Article Date: 3/1/2008

SUBSPECIALTY NEWS
SUBSPECIALTY NEWS

Retina Fellows Gather to Meet and Learn

Dr. Trese Gives Guest Lecture to 70 Attendees.

■ Seventy senior vitreoretinal fellows gathered in Chicago on Jan. 5-6 at the 8th Annual Retina Fellows' Forum, a weekend program that gave attendees an opportunity to socialize with their peers, hear from companies that provide vital products and services, receive professional advice from leading retina specialists, and listen to a guest lecture from a leading retina authority.

Carl C. Awh, MD, of Tennessee Retina, Nashville, TN, served as Course Director. Course co-directors were David Chow, MD, and Tarek Hassan, MD. Bausch & Lomb served as the major corporate sponsor, along with 18 additional sponsors representing a cross-section of industry.

Dr. Awh says the overall mission of the program is to provide a unique educational and social opportunity for all North American vitreoretinal fellows in their final year of training.

"The fellows benefit by having the opportunity to interact with the entire 'graduating class' of their professional peers, by introduction to representatives of companies that provide vital devices and services, and by participating in academic sessions devoted to the major clinical challenges they will face in practice. We also spend time discussing practice and lifestyle management issues relevant to new practitioners," notes Dr. Awh.

The Retina Fellows' Forum began with a Friday evening session, sponsored by an educational grant from Genentech, and devoted to the subject of age-related macular degeneration. "There is so much new information about this increasingly large component of our practices," noted Dr. Awh. "Even with this special session, we were only able to cover a portion of all the new diagnostic and therapeutic options."

As at previous Retina Fellows' Forums, the entire faculty remained assembled on stage throughout the meeting. Presentations were largely discussion-driven, with an electronic audience response system used for immediate feedback from the fellows and faculty. Prizes ranging from iPods to surgical instruments were awarded throughout the meeting. That, combined with typical Chicago winter weather, kept the fellows in attendance throughout the meeting.

The 2008 Fellows' Forum faculty. From left to right: Peter Kaiser, MD, Diana Do, MD, David Chow, MD, Tarek Hassan, MD, Carl Awh, MD, Brandon Busbee, MD, Mike Trese, MD, John Pollack, MD, and Tom Chang, MD.

Saturday's session covered topics including management of diabetic retinopathy, retinal vascular occlusion, sutureless vitrectomy, vitreous substitutes and tamponades, and new instrumentation. New this year was a more informal final discussion session devoted to practice and career issues. As always, a highlight of the Saturday session was the Distinguished Guest Lecture, given this year by Michael T. Trese, MD, on "Fly Fishing and Vitreoretinal Practice."

Interspersed with the faculty presentations were informational talks by industry sponsors.

"I feel that a broader awareness of the range of devices and equipment is of educational value to physicians preparing to start practice," says Dr. Awh.

"We were fortunate to find a major sponsor, Bausch & Lomb, willing to allow competing companies to exhibit and present at the meeting. It's a nice opportunity for the companies to present themselves to the fellows, and it's great for the fellows to be at the center of attention."

A closing dinner and the Third Annual Fellows' Forum Bowling tournament, won by a team captained by Brandon Busbee, MD, topped off the weekend.

In addition to Drs. Busbee, Chow, Hassan, and Awh, Fellows Forum faculty included Thomas Chang, MD, Diana Do, MD, John Pollack, MD, and Peter Kaiser, MD.

The 9th Annual Fellows Forum will be held in Chicago on Friday, Jan. 30 and Saturday, Jan. 31, 2009.

Judah Folkman, MD, Famed Researcher

His First Focus Was Eye Disease.

■ When Judah Folkman, MD, gave the keynote address at the American Academy of Ophthalmology (AAO) meeting in November, he noted that he believed that his groundbreaking research into angiogenesis and antiangiogenic drugs would initially lead to new treatments for retinal diseases.

Though Dr. Folkman, who died in January at the age of 74, became best known for his research into the growth processes of malignant tumors, he was correct in his belief that his theories would be useful in ophthalmology. The development of the antiangiogenic drug Lucentis for the treatment of wet AMD, along with the development of the colorectal cancer drug Avastin, which is also widely used off-label to treat AMD, can both be traced directly to Dr. Folkman's laboratory. At the root of Dr. Folkman's research was his belief that tumors can be starved by choking off their blood supply. Thus, the antiangiogenic drug Avastin can not only work to cut off the blood supply to tumors, it can also help eliminate unwanted blood vessels in proliferative retinal disease.

The AAO took notice of Dr. Folkman's important contributions to ophthalmology.

"Dr. Folkman's death is a loss to ophthalmology and to all of medicine," said H. Dunbar Hoskins, Jr., MD, executive vice president for the Academy. "Because of his groundbreaking work, we have seen remarkable advances in helping patients with age-related macular degeneration save their vision and even regain some of their eyesight."

In his address to the Academy, Dr. Folkman stressed that ophthalmology was present at the beginning of his research into angiogenesis. To prove his theory, he performed his early angiogenesis experiments in rabbit eyes because their corneas were ideal for detecting new blood vessels. The eye was the best way he and his colleagues could show that a tumor could make a protein that could stimulate new blood vessels.

Dr. Folkman and his research group identified the first angiogenesis inhibitors in 1985, after enduring fellow scientists' indifference or scorn for their approach for 20 years. Today, at least 40 compounds that affect angiogenesis are being tested in humans to combat a range of cancers, heart disease, and eye diseases including AMD, retinopathy of prematurity, and diabetes-related disorders.

The son of a rabbi, Moses Judah Folkman graduated from Ohio State University and then Harvard Medical School. Trained as a surgeon, he would later spend more and more of his time doing research. While working for the Navy on blood substitutes, Dr. Folkman experimented with tumors and observed that all of them grew to approximately similar size. He theorized that the tumors needed a blood supply to grow and that tumors must have some mechanism to induce the formation of blood vessels. He first published his research in 1971.

In brief
Lucentis/NSAID combination. ISTA Pharmaceuticals, Inc. announced positive results from a study using the NSAID Xibrom in combination with Lucentis in patients with wet AMD.
According to an abstract, patients who received Xibrom required 1.6 +/- 0.69 injections of Lucentis during the 6-month study period, while patients who received only Lucentis received 4.5 +/- 0.41 injections. Patients with Lucentis alone received significantly more (2.83 times) injections of ranibizumab than those receiving the combination. There was a numerical trend in favor of the combination treatment group on improvement in visual acuity but this difference did not achieve statistical significance.
The study results were gathered from 60 patients receiving Lucentis therapy for wet AMD. Patients were monitored monthly using OCT and fluorescein angiography. When leakage from vessels was detected, patients were re-injected with Lucentis. Thirty patients received Xibrom dosed twice daily in addition to the Lucentis injection, and their results were compared to 30 patients who received Lucentis only. There were no adverse events associated with the extended topical administration of bromfenac.
Bevasiranib duration of response. OPKO Health reports that between 60% and 70% of the wet AMD patients who received either 1.5 mg or 3 mg of bevasiranib in a phase 2 study have passed the 200-day mark without requiring retreatment. Previously, OPKO said that patients who received a lower 0.2 mg dose averaged 153 days before they needed retreatment.
Bevasiranib, which is a small interfering ribonucleic acid (SiRNA) molecule, is currently in a phase 3 study. It is the first SiRNA drug to ever reach a phase 3 trial.
Stem cell study for AMD. Stemedica Cell Technologies, a manufacturer of adult stem cells, is collaborating with Lumenis, a leader in medical laser technology, in implementing a year-long comprehensive clinical study for the treatment of AMD using Stemedica adult stem cell technology and the Lumenis SRT laser.
The 30-patient phase 1 study is being conducted at the Fyodorov Eye Institute in Moscow and at the Hospital Angeles in Tijuana, Mexico
Lucentis sales stabilize. Sales of Lucentis, Genentech's market-leading drug for the treatment of wet AMD, stabilized at $197 million for the final 3 months of 2007. Lucentis had recorded $198 million in sales for the previous 3 months.
On a year-over-year basis, Lucentis sales slipped approximately 9% from an all-time high of $217 million in the final 3 months of 2006 to the $197 million recorded in the most recent 3 months.
Off-label use of Genentech's colorectal cancer drug Avastin for wet AMD has been cited by Genentech as the major factor in declining Lucentis sales.
Slight increase in Visudyne usage. QLT Inc., the developer of Visudyne therapy for wet AMD, said Visudyne sales in the United States for the quarter ending Dec. 31 were approximately $10 million, representing 22% of total worldwide sales for the quarter. Average daily Visudyne sales in the United States increased to 127 vials in the fourth quarter of 2007 compared to 118 vials in the third quarter. The growth in daily Visudyne vial sales translates to a $600,000 total sales increase quarter over quarter.
In a related move, QLT said it intends to restructure the company by selling off non-ophthalmic assets and cutting 115 jobs. The company will now focus primarily on Visudyne and the development of new drug-delivery systems.
Code for radiation therapy. The American Medical Association (AMA) Current Procedural Terminology (CPT) Editorial Panel recently announced the release of a new Category III CPT code for NeoVista, Inc.'s novel radiation therapy for the treatment of wet AMD. The new CPT code (0190T) was recently released on the AMA's Web site. This new code will become effective July 1, 2008, and will be used in conjunction with the code for performing a basic posterior vitrectomy (67036).
No Macugen sale yet. OSI Pharmaceuticals recently announced that the sale of its wet AMD treatment Macugen is now expected to occur in 2008. Previously, the company had targeted the second half of 2007 for a sale. The Macugen franchise, along with other eye disease research assets, are being carried on OSI's books as a discontinued operation and accounted for more than $30 million in losses in 2007.
OCT usage grows. According to "Optical Coherence Tomography (OCT): Technology, Markets, and Applications: 2008-2012," a new market research report from the publishers of BioOptics World, the global market for optical coherence tomography (OCT) systems is currently around $200 million and growing at an annual rate of 34%. This growth is expected to continue at this pace for the next several years, with revenues topping $800 million by 2012.
The first commercial application of OCT was in ophthalmology and the report says eye care should remain the dominant application through 2012. However, the report states that new applications and products are emerging in cardiology, dentistry, cancer detection, glucose monitoring, and dermatology. In particular, commercial activity for OCT in intravascular imaging has been gaining momentum over the past 12 months, and this sector looks to be the next growth market for OCT technologies.
Much of this activity is being driven by a shift from time-domain to Fourier-domain OCT. While similar in theory and design, the Fourier-domain systems offer twice the resolution and 50 to 100 times the image-acquisition speed. In addition, because the Fourier-domain technique is not protected under the original tightly held patents that have limited competition with time-domain systems, a number of companies are now developing or marketing Fourier-domain OCT products.
"In 2006, a number of companies introduced spectral domain systems to the ophthalmic market," said Greg Smolka, author of the OCT report. "These systems offer not only much faster image capture but, more important, much higher image accuracy. These instruments generated a lot of buzz at the 2007 American Academy of Ophthalmology meeting, and many see them becoming the dominant imaging system in ophthalmology."
New B'L CEO. Bausch & Lomb has announced that Gerald M. Ostrov, who served as Johnson & Johnson's company group chairman of Worldwide Vision Care from 1998 to 2006, has become the company's new chairman and CEO. Ostrov, an MBA from Harvard, replaces Ronald L. Zarrella, who will retire and then serve as chairman emeritus of Bausch & Lomb.
Dr. Parke heads AAO. David W. Parke II, MD, became the new president of the American Academy of Ophthalmology for 2008 on Jan. 1, succeeding departing president C.P. Wilkinson, MD. Dr. Parke, 56, is the Edward L. Gaylord Professor and chairman of the Department of Ophthalmology at the University of Oklahoma in Norman. He is also president and CEO of the Dean A. McGee Eye Institute in Oklahoma City.
"There has never been a more exciting time for ophthalmology as medical advances give ophthalmologists breakthrough treatment options to save vision," says Dr. Parke, who has held numerous leadership positions within the Academy. "Ophthalmology is also faced with challenges ranging from Medicare reimbursement to scope of practice. I look forward to serving the Academy and its members in the year ahead."
Eyecare Web site honored. EyeCare America, a national non-profit organization that works to preserve eyesight by raising awareness about eye disease and providing access to no-cost medical eye care, won the eHealthcare Leadership Awards Gold Award for Best Web site Design and the Silver Award for Best Interactive Site. These wins were in the category of consumer disease-focused Web sites.
EyeCare America launched its Web site as part of its educational mission to empower consumers with reliable information. As the number of Americans seeking healthcare information on the Internet grows, EyeCare America worked to match that trend by providing visitors to the eyecareamerica.org site with centralized health information written in language that is clear and easy for them to understand. RP

Erratum In the special January 2008 issue of Retinal Physician, a list of incorrect references was run along with the article "OCT imaging: advances over the past 5 years and beyond" by Henry Alexander Leder, MD, and Scott W. Cousins, MD. Below please find the correct references for that article. The editorial board at Retinal Physician deeply regrets the error.

REFERENCES

  1. Schuman JS, Puliafito CA, Fujimoto JG, eds. Optical Coherence Tomography of Ocular Diseases. 2nd ed. Thorofare, NJ: SLACK Inc.; 2004.
  2. Huang D, Swanson EA, Lin CP, et al. Optical coherence tomography. Science. 1991;254:1178-1181.
  3. Brusini P, Zeppieri M, Tosoni C, Parisi L, Felletti M, Salvetat ML. Stratus-OCT imaging in early glaucomatous and in ocular hypertensive patients with and without frequency-doubling technology abnormalities. Eye. 2007 Feb 16; [Epub ahead of print].
  4. Chen RWS, Duker JS, Srinivasan V, Fujimoto JG. Speed and resolution improve in newest OCT: high-speed, spectral/Fourier domain OCT brings better imaging and the potential for more sensitive diagnosis. Rev Ophthalmol. 2007;14. http://www.revophth.com/index.asp?page=1_13446.htm. Accessed December 1, 2006.
  5. Podoleanu AG. Optical coherence tomography. Br J Radiol. 2005;78:976-988.
  6. Brezinski ME. Optical Coherence Tomography: Principles and Applications. New York, NY; Academic Press; 2006.
  7. Stratus OCT Software [computer program]. Version 4.0. Dublin, CA: Carl Zeiss Meditec; 2007.
  8. Cirrus HD-OCT High Definition Spectral Domain Imaging [computer program]. Dublin, CA: Carl Zeiss Meditec; 2007.
  9. The OCT Revolution [computer program]. Meridianville, AL; Optovue; 2007.
  10. Spectral OCT/SLO Combination Systems [computer program]. Toronto, Canada: Ophthalmic Technologies, Inc.; 2007.
  11. Spectralis HRA+OCT: Simultaneous Spectral Domain OCT and Angiography [computer program]. Vista, CA: Heidelberg; 2007.
  12. Topcon 3D OCT-1000 [computer program]. Paramus, NJ: Topcon; 2007.
  13. Copernicus Spectral OCT System [computer program]. Depew, NY: Reichert; 2007.
  14. Foster BS, Bhisitkul RB. Optical Coherence Tomography in the Management of Retinal Disorders. San Francisco, CA: American Academy of Ophthalmology; 2007.
  15. Merino D, Dainty C, Bradu A, Podoleanu AG. Adaptive optics enhanced simultaneous enface optical coherence tomography and scanning laser ophthalmoscopy. Optics Express. 2006;14:1-9.


Retinal Physician, Issue: March 2008