Tanner Ferguson, MD, an ophthalmology resident at the Cleveland Clinic's Cole Eye Institute, discusses findings from the study "Trabecular Micro-bypass Stent Implantation (iStent)" + Phacoemulsification in PXG: Six-Year Outcomes," during the virtual AAO 2020 meeting. 


Videos

Tanner Ferguson, MD, Cole Eye Institute, discusses findings from the study "Trabecular Micro-bypass Stent Implantation (iStent)" + Phacoemulsification in PXG: Six-Year Outcomes," during the virtual AAO 2020 meeting. 

Evaluating long-term safety of micro-bypass implant with phaco in PXG

Daniel H. Chang, MD, medical director, Empire Eye and Laser Center in Bakersfield, CA, speaks on the highlights of his presentation on "Violet Light-Filtering IOLs: Visual and Non-Visual Benefits," during the American Academy of Ophthalmology's virtual 2020 meeting. 

Daniel H. Chang, MD, speaks on the highlights of his presentation on "Violet Light-Filtering IOLs: Visual and Non-Visual Benefits," during the virtual AAO 2020 meeting.

Visual and non-visual benefits of violet light-filtering IOLs


John A. Hovanesian, MD, clinical instructor, UCLA Jules Stein Eye Institute, Laguna Hills, CA, discusses the highlights of his presentation titled "The D3 Study: Drug Delivery vs Drops — A Prospective Clinical Study Evaluating Dexycu vs Prednisolone Acetate 1% in Controlling Post-operative Pain and Inflammation in Patients Undergoing Sequential Cataract Surgery," during the virtual 2020 American Academy of Ophthalmology (AAO) meeting. 

John A. Hovanesian, MD, discusses the highlights of his presentation on a clinical study evaluating dexamethasone vs prednisolone acetate 1% in controlling postop pain/inflammation in sequential cataract surgery patients.

Drug delivery vs drops: Controlling postop pain, inflammation in cataract surgery patients

Michael R. Robinson, MD, vice president, Global Therapeutic Area Head, Ophthalmology at Allergan, shares the highlights of the study "Single administration of intracameral bimatoprost implant 10 µg: IOP lowering and safety," presented during the virtual AAO 2020 meeting.


Michael R. Robinson, MD, shares the highlights of the study "Single administration of intracameral bimatoprost implant 10 µg: IOP lowering and safety," presented during the virtual AAO 2020 meeting. 


Single administration of intracameral bimatoprost implant: IOP lowering, safety

Ehsan Rahimy, MD, speaks on the highlights of a study he presented at this year's virtual AAO 2020 meeting that aimed to integrate an artificial intelligence screening system for managing diabetic retinopathy referrals in a primary care setting — with limited specialty support.



Read and watch more AAO 2020 coverage here

Podcasts

Ehsan Rahimy, MD, speaks on the highlights of a study he presented at this year's virtual AAO 2020 meeting that aimed to integrate an artificial intelligence screening system for managing diabetic retinopathy referrals in a primary care setting — with limited specialty support.

Integrating AI to manage DR in a primary care setting


During AAO 2020, Davinder Grover, MD, MPH, glaucoma specialist, Glaucoma Associates of Texas speaks on the highlights of his presentation regarding outcomes of a 12-year study comparing ab externo vs ab interno xen gel stents in tertiary glaucoma practice.


Davinder Grover, MD, MPH, speaks on the highlights of his presentation regarding outcomes of a 12-year study comparing ab externo vs ab interno xen gel stents in tertiary glaucoma practice. 

(AAO) Comparing outcomes of xen gel stents in glaucoma practice


For ophthalmology, 2020 has been a year of tumult and change as physicians have grappled with the impact of a global pandemic and uncertainty in the US amid a hotly contested presidential election.

With former Vice President Joseph R. Biden, Jr. besting incumbent President Donald Trump in the Nov. 3 election, industry leaders are looking toward the future under a Biden administration, Cathy G. Cohen, MHSA, CAE, the American Academy of Ophthalmology’s vice president for governmental affairs, said at a press conference during the AAO virtual 2020 annual meeting.


Medical professionals urge Congress to retain Medicare sequester pause

“We are all consumed about what the new administration is going to mean for the industry,” Cohen said. “One of the most timely issues is the leadership transition that we are seeing and the impact the Biden administration will have on ophthalmology’s top policy issues.”

Cohen said a positive first sign has been Biden’s focus on a response to COVID-19 and getting the pandemic under control. This is stirring hope in health care circles.

“We also look forward to working with his administration on the stimulus programs and making sure there is continued support for medical practices as they recover,” Cohen said.

As the recovery unfolds, the Biden administration would have control over reinstating the Medicare Advance program. This gives practices their payments in advance as a loan, which they can later repay.

However, ophthalmologists have resisted the program due to what Cohen described as unfavorable interest rates and a short-term payback period. Those issues were resolved by Congress, but the program was shelved by the Centers for Medicare and Medicaid Services (CMS).


Planning for financial safety in uncertain times

Despite ongoing hurdles to the transition, Cohen said the incoming administration will work on the distribution of a coronavirus vaccine.

During the campaign, Biden highlighted an agenda that also included fixing and expanding the Affordable Care Act. His proposals have included the creation of a new public option for those in the individual market. The administration also would examine premiums and implement an auto-enrollment process for participants.

“We won’t know who will control the Senate until Jan. 5,” Cohen explained. “A Republican Senate would make it difficult for Biden to get something as bold as a public option approved.”

One tool that will be at Biden’s disposal is the executive order, which has been used with increasing frequency by recent administrations.

“Biden can use executive orders to get somethings done,” Cohen said. “The Trump administration has used executive orders frequently, and I think we will see the Biden administration do this as well.”

One move the administration could take is to call for a special enrollment period for people who have lost their coverage due to the pandemic. They would then be eligible to sign up for coverage under the exchange. 



AMA supports House plan to ease Medicare loan repayment terms

Cohen also noted that Biden’s plans for Medicare could benefit ophthalmology.

“He has supported a plan to expand Medicare by lowering the age from 65 to 60,” she said. “A Republican senate would be an obstacle to that proposal.”

Cohen also noted that she believes the new administration will be committed to ensuring Medicare works for beneficiaries.

“They will be interested in some of our ideas about stabilizing the program,” she said. “Ophthalmology is a very big Medicare specialty and will have a lot to say about solutions.”

Containing drug costs is another focus of the incoming administration. Biden has floated a proposal to allow Medicare or the government to negotiate with pharmaceutical companies on drug prices.

“We do think the administration will look at what other countries are paying for pharmaceuticals, much like the current administration has tried to do,” Cohen said.

In 2016, the Obama administration proposed a Medicare Part B plan that would have been based on what other countries were paying. Cohen said it was an ambitious plan that ultimately was withdrawn.

Cohen said the priority list for ophthalmology would include revising the E/M policy.

This could reopen discussions about the way physicians are paid by Medicare,” she said. “This can be risky.”



COVID-19: Practices falling short of pre-pandemic levels

Another priority is burden reduction. Cohen noted that, for the first time, the Trump administration allowed Medicare Advantage health plans to use step therapy. 

That was a complete reversal in a long-standing ban against that practice that the previous two administrations had in place.

“I do not know if we can get that genie back in the bottle,” she said. “There are lot of specialties that will work with us to get that reversed.”

Cohen also hopes to work on securing coverage for devices that help people with low vision to see. Eyeglasses have long been prohibited from coverage, but that has been broadly interpreted to include anything that helps patients see.

“We hope that we can work with the Biden administration to get that reversed,” she said. “It is important to people for whom this could mean the difference in their vision.”

Articles

During AAO 2020, Cathy G. Cohen, MHSA, CAE, AAO vice president for governmental affairs, offered some optimism for the future of health care under the Biden administration.

AAO official voices optimism for future of health care with incoming Biden admin

Creativity abounds during the COVID-19 pandemic with all manner of virtual things to do. The American Academy of Ophthalmology Truhlsen-Marmor Museum of the Eye, in San Francisco, plans to open its virtual doors with a series called 

. This educational opportunity presents some of the museum’s collection for a fun and informative presentation and question-and-answer session that can be appreciated from the safety of home. 

The first of two events is on November 18. The second event is slated for December 16. Registration for both activities is open now.

The first of the free and open-to-the-public series is entitled "The National Trachoma Service."

Jenny Benjamin, the director of the Museum of the Eye, will showcase medical oddities in this video. This episode is said to feature “a rare set of glass propaganda teaching slides prepared by the National Trachoma Service. Trachoma is a bacterial infection that attacks the eyes and has been documented for thousands of years. Learn about the trachoma epidemic in the United States between 1912 and 1924, and its parallels to our current health crisis—the COVID-19 pandemic.”

The launch of The National Trachoma Service is scheduled for Wednesday, November 18, 2020, from noon to 1 pm Pacific time.

Those interested can register for this event at 

https://www.eventbrite.com/e/behind-the-scenes-the-national-trachoma-service-tickets-124454931049

 series is entitled "Renaissance Medicinal Recipes."

Clinical herbalist, Rylan Sian of North Wind Apothecary in San Francisco, is scheduled to discuss the smells and tastes of 16th-century herbal eye medicines as they were described in a 1583 publication authored by Georg Bartisch, “Ophthalmodouleia,” the oldest text in the museum. This video promises to be imminently entertaining. The presentation will take a close look at the Renaissance era medicinal recipes and the ingredients used to treat eye issues. 

This discussion is scheduled to run on Wednesday, December 16, 2020, from noon to 1 pm Pacific time.

Registration also is required for this free event at 

https://www.eventbrite.com/e/behind-the-scenes-renaissance-medicinal-recipes-tickets-125205319481?aff=erelpanelorg

“We’re taking advantage of the fact that many people are at home right now and looking for new ways to entertain and educate themselves. We’re thrilled to offer this online series so people can marvel at the medical oddities and scientific collection of the Museum of the Eye, all from their own homes. 

 represents our commitment to providing the public with fun and fascinating educational opportunities, free of cost,” Benjamin said.

For further information about the museum itself, please see 

A unique Behind-the-Scenes series from the American Academy of Ophthalmology Truhlsen-Marmor Museum of the Eye kicks off November 18, from noon to 1 pm Pacific, with “The National Trachoma Service.” Register now for this event.

Virtual AAO Museum of the Eye event kicks off November 18


Robert Weinstock, MD, director of Cataract & Refractive Surgery, The Eye Institute of West Florida; the Weinstock Laser Eye Center, presents real-world data from a retrospective multicenter study focusing on the efficacy of dexamethasone intraocular suspension 9% delivered at the time of cataract surgery.

Weinstock notes that research shows the injections can decrease inflammation and control IOP.

Robert Weinstock, MD, presents data from a retrospective multicenter study focusing on the efficacy of dexamethasone intraocular suspension 9% delivered at the time of cataract surgery. 


(AAO) Study outlines use of injectable intraocular steroid over drops

The first-line treatment for multiple sclerosis (MS), fingolimod 0.5 mg (Gilenya, Novartis), reduces both the number of relapses and disease progression in patients with relapsing-remitting MS and may reduce the incidence of uveitis, which is higher in this patient population compared with the general population. 

However, the downside is that the drug can cause fingolimod-associated macular edema (FAME), and patients require close observation.

The drug works by blocking movement of central memory T-cells from the lymph nodes to the blood stream and has been shown to have a favorable effect on murine models of experimental autoimmune uveitis, according to Bradley Smith, MD, and Scott Sonne, who discussed the topic during a presentation at the American Academy of Ophthalmology’s virtual 2020 annual meeting.

Dr. Smith is a physician partner at The Retina Institute in St. Louis and an instructor in Clinical Ophthalmology & Visual Sciences at the Washington University School of Medicine in St. Louis, MO. Sonne is from the St. Louis University School of Medicine in St. Louis.

The investigators conducted a retrospective analysis

 to determine the incidence of uveitis and macular edema in patients with MS who were treated with fingolimod 0.5 mg. The study patients were identified in the electronic health record at The Retina Institute.


A total of 188 patients were included in the study; they had been followed for from 1 to 104 months (mean, 60.9) after treatment with fingolimod.

The authors reported that no patient had or developed uveitis. Acute macular neuroretinopathy developed in 1 patient. Twenty-six (13.83%) patients had a history of optic neuritis and 7 (3.7%) had a recurrence during the study. Fingolimod was discontinued in 3 patients after 57, 43, and 13 months for nonophthalmic reasons.

FAME developed in 3 (1.6%) patients, none of whom had intraocular inflammation or another identifiable cause of the ME.

The authors also reported good visual acuity (VA) results in most patients, i.e., 20/40 or better in 93% of eyes; 5% had a VA ranging from 20/50 to 20/200, and 2% had a VA below 20/200.

“The VA in 2 eyes was worse than 20/400 as a result of optic neuritis. Additional causes of visual loss in the patients with worse than 20/100 were optic neuritis, ischemic optic neuropathy, ruptured globe, keratoconus, macular hole, and amblyopia,” they commented.

It is recognized that uveitis occurs more frequently in patients with MS and develops in from 3.6 to 9 years on average. By contrast, uveitis did not develop in this patient cohort after a mean follow-up exceeding 5 years.

According to the investigators, fingolimod was well tolerated.

“Our retrospective review suggests possible efficacy against the development of uveitis in an at-risk population that is consistent with fingolimod’s anti-inflammatory effect in animal models,” they said. 

However, the investigators concluded that more work will need to be done to confirm or deny this possibility.

“Although there was a higher incidence of FAME, all patients were treated successfully with topical therapy,” they said.


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

Sonne SJ, Smith BT. Incidence of uveitis and macular edema among patients taking fingolimod 0.5 mg for multiple sclerosis. 

 2020 Sep 21;10(1):24; https://doi.org/10.1186/s12348-020-00215-1

Bradley Smith, MD, presents at AAO 2020 on how fingolimod 0.5 mg, a first-line treatment for multiple sclerosis, may reduce both the number of relapses and disease progression in patients with relapsing-remitting MS as well as the incidence of uveitis.

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