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SUBSPECIALTY NEWS: Gene therapy data from AAO, FDA approval of Beovu, and more.

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Progress Report on Gene-Derived Anti-VEGF

Adverum and Regenxbio report positive early data.

■ The 2 companies pursuing the concept of a single injection, gene-derived anti-VEGF therapy for wet AMD both reported positive early-stage results at the recent AAO meeting, though each trial had its own specific areas of strength. Both companies plan to continue to advance their concepts.

Adverum could point to the fact that all 6 of the patients in the first cohort of its OPTIC phase 1 trial for ADVM-022 (aflibercept) went a median follow-up of 34 weeks without needing a rescue injection, while Regenxbio reported improved mean BCVA and decreased retinal thickness over a larger patient base with its RGX-314 (ranibizumab), though some patients did require rescue injections.

“The data for ADVM-022 are promising, as this is the first time that an intravitreal injection gene therapy has provided sustained efficacy for patients with wet AMD who currently require frequent ocular anti-VEGF injections to maintain their vision,” said Szilárd Kiss, MD, who presented the data at AAO. “Now, with a 34-week median follow up, a one-time treatment that achieves the goal of improving retinal anatomy and preserving vision would clearly be transformative for these patients and fulfill an important unmet need in wet AMD.”

“The interim update from the RGX-314 phase 1/2a dose-escalation study further demonstrates the significant reduction in anti-VEGF treatment burden and encouraging improvement or maintenance of effects on vision and retinal thickness in the 3 higher dose cohorts,” said Jeffrey Heier, MD, investigator for the RGX-314 study. “These effects are especially important as subjects in this study had been previously treated with chronic and burdensome anti-VEGF injections over several years, highlighting the severity of their disease. These results further support the potential of RGX-314 gene therapy to have meaningful and durable effects in patients following a one-time intervention.”

In the ADVM-022 OPTIC trial, only data from the first 6-patient cohort was made available. The data showed generally stable vision (mean loss of 1.5 letters at 34 weeks) and no increases in fluid or retinal thickness that would call for retreatment. Inflammation was reported, but Adverum is changing its approach in that area. Because inflammation has generally been mild and responsive to steroid eye drops, patients in the third and fourth cohorts will receive prophylactic steroid eye drops instead of prophylactic oral steroids. Dosing has already begun for a 9-patient third cohort.

For RGX-314, subjects in cohort 3 continue to demonstrate long-term reductions in anti-VEGF treatment burden over 1.5 years, with 3 out of 6 subjects (50%) continuing to remain anti-VEGF injection-free at 1.5 years. The 6 subjects across the cohort demonstrated a mean annualized rate of 2.6 anti-VEGF injections following administration of RGX-314, a reduction of more than 50% from the mean annualized injection rate during the 12 months prior administration of RGX-314. Subjects in cohort 4 on average also had a meaningful reduction in anti-VEGF treatment burden, with 5 out of 12 (42%) subjects receiving no anti-VEGF injections in the 6 months following administration of RGX-314. Across the 12 subjects in the cohort, there was a mean of 2.2 injections over 6 months following administration of RGX-314, a reduction of over 50% from the mean annualized injection rate during the 12 months prior to administration of RGX-314. Subjects in cohort 4 maintained visual acuity and decreased retinal thickness, with a mean BCVA change of +2 letters, and a mean change in CRT of -42 µm. 

Subjects in cohort 5 on average had a meaningful reduction in anti-VEGF treatment burden, with 9 out of 12 (75%) subjects remaining anti-VEGF injection-free as of the data cut-off. Across the 12 subjects, there was a mean of 0.8 injections through 5 or 6 months following administration of RGX-314, a reduction of over 80% from the mean annualized injection rate during the 12 months prior to administration of RGX-314. Subjects in cohort 5 improved visual acuity and decreased retinal thickness, with a mean BCVA change of +4 letters and a mean change in CRT of -68 µm after one-time administration of RGX-314. Several of the individual responses to RGX-314 were cited and deemed outstanding in subjects who had previously required numerous anti-VEGF injections.

From a safety standpoint, both ADVM-022 and RGX-314 have been well tolerated, with no serious adverse events. Both Adverum and RegenxBio said they will pursue a second indication in diabetic retinopathy.

Brolucizumab Gets FDA Approval for Wet AMD

For most patients, 3-month dosing is achievable.

■ The FDA has approved Beovu intravitreal injection (brolucizumab-dbll; Novartis) for the treatment of wet AMD. Novartis said Beovu is the first FDA-approved anti-VEGF to offer both greater fluid resolution vs aflibercept (Eylea; Regeneron) and the ability to maintain most wet AMD patients on a 3-month dosing interval after a 3-month loading phase with proven efficacy. The approval represents a step forward in both durability and fluid reduction compared to the existing approved treatments for wet AMD. Beovu intravitreal injection is an advanced humanized single-chain antibody fragment. Single-chain antibody fragments are highly sought after in drug development due to their small size, enhanced tissue penetration, rapid clearance from systemic circulation, and drug-delivery characteristics. The proprietary innovative structure results in a small molecule (26 kDa) with potent inhibition of, and high affinity to, all VEGF-A isoforms.

“With BEOVU, greater fluid reduction was demonstrated through larger decreases in retinal thickness and a higher proportion of patients with drier retinas. Coupled with the potential to treat patients with quarterly injections, this approval may change the way we approach the treatment of wet AMD,” said Pravin U. Dugel, MD, of Retinal Consultants of Arizona and principal investigator of the HAWK clinical trial, in a news release.

The approval was based on findings from the phase 3 HAWK and HARRIER clinical trials, in which Beovu demonstrated noninferiority vs aflibercept in mean change in BCVA at year 1. In both trials, approximately 30% of patients gained at least 15 letters at year 1. Beovu also showed greater reduction in central subfield thickness as early as week 16 and at year 1, and fewer patients had intra- and/or subretinal fluid. Eligible patients could be maintained on a 3-month dosing interval immediately after the loading phase. At year 1, more than half the patients were maintained on 3-month dosing (56% in HAWK and 51% in HARRIER). The remaining patients in the study were treated on a 2-month dosing schedule. Beovu exhibited an overall safety profile comparable to aflibercept. Novartis also recently announced it is initiating the phase 3b TALON trial for brolucizumab in wet AMD, matching its investigational drug against aflibercept.

Ranibizumab Implant Shows Impressive Durability

Median time to refill was 15.8 months at highest dose.

■ Genentech/Roche reported positive end-of-study data from its phase 2, 220-patient LADDER trial of a sustained-release formulation of ranibizumab for wet AMD administered through its refillable Port Delivery System (PDS). If approved, sustained-release implants such as the PDS could play a major role in eliminating the need for frequent intravitreal injections of anti-VEGF agents for retinal disease.

As presented by Carl Regillo, MD, FACS, at the recent AAO annual meeting, the average patient in the highest dose 100 mg/mL group went 15.8 months before needing the implant reservoir refilled. This means that many patients went even longer without meeting the refill criteria of increase in central foveal thickness, vision loss, or new macular hemorrhage. For those in the 100 mg/mL group who needed refills, the average time to both the first and second refills was 8.8 months. PDS treatment consistently maintained vision and anatomic outcomes, with comparable results in the 100 mg/mL group and the comparator monthly ranibizumab 0.5 mg group.

The primary endpoint for the LADDER trial is change in BCVA from baseline to the average BCVA of weeks 36 and 40. Patients were all responders to previous anti-VEGF treatment. They were randomized to monthly intravitreal injections of ranibizumab or to treatment using the PDS filled with 1 of 3 different concentrations of ranibizumab. For PDS patients receiving the 100 mg/mL dose (n=59), approximately 80% went 6 months or longer until their first refill. A high incidence of postoperative vitreous hemorrhages in the initial months of LADDER was minimized to about 4% by modifying the procedure to include laser coagulation of the choroid before incision. The PDS is currently in the 360-patient, 96-week, phase 3 ARCHWAY trial with refills scheduled every 24 weeks.

DARPin Continues to Be Durable in Year 2

New data were announced by Allergan and Molecular Partners.

■ Allergan and Molecular Partners said 2-year results from the phase 3 CEDAR and SEQUOIA trials in wet AMD demonstrate that vision gains observed with the DARPin therapeutic abicipar pegol after 1 year with every-8-week and every-12-week dosing were maintained in the second year. The results were announced at the recent AAO meeting.

CEDAR and SEQUOIA are identical global studies designed to assess the efficacy and safety of abicipar 8-week and 12-week treatment regimens compared with monthly ranibizumab (Lucentis; Genentech) in treatment-naïve patients with wet AMD. Allergan previously announced that abicipar met the prespecified primary endpoint of the proportion of patients with stable vision at week 52 demonstrating noninferiority in both the 8-week and 12-week treatment regimens compared to monthly ranibizumab.

Through week 104, patients received abicipar 2 mg every 8 weeks or every 12 weeks or ranibizumab 0.5 mg every 4 weeks. At week 104 in the pooled phase 3 data, the proportion of patients with stable vision was 93%, 90%, and 94% in 8-week abicipar; 12-week abicipar and 4-week ranibizumab treatment regimens, respectively. This continuation of stable vision in year 2 reinforces the ability of abicipar to deliver consistent quarterly dosing for the majority of patients.

“Based on the results of CEDAR and SEQUOIA, which reinforce the efficacy of abicipar while decreasing the number of injections, abicipar could transform anti-VEGF treatment regimens,” said investigator Rahul N. Khurana, MD, of Northern California Retina Vitreous Associates Medical Group, in a news release.

Mean changes in BCVA seen in year 2 were similar when compared to year 1 across all treatment arms. Central retinal thickness (CRT) continued to decrease during year 2 when compared to year 1. CRT for patients treated with abicipar dosed quarterly and every 8-weeks were similar to ranibizumab dosed every 4 weeks through week 104. Adverse events at the end of year 2 were comparable between treatment groups. The pooled rate of new cases of intraocular inflammation in year 2 for patients who received abicipar in the 8-week and 12-week arms was 1.9%, which is similar to the ranibizumab arm of 1%. Most intraocular inflammation that did occur was seen during the first 12 weeks in the first year, said Dr. Khurana.

Graybug Drug May Provide 6-Month Durability

Trials are investigating the drug for DME, RVO, and wet AMD.

■ Graybug Vision has begun a phase 2a study of its microparticle depot formulation of sunitinib malate (GB-102) in patients with macular edema (ME) secondary to DME or RVO and a 160-patient phase 2b study (ALTISSIMO) for GB-102 in wet AMD. Sunitinib malate, a pan-VEGF inhibitor and potential twice-per-year therapy, is targeted to reduce the need for frequent intravitreal injections in retinal diseases, including wet AMD, DME, and RVO. Sunitinib malate consists of microparticles made from poly-lactic-co-glycolic acid (PLGA) combined with the company’s proprietary surface treatment designed to eliminate inflammation typically associated with ocular administration of PLGA.

The GB-102 open label, 6-month study in ME is intended to establish the safety of GB-102 and provide preliminary evidence of its durability in ME patients secondary to DME and RVO. It will enroll 20 ME patients at 6 centers in the United States. They will be treated with a single intravitreal injection of 1 mg or 2 mg of GB-102.

“DME and RVO frequently cause irreversible vision loss in older adults and currently available treatments are extremely burdensome for patients, their caregivers, and treating physicians due to the need for frequent intravitreal injections,” said Fred Guerard, president and CEO of Graybug Vision. “With its potential of a twice-per-year therapy, GB-102 could substantially transform patient outcomes and improve the current clinical practice.”

Graybug Vision completed a phase 1/2a study (ADAGIO) in 2019 in which GB-102 met its primary endpoint of safety and tolerability and provided evidence of a durable biological signal of 6 months or longer from a single intravitreal injection in wet AMD patients.

IN BRIEF

Research and industry news in retina.

BY JERRY HELZNER, CONTRIBUTING EDITOR

Methotrexate vs Mycophenolate in Uveitis Trial

■ Methotrexate and the more expensive mycophenolate mofetil performed similarly in a head-to-head international clinical trial that compared the 2 drugs for treating noninfectious uveitis. Investigators published results from the trial in JAMA. The National Eye Institute funded the trial.

The First-line Antimetabolites for Steroid-sparing Treatment (FAST) Uveitis Trial enrolled and randomly assigned 216 patients with intermediate or posterior/panuveitis to methotrexate or mycophenolate. Over 6 months, participants tapered to a maximum dose of 7.5 mg prednisone daily, while receiving either 3 g oral mycophenolate daily or 25 mg methotrexate weekly. Participants reduced their dose, if necessary, to control adverse side effects such as nausea.

At 6 months, 67% of participants in the methotrexate group and 57% of participants in the mycophenolate group had controlled their inflammation and successfully tapered steroids. The remainder had the option to switch treatments. Differences in success rates between treatment groups were not statistically significant at 6 months. At 12 months, 69% of participants who had switched from mycophenolate to methotrexate achieved treatment success, whereas only 35% of those participants who switched from methotrexate to mycophenolate achieved treatment success. Of the participants who continued with their original treatments, 80% on methotrexate and 74% on mycophenolate maintained inflammatory control at 12 months.

In patients with posterior or panuveitis, the most severe forms of uveitis, 74% in the methotrexate group achieved control at 6 months and 55% achieved control in the mycophenolate group, indicating that methotrexate was significantly more effective at controlling inflammation for this subtype of uveitis.

“This study gives doctors and their patients with uveitis a starting point when considering treatment beyond corticosteroids,” said lead study author Nisha Acharya, MD, MS, University of California, San Francisco.

Kodiak Drug Shows Durability in Retinal Diseases

■ At the recent AAO meeting, Kodiak Sciences announced positive durability data in patients with wet AMD, DME, RVO, and diabetic retinopathy treated in its phase 1b clinical study of its investigational therapy KSI-301.

“The emerging durability data suggest our objective for KSI-301 to be a leading next-generation anti-VEGF therapy with a long-interval durability profile is achievable,” said Jason Ehrlich, MD, PhD, Kodiak’s chief medical officer and chief development officer. “In the presented cohort of treatment-naïve wet AMD patients followed for 12 weeks or longer after the loading phase, all achieved a treatment-free interval of 3 months or longer, with the majority reaching a 4- or 5-month interval and continuing to be followed without retreatment to date.

“In DME, a pan-retinal disease that typically has a high initial treatment burden, we observed that 82% of patients were extended beyond 3 months without receiving retreatment following only 3 initial loading doses. Further, we are seeing promising early signs of improvement in diabetic retinopathy, with 40% of patients improving in diabetic retinopathy severity level within the first 12 weeks of treatment and no patients worsening. In RVO, a disease which typically requires monthly anti-VEGF therapy to achieve the best results, we observed that over half the patients were extended beyond 3 months after only 3 loading doses without receiving retreatment and over a quarter of patients received their first retreatment at 2 months.”

KSI-301 is an investigational therapy built on Kodiak’s antibody biopolymer conjugate (ABC) platform and is designed to maintain potent and effective drug levels in ocular tissues for longer than existing agents. Kodiak’s objective with KSI-301 is to develop a new first-line agent to improve outcomes for patients with retinal vascular diseases and to enable earlier treatment and prevention of vision loss for patients with diabetic eye disease.

Aura Biosciences Therapy Effective in Uveal Melanoma

■ At the recent AAO meeting, Aura Biosciences presented updated clinical data from its ongoing phase 1b/2 clinical trial evaluating the safety and efficacy of light-activated AU-011, the company’s lead product candidate for the first-line treatment of primary choroidal melanoma.

“With its ability to provide tumor control and vision preservation, AU-011 holds significant potential as a new targeted therapy for the primary treatment of choroidal melanoma,” said Cadmus Rich, MD, chief medical officer and head of research and development for Aura Biosciences, in a news release.

The clinical data presented at AAO demonstrate that multiple administrations of light-activated AU-011 in a 2-step procedure were well tolerated. Among the patients evaluated for safety (n=46), the most common treatment-related adverse events were expected and included anterior-chamber inflammation, posterior-chamber inflammation, and increase in IOP; all were manageable with standard-of-care treatments and the majority resolved without clinical sequelae. Notably, the posterior inflammation appears to originate within and/or around the tumor, which is consistent with AU-011’s mechanism of action of acute tumor necrosis.

Tumor control and vision preservation data continue to be supportive of the planned phase 3 registration trial. In the subset of patients with documented tumor growth prior to trial enrollment (n=17), treatment with AU-011 resulted in tumor control in 15 patients (88%; P=.0117), with some patients followed for up to 24 months. The results from this ongoing phase 1b/2 study will inform the design of Aura’s planned pivotal phase 3 program for AU-011.

PanOptica Reports on Topical Therapy for Wet AMD

■ PanOptica reported positive phase 1/2 clinical data for PAN-90806, a once-daily topical formulation of a small-molecule anti-VEGF eye drop for the treatment of neovascular eye diseases. The company presented topline results from a 51-patient, dose-ranging clinical trial in which PAN-90806 was the first topical anti-VEGF eye drop to demonstrate both safety and biologic response as monotherapy in treatment-naïve patients with wet AMD.

More than half of participants receiving once-daily topical PAN-90806 ophthalmic suspension for 12 weeks completed the study without needing rescue with anti-VEGF intraocular injection medication. Of those patients, 88% experienced either clinical improvement or stability of their disease, as confirmed by a panel of independent retina experts, with no serious or severe adverse effects related to PAN-90806.

“The phase 1/2 trial results constitute the most robust set of data exploring a topical anti-VEGF eye drop as monotherapy, and the favorable safety profile and biological response to PAN-90806 support its continued clinical development in wet AMD and other neovascular eye diseases,” said Paul G. Chaney, president and CEO of PanOptica.

Optos Launches UWF Retinal Imaging and Swept-Source OCT Combo

■ Optos has introduced Silverstone, a first-of-its-kind device combining ultrawidefield retinal imaging with integrated, image-guided, swept-source OCT. Silverstone produces a 200° single-capture optomap image with guided OCT allowing advanced OCT imaging anywhere across the retina, from posterior pole to far periphery. This provides a new standard in ultrawidefield-guided multimodal imaging in support of detection, investigation, and monitoring of retinal disease. Optos says Silverstone provides greater imaging functionality and expands the company’s product portfolio for ophthalmic markets. It combines color, autofluorescence, fluorescein, and indocyanine green angiography with swept-source OCT imaging capabilities.

FDA Creates Panel to Review Ophthalmic Drugs

■ In response to requests from ASCRS and other ophthalmology-related organizations, the FDA has created a panel to specifically review ophthalmic drug submissions. The move is part of an FDA initiative to make all of its review panels more aligned with specific diseases. In the past, ophthalmic drugs were reviewed by combined panels that also reviewed transplant applications and, earlier, dermatologic submissions.

Enrollment Complete in Faricimab DME Trials

■ Genentech/Roche has completed patient enrollment in the phase 3 YOSEMITE and RHINE clinical trials investigating faricimab in DME. Together, these represent the largest clinical trials of an investigational medicine in DME to date. Faricimab is the first bispecific antibody designed specifically for the treatment of retinal eye diseases. This investigational medicine simultaneously binds to and neutralizes Ang2 and VEGF-A.

The YOSEMITE and RHINE studies will evaluate the safety and efficacy of faricimab for the treatment of DME compared to aflibercept (Eylea; Regeneron) injection. The primary endpoint of each study is the change in BCVA at 1 year. YOSEMITE and RHINE aim to confirm the significant and sustained vision gain results in the phase 2 BOULEVARD study.

Verana Health Partners With AAO on IRIS Registry

■ The AAO and Verana Health have announced the launch of Verana Practice Insights, a powerful new tool that enables physicians to improve patient outcomes and provide better care through critical data insights and trends procured from the largest specialty clinical database in medicine, the IRIS Registry. Verana Practice Insights gathers key data from the IRIS Registry to provide ophthalmologists with a de-identified aggregate view of physician practice trends, patient diagnoses, and interventions across the United States. Furthermore, the Verana Practice Insights software enables IRIS Registry participants to benchmark their individual clinical care patterns relative to a cohort of their peers. Data on retinal indications will be available in 2020.

The partners are now also facilitating no-cost genetic testing and counseling for patients with certain inherited retinal diseases through Verana Trial Connect, a cloud-based application that facilitates physician and patient awareness of clinical trial opportunities. Leveraging the information found in the IRIS Registry, Verana Trial Connect aims to accelerate trial enrollment and, with the addition of genetic screening and counseling, now has the potential to open up new options to patients for whom limited or no treatments exist. Verana Trial Connect will initially enable genetic screening and counseling at no cost for select conditions, and later will expand to include patients with other inherited retinal conditions.

Bladder Medication Seen as Threat to Retina

■ A drug widely prescribed for a bladder condition now appears to be toxic to the retina. After an initial report last year that Elmiron (pentosan polysulfate sodium) may be associated with retinal damage, 3 ophthalmologists conducted a review of patients at Kaiser Permanente in Northern California. They found that about one-quarter of patients with significant exposure to Elmiron showed definite signs of eye damage, and that this medication toxicity could masquerade as other known retinal conditions, such as AMD or pattern dystrophy.

ProQR Reports Positive Early LCA10 Trial Data

■ ProQR Therapeutics N.V. has announced positive top-line results from the PQ-110-001 study, a phase 1/2 dose range finding, first-in-human trial of sepofarsen (QR-110) in patients with Leber congenital amaurosis 10 (LCA10) due to the p.Cys998X mutation in the CEP290 gene.

In the target registration dose group, at 12 months, 4 of 6 subjects showed an improvement of more than -0.3 LogMAR from baseline, equivalent to 3 lines, or 15 letters, on the ETDRS chart.

In related news, ProQR has received fast-track designation from the FDA for QR-1123, a first-in-class investigational antisense oligonucleotide designed to address the cause of vision loss associated with autosomal dominant retinitis pigmentosa (adRP) due to the P23H mutation in the rhodopsin (RHO) gene.

Eyevensys Has New Approach to Uveitis

■ Eyevensys presented early results from part 1 of its phase 1/2 study for noninfectious intermediate and posterior uveitis (NIU) at the recent AAO meeting. The company’s technology is a nonviral gene therapy ocular drug delivery platform that uses a two-part electrotransfection system, including a proprietary ocular device and electrical pulse generator, that delivers DNA plasmids encoding therapeutic proteins into the ciliary muscle. This turns the eye into a biofactory, allowing the ciliary muscle to produce the therapeutic protein. The secreted protein reaches the back of the eye, including the retina and choroid.

Eyevensys has successfully completed part 1 of a clinical safety study of its lead product EYS606, a nonviral vector encoding an anti-TNFα protein. Tumor necrosis factor alpha is a cytokine that has been shown to play a pivotal role in mediating intraocular inflammation.

Despite their advanced disease stage at enrollment, 3 of the 9 patients (3 cohorts) treated with EYS606 showed clinical improvements lasting for 6 months after 1 administration of the treatment. The first patient treated in the lowest-dose cohort experienced a >10 ETDRS letter improvement in BCVA while 2 patients treated in the highest dose cohort showed a significant reduction of macular edema via OCT associated with at least +12 ETDRS letters increase in BCVA from baseline.

Safety Data on Iluvien IOP Effects

■ A poster presented at the recent AAO meeting presents data from the 2018 Periodic Safety Update Report/Periodic Benefit Risk Evaluation Report (PSUR/PBRER), which evaluated real-world, long-term safety data for the fluocinolone acetonide intravitreal implant (Iluvien; Alimera Sciences). The August 2018 PSUR/PBRER for fluocinolone acetonide implant encompasses data from the US-based phase 4 IOP Signals Associated with Iluvien Study (PALADIN), the US retrospective chart review (USER), and non-US studies (Retro IDEAL, IRISS, and MEDISOFT), as well as global spontaneous reporting data.

The research included 18,082 eyes that received a fluocinolone acetonide intravitreal implant; 69 (0.38%) eyes required incisional surgery. Per data from the FAME trials, out of 375 eyes, 18 (4.8%) required incisional surgery. The FAME trials reported a higher rate of trabeculoplasty (1.1%) than the PSUR/PBRER (0.22%).

Opioid Use Up After Eye Surgery

■ From 2000 to 2014, rates of filled opioid prescriptions after eye surgery rose considerably, despite reduced invasiveness of these procedures, according to a new study by researchers in the Perelman School of Medicine at the University of Pennsylvania. The results were published in JAMA Ophthalmology.

“This really is surprising, given that there have been tremendous strides in the past decade to reduce the invasiveness and recovery time for these procedures. We would have expected rates to go down, not up,” said the study’s senior author Brian VanderBeek, MD, MPH, MSCE, an assistant professor of ophthalmology at Perelman School of Medicine.

The rate of filled opioid prescriptions after these procedures more than doubled, from 1.2% in 2000/2001 to 2.5% in 2014, across 6 different ocular subspecialties. Rates dropped for the first time during this time period to 2.2% in 2015 and then to 2.1% in 2016. However, the researchers found that after controlling for differences among the types of surgeries, the odds of having an opioid medication filled after any incisional ocular surgery was more than 3 times higher from 2014 to 2016 than from 2000 to 2004.

EVRS Welcomes Attendees From 56 Countries in Lisbon

■ The 19th annual meeting of the European Vitreoretinal Society (EVRS) was held in Lisbon, Portugal, this summer. More than 800 participants from 56 different countries attended the three-and-a-half day event.

The scientific program featured more than 150 papers, a full day of practical courses, a 3-day wet-lab session with vitrectomy machines from all major companies, instructors providing courses throughout each day tailored to individual participants’ needs, and 3D symposiums. Keynote lectures were given by the recipients of the Zivojnovic Award, Dr. Stanley Chang, and the EVRS Lecture Award, Dr. David Sarraf.

“We continue to share our philosophy of collaboration and peer-to-peer atmosphere with members after 20 years,” said EVRS president Giampaolo Gini, MD. He added that through meetings, training school, and everyday work, the organization encourages its younger members to follow a path of innovative, independent thinking.

EVRS will host its 20th meeting from June 4 to 7, 2020, in Verona, Italy. RP