted a new drug application to the U.S. Food and Drug Administration (FDA) for KPI-121 (0.25%) for the treatment of dry eye based on the strength of one phase 2 trial and two phase 3 trials, STRIDE 1 and STRIDE 2. 

The trials enrolled almost 2,000 patients, and indicated statistical significance for the primary endpoint of conjunctival hyperemia, as well as the primary symptom endpoint of ocular discomfort severity.

If approved, KPI-121 would be first product indicated for the temporary relief of the signs and symptoms of dry eye disease and flares. The agent uses Kala’s AMPPLIFY drug delivery technology to better penetrate the target tissues.
	Data from the phase 3 clinical trial, STRIDE 3 (ClinicalTrials.gov Identifier: NCT03616899), is expected to be released later this year.


	Aldeyra Therapeutics is now enrolling patients into the RENEW phase 3 clinical trial, which will evaluate the efficacy of reproxalap ophthalmic solution (0.25%) versus vehicle in 400 patients with moderate and severe DED.

Co-primary endpoints are ocular dryness and fluorescein nasal region ocular staining (ClinicalTrials.gov Identifier: NCT03879863).

The phase 3 trial comes on the heels of successful phase 2b trial results, which demonstrated statistical superiority of reproxalap versus vehicle across multiple dry eye signs and symptoms.

In the new study, patients will be randomly assigned to one of four arms: reproxalap 0.25% administered QID for 12 weeks; reproxalap 0.25% administered QID for four weeks, then BID for eight weeks, or vehicle comparators to each of the active arms. Targeted trial completion is April 2021.

Aurinia Pharmaceuticals recently announced phase 2 data of its 100-person, double-masked, head-to-head trial comparing voclosporin ophthalmic solution (VOS) to Restasis. Both drugs were well-tolerated and there was no statistical difference between VOS and Restasis for the primary endpoint; both drugs exhibited low drop-discomfort scores.
	VOS did show statistically significant improvements over Restasis at week 4 for objective tests, including Schirmer’s and fluorescein corneal staining.

Rethinking clinical strategy for treating dry eye disease

Lacripep is currently in a phase 2 trial to compare its efficacy versus placebo in patients with Sjogren’s syndrome dry eye (ClinicalTrials.gov Identifier: NCT03226444). The primary endpoint is change in fluorescein corneal staining score at week four from baseline.

Secondary endpoints include changes in eye dryness, mean SANDE 2 scores, and individual symptom assessments, among others.

Mitotech is developing a few drug formulations of SkQ1, such as Visomitin, which is currently in phase 3 trials for the treatment of DED (ClinicalTrials.gov Identifier: NCT03764735).

Visomitin is already approved for this indication in Russia. Clinical trials have shown that Visomitin is efficacious in improving corneal and conjunctival staining, tear quality, and other DED symptoms.

According to the company website, one part of SkQ1 functions as a molecular “tow truck,” carrying the other part of the molecule - an extremely active antioxidant plastoquinone - into mitochondria.

The molecule was designed to act as a mitochondria-targeted ROS scavenger in general and as a very efficient cardiolipin peroxidation inhibitor, in particular. Mitotech is also developing SkQ1 as a potential treatment for uveitis and dry age-related macular degeneration.

Novaliq has two DED products in the pipeline: NOVO3 (100% perfluorohexyloctane) and CyclASol (ophthalmic solution of 0.1% cyclosporine A in EyeSol). NOVO3 is being developed for evaporative DED from meibomian gland dysfunction. The SEECASE-1 U.S. study, enrolled 336 patients, and the SEECASE-2 study, which is beginning this year. CyclASol is in development for the treatment of aqueous deficient DED. The ESSENCE-1 U.S. study enrolled 328 patients; the ESSENCE-2 study is beginning this year. New Drug Application submissions for both drugs are expected in 2021.

Oyster Point Pharma has two nasal spray therapeutics in clinical trial development for the treatment of DED. OC-01 (ClinicalTrials.gov Identifier: NCT03873246) and OC-02 are selective nicotinic acetylcholine receptor (nAChR) agonists that harness the trigeminal parasympathetic pathway to improve tear film production.

Report promotes step therapy approach to dry eye disease management

The OC-02 RANIER and PEARL studies are complete, but data have not been released. The OC-01 MYSTIC (ClinicalTrials.gov Identifier: NCT03873246) and IMPERIAL (ClinicalTrials.gov Identifier: NCT03688802) studies are recruiting with an expected study completion date in August; the ONSET-1 study is complete, but data have not been released. According to the company, in Phase 2b clinical studies patients administered either OC-01 or OC-02 experienced rapid and significant improvements in both the signs and symptoms of DED.

Both were well-tolerated with no significant ocular adverse events or drug-related serious adverse events.

ReGenTree will begin enrolling patients into ARISE-3, a phase 3 trial designed to evaluate RGN-259 for the treatment of DED (ClinicalTrials.gov Identifier: NCT03937882).

RGN-256 is a preservative-free sterile eye drop solution containing Thymosin beta 4 designed for direct instillation into each eye.

ARISE-3 is designed to compared RGN-259, dosed QID for 14 days, against placebo. The trial is expected to enroll 700 patients in 15 sites across the United States.

The primary completion date is expected to be April 2020, with final completion in July 2020.

TearCare, from Sight Sciences, is a wearable, open-eye technology that delivers regulated, localized heat to the eyelids to clear the meibomian glands of obstructions and restore the production of healthy meibum.

Sight Sciences is now enrolling patients into OLYMPIA, a prospective, multicenter, randomized, controlled study designed to compare the safety and efficacy of TearCare to the LipiFlow Thermal Pulsation System (Johnson & Johnson Vision) in patients with dry eye disease. The TearCare SmartLids will be applied to the external surface of each eyelid.

The TearCare System will be turned on and heat will be delivered to the eyelids for 15 minutes. Immediately following the thermal portion of the procedure, the SmartLids will be removed and the doctor will manually express the meibomian glands.

The LipiFlow activators will be placed between the inner eyelid and the corneal surface of each eye. The LipiFlow System will be turned on and heat and pressure will be delivered to each eyelid for 12 minutes. OLYMPIA will enroll 138 patients across 10 centers in the United States and has a target completion date of October 2019. (ClinicalTrials.gov Identifier: NCT03857919)

Topivert Pharma’s TOP1630, a novel anti-inflammatory kinase inhibitor, is in a multicenter, randomized, placebo-controlled phase 2b/3 trial that will enroll 200 patients with moderate and severe DED compared to placebo (ClinicalTrials.gov Identifier: NCT03833388). Primary endpoints include ocular grittiness and ocular surface lissamine green staining at day 29. Top line data are expected later this year.

1. Moshirfar M, Pierson K, Hanamaikai K, et al. Artificial tears potpourri: a literature review. Clin Ophthalmol 2014;8:1419-33.
	2. Hawkes N. US's $2bn annual spend on dry eye disease "brings tears to your eyes," say critics. BMJ 2018;360:k492.
	3. Yao W, Le Q. Social-economic analysis of patients with Sjogren's syndrome dry eye in East China: a cross-sectional study. BMC Ophthalmol 2018;18(1):23.

New compounds could offer more options for physicians in treating patients, leading to better outcomes. 

New for 2020 and beyond: Dry eye disease agents in pipeline 

Migraine affects 12% of the population, and is the third most prevalent illness in the world.

It has been associated with stroke and myocardial infarction, as well as retinal vessel occlusion, ischemic optic neuropathy and normal tension glaucoma, according to Alexander Barash, MD, New York Medical Care.

Dr. Barash pointed out that these associations are stronger for those patients who have migraine with aura than without aura. Whether or not migraine can significantly increase the risk of developing primary open-angle glaucoma remains controversial.

Aura (which includes visual disturbances and/or other neurologic symptoms) occurs in about 25% of patients who experience migraine,

 and is often a cause for referral to an ophthalmologist.

“During aura, there are changes in the cerebral blood flow,” he said, noting that people who have migraine also have brains that are more easily damaged, and they need a higher blood flow to survive focal ischemia.

The pattern of migraine aura cannot be fully explained by changes in cerebral blood flow, and the areas of decreased blood flow do not directly correspond to the cortical areas responsible for the aura. “Aura may indicate more severe ischemia that predisposes to complications,” Dr. Barash said.

Using optical coherence tomography angiography (OCT-A), Dr. Barash and colleagues aimed to identify changes to macular and peripapillary retinal perfusion during migraine with aura. “We wanted to know what happens to retinal perfusion during migraine,” he said.

Dr. Barash recruited three male patients who had migraine with aura.

Patients underwent 3x3 mm and 6x6 mm macular and 4.5x4.5 mm optic nerve head OCT-A scans in both eyes during a baseline day without migraine, and during five episodes of aura and immediate post-aural migraine. The analysis included angiographic densities of macular superficial and deep capillary layers, and the radial peripapillary capillary layer. (Patients with migraine without aura were not included.)

Overall macular perfusion density was significantly decreased during post-aural migraine as compared to that of baseline in the superficial and deep macula 6x6 mm scans (p=4.2 x10^-8 and p=0.03206, respectively), and the deep macula on 3x3 mm (p=0.01996).

The overall perfusion density was significantly decreased during post-aural migraine as compared to that of aura in both the superficial and deep macula on 6x6 mm scans (p=0.00131 and p=0.00689, respectively; see figure).

There were no statistically significant changes to macular perfusion noted between baseline and aura, nor were there significant changes to the peripapillary perfusion between baseline, aura or post-aural migraine.

OCT-A detected microcirculatory disturbances during acute post-aural migraine attacks “may be an important took in elucidating the pathophysiological relationship between migraine, aura, and ischemia,” Dr. Barash said.

“There were acute reductions in retinal perfusion in real time, and this may explain the retinal thinning and progression of glaucoma that you see in patients with migraine,” he said.

Dr. Barash recommended further studies with a greater number of enrolled patients to corroborate his findings.

Dr. Barash noted that while he did not account for potential medication use, “it would be interesting to see what the results might be if patients are on vasodilators.”

Dr. Barash also acknowledged that future studies should include females, as migraine tends to affect more women than men (with a lifetime prevalence of 43% for women-about 28 million women in the U.S. alone-and only 18% for men).

The small number of patients in this study did not allow for statistical comparison of concordance between the eyes, but Dr. Barash hopes larger studies will allow for proper powering.

Panelists J. Fernando Arevalo, MD, PhD, FACS, Johns Hopkins University; and Michael S. Ip, MD, Doheny Eye Institute, said they don’t often see patients with migraine. However, while the data is interesting, neither said it would alter their current treatments for patients with retinal vein occlusion or glaucoma. 


	P: 212/243-2300
	This article is derived from Dr. Barash’s presentation at the 2019 American Society of Retina Specialists annual meeting in Chicago. He has no financial disclosures.

1. Migraine Research Foundation. About Migraine. Available at: https://migraineresearchfoundation.org/about-migraine/ migraine-facts/
	2. Xu C, Li J, Li Z, Mao X. Migraine as a risk factor for primary open angle glaucoma. Medicine (Baltimore). doi: 10.1097/ MD.0000000000011377

OCT-A detected microcirculatory disturbances during acute post-aural migraine attacks may be an important tool in elucidating the pathophysiological relationship between migraine, aura, and ischemia.

Migraines, retinal perfusion: Pain for physicians, patients

While articles and discussions on minimally invasive glaucoma surgery (MIGS) seem to be everywhere (for better or worse), “trabeculectomy will survive,” said Kuldev Singh, MD, because of the aging population, the ease of postoperative titration, and the need for even lower pressures.

The glaucoma device market is expected to grow at three to four times the rate of the refractive and cataract surgery and the IOL markets over the next few years, Dr. Singh said.

Dr. Singh’s presentation was part of the 23rd Annual Glaucoma Symposium at the 2019 Glaucoma 360 meeting. Dr. Singh is professor of ophthalmology and director of the Glaucoma Service, Stanford University School of Medicine, Palo Alto, CA. “We currently have 17 distinct procedures for glaucoma inflow/outflow procedures,” Dr. Singh pointed out. “We have non-device MIGS procedures, and we have lasers that reduce aqueous production.”

All of these procedures are leading to a “Glaucoma Restoration” period, likening the current state of glaucoma to a “Glaucoma Renaissance.”

“Not all these procedures and devices will survive,” he said. “There will always be a role for trabeculectomy as a result.”

In the new era, there may even be a greater need for trabeculectomy than there is now, Dr. Singh said. Among his predictions:

The entire MIGS segment will continue to grow. The procedures “have really revolutionized how we care for patients with mild-to-moderate disease,” Dr. Singh said. “We offer a non-pharmaceutical option for these patients and that category will continue to grow.”

Trabeculectomy will continue to be relevant, especially when MIGS fail, or when patients have more severe disease or are older and need lower pressures. “From a numbers standpoint, there are going to be more people who need tra-beculectomy 10 or 15 years from now than there ever have been,” he added.

But will there be people out there who know how to perform the surgery? “That’s a different issue,” Dr. Singh said.

The “ideal” intraocular pressure (IOP) level is continually decreasing-from 21 mm Hg, to 18 mm Hg, then to 12 mm Hg.

“Most people don’t need 12 mm Hg,” Dr. Singh said. “But there’s a small subset in whom 12 mm Hg is not enough-they need 6 mm Hg. Six will be the new 12.”

He added that procedures, such as MIGS, won’t be able to achieve those lower levels for people with much worse disease.

There will always be two types of glaucoma patients, Dr. Singh said-those who continually do well regardless of treatment, and those who continually fare poorly, regardless of treatment.

“We have to know our patients,” Dr. Singh outlined. “The treatment can't be worse than disease. And fortunately, there are many more with mild disease and low risk for progression than high risk for progression.”

MIGS and drops will continue to be the norm for “Glaucoma Lite,” Dr. Singh said. 

But for that subset of patients who progress fast and have catastrophic outcomes, treatment needs to be aggressive. The aging population means it is likely glaucoma specialists are going to be seeing greater numbers of patients who fall into that category.

“As patients age, they start to lose optic nerve tissue from the aging process,” Dr. Singh said. “Glaucoma becomes difficult to treat in patients with IOPs of 10 mm Hg to 15 mm Hg in their 80s and 90s who may be going downhill very fast.”

Be aggressive in aiming for lower pressures, he advised, adding that only trabeculectomy achieves that. Dr. Singh recommends using lower dose mitomycin over a broader area, resulting in more diffuse, minimally vascular blebs.

Dr. Singh’s preferred trabeculectomy technique includes making a limbus-based flap in the majority of his patients (about 85%), but notes in Asian patients, he may prefer fornix-based procedure. A limbus-based procedure allows surgeons “to cut sutures early in the postoperative period without worrying about leaks,” he added.

While Dr. Singh acknowledges trabeculectomies are more work than other procedures, having an assistant to hold the conjunctiva or providing more exposure “makes limbus-based trabeculectomy a lot easier.”

Trabeculectomies done properly “require a lot of postoperative work, a lot of care.” Dr. Singh believes releasable suture lysis is as important as antifibrotics, because that will allow surgeons “to titrate pressure postoperatively,” he explained. “Those two together have made trabeculectomy a unique procedure.

“We can perform the surgery and postoperatively aim for whatever IOP you think is best, based on how you release sutures,” he added. “None of the newer procedures offers that. That’s one of the real advantages of this type of approach.”

Dr. Singh also advised that when performing the newer procedures, “Don't ruin the superior conjunctiva. Most likely, these patients are going to need a trabeculectomy if they have bad disease,” he said.

“I like procedures in the canal and in the eye that don’t adversely impact the conjunctiva,” he said. “I have had patients who underwent some of these newer procedures and now have to go straight to a tube because there is not enough healthy conjunctiva at 12 o’clock to perform a trabeculectomy.”

Finally, Dr. Singh aims to see wound closure at the time of surgery and will inflate the bleb.

“Most of these patients will have double-digit IOPs in the early postoperative period,” he said. “I don't like to see early hypotony-you want to quiet the eye down and remove stitches one to two weeks out rather than right away. The eye will do much better.”

MIGS and Trab: Peaceful co-existence

2019 American Society of Retinal Specialists

 (ASRS) annual meeting is dedicating an entire session to honoring current and future leaders in the retina community.

 will recognize leaders whose dedication and outstanding contributions have helped evolve the field and improve patient care.

Carl C. Awh, MD, and John S. Pollack, MD, will serve as moderators for the session. Several awards will be given out. These include:


	The Retina Research Foundation (RRF) will present its Gertrude D. Pyron Award to Joan M. O’Brien, MD, chairperson of the department of Ophthalmology, director of the Scheie Eye Institute, and William F. Norris and George E. de Schweinitz Professor of Ophthalmology at the University of Pennsylvania School of Medicine. She will speak on “Genetics of Retinal Disease.”

In addition to her duties as a chairman and ocular oncologist, Dr. O’Brien serves as the principal investigator of a five-year, $11.25 million R01 glaucoma genetics study on African Americans that has enrolled more than 10,000 patients in Philadelphia and has the potential to provide more targeted screenings and treatments for this disease.

Dr. O’Brien’s research on ocular genetics has advanced diagnostic and treatment options for several diseases. Working with Boris Bastian’s lab at the University of California-San Francisco (UCSF), Dr. O’Brien discovered and characterized two novel oncogenes in uveal melanoma, GNAQ and GNA11, which were published in Nature and the New England Journal of Medicine. This discovery allowed for personalized, targeted therapy for patients with uveal melanoma, improving their quality of life.

Dr. O’Brien also identified numerous unique pathogenic variants in the retinoblastoma gene (RB1). This testing, which allowed retinoblastoma therapy to be directed according to underlying genetic risk, is now offered nationwide at no charge through the National Eye Institute’s (NEI’s) eyeGENE initiative.

The Pyron Award is endowed by an estate gift from Gertrude D. Pyron, an imminent geologist during her lifetime, who bequest to the Retina Research Foundation (RRF) out of admiration for Alice McPherson, MD’s leadership in vision science. The RRF was founded by Dr. McPherson, an ASRS member, in 1969 to establish and fund programs for the eradication of vitreoretinal disease.

Dr. O’Brien will receive a $30,000 cash prize, including a $5,000 personal honorarium and a $25,000 research grant.


	The ASRS Founders Award recognizes individuals who have made major contributions to the advancement of vitreoretinal surgery, treatment, research, surgical instrumentation, and patient care.

This year’s recipient, Lawrence A. Yannuzzi, MD, will speak on “The Legend of Cuticular Drusen.”

Dr. Yannuzzi is a professor of clinical ophthalmology at Columbia University (New York), and has authored nine books and more than 270 publications. He has received a lifetime achievement award from the American Academy of Ophthalmology, and is the founder of the Vitreoretinal Fellowship, head and founder of the LuEsther T. Mertz Retinal Research Center and founder of The Macula Foundation.

The Founders Award was first presented in 1997 to honor the efforts of the society’s founders, Drs. Jerald A. Bovino, Roy A. Levit, and Allen Z. Verne, for their foresight, dedication, and leadership in establishing the society as an open, democratic, worldwide organization dedicated to the advancement of vitreoretinal surgery and the study of vitreoretinal diseases.


	
	The Crystal Apple is a special recognition that is presented to an ASRS member who has gone to great lengths to advance the education and professional development of young vitreoretinal specialists.

In addition to receiving the award, each year's recipient also presents a distinguished lecture during the Early Career Section's Annual Meeting luncheon.
	This year’s recipient is Seenu M. Hariprasad, MD. He is the inaugural Shui-Chin Lee Professor of Ophthalmology and visual science chief, Vitreoretinal Service at the University of Chicago.

The ASRS Service Award is being presented to Kirk H. Packo, MD, FACS, vitreoretinal surgeon, educator, researcher and inventor of more than 25 surgical instruments who also holds two U.S. patents. He is professor and chairman of the Department of Ophthalmology at Rush University Medical Center in Chicago, where he also serves as Director of the Retina Section and co-founder of the medical center’s Fellowship in Vitreoretinal Surgery.

“Doing something ‘good enough’ has never been acceptable,” Dr. Packo said. “I approach my patients in the same way. If the patient were me or someone in my family, I would want the surgery to done absolutely right. I have never accepted less.”

The Retina Young Investigator Award is given in recognition of an outstanding paper published during the past year and other accomplishments of a young investigator (45 years of age or younger) who shows potential for impactful contributions to the field in the future.

This year’s recipient, Sophie J. Bakri, MD, is being recognized for her paper “Question Everything and Challenge the Dogma.”
	 

Annual meeting schedule to include presentations, live surgery, awards