Q&A: Alexandra Miere discusses the ACTOR and HERMES studies

Alexandra Miere discusses retinal studies published in EURETINA journal. The first, the ACTOR study, explores vascular remodeling in neovascular AMD patients treated with ranibizumab. The second, the HERMES study, investigates perfusion changes in central retinal vein occlusion patients over 24 months. She highlights the importance of comprehensive imaging techniques, peripheral monitoring, and the potential of machine learning in predicting treatment responses in retinal diseases.

Note: The following conversation has been lightly edited for clarity.

Ophthalmology Times: Can you share what you presented at the 2025 EURETINA meeting?

Alexandra Miere: So I wrote 2 studies to EURETINA. These are 2 studies that were recently published in EURETINA, in the EURETINA journal. One is on retinal vein occlusion, and the other one is on neovascular AMD.

So the one on neovascular AMD is called the ACTOR study. This is a prospective study in which we looked at vascular remodeling on OCT angiography in patients with neovascular AMD treated by ranibizumab, and we tried to capture if the vascular remodeling could be predicted for exudative recurrence on SD OCT in the month following the OCT angiography. So this is a question that has puzzled retina specialists since OCT angiography has been has been introduced, and we didn't quite have the answer to this question. So the short answer is no OCT-A cannot predict executive recurrence on OCT in patients with nAMD. However, OCT angiography brings other types of information, so vascular remodeling is an information in itself with a decrease in quite a bunch of vascular parameters. I'm not going to go into details, but it does not predict unfortunate recurrence on standard OCT however, the 2 imaging modalities are complementary and should be used together in our nAMD patients. So this is the ACTOR study.

OT: You also mentioned the HERMES study. Can you share more about this?

Miere: The other study I wanted to talk to you about is the HERMES study. This was also a prospective study on changes in perfusion in patients with central retinal vein occlusion. So for this study, we included patients treating my patients with retinal vein occlusion. They were followed up and treated for 24 months with aflibercept. In these patients, what we noted by doing ultra-widefield fluorescence angiography and OCT angiography was that on ultra-widefield fluorescence angiography, the peripheral non-perfusion worsened during time, and we had a very important increase in the ischemic index in these patients with RVO. However, despite this increase in non-perfusion in the peripheral area, in the central area, the vascular density on OCT angiography stayed perfectly stable. So even though we have a stable visual acuity and the stable vascular density in the macula area in patients with RVO, we should also always, always, always check the periphery, because there is a worsening in non-perfusion with potential complications such as neovascular glaucoma that can arise.

OT: How do you think AI and machine learning will impact the future of retina?

Miere: I have a lot of questions regarding, for instance, sub-macular hemorrhages, predictive factors of treatment response in retina, and I think that machine learning and deep learning algorithms will shed light on how patients respond, both with neovascular AMD and fluid, but also patients with, for instance, diabetic macular edema, where sometimes we have an inflammatory part that is more important. So I think that with deep learning, we will be able to answer all these questions in the near future. However, deep learning is quite challenging, because we have to make sure to have sufficient patients, sufficient images in order to train models that are reliable. There is an enormous number of patients with geographic atrophy that in France, for instance, do not benefit of treatment. I know that complement inhibitors are available in the US, but in France, for instance, in Europe, is not the case. So I mean, this is, I think, very important from a clinical research perspective and from a clinical perspective.