2014 NY
COURSE DIRECTOR CARL C. AWH, MD
COURSE CO-DIRECTORS DAVID R. CHOW, MDTAREK S. HASSAN, MD
DECEMBER 4-6, 2014 • NEW YORK, NY
A FELLOWS’ FORUM, INC. PRODUCTION
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CME ACCREDITATION AND CREDIT DESIGNATION
This activity has been planned and implemented in accordance with the accreditation requirements andpolicies of the Accreditation Council for Continuing Medical Education through the joint providership of
William Beaumont Hospital and Medical Conference Planners, Inc. William Beaumont Hospital isaccredited by the ACCME to provide continuing medical education for physicians. William Beaumont
Hospital designates this live activity for a maximum of 14.25 AMA PRA Category 1 Credit(s).™
Physicians should claim only the credit commensurate with the extent of their participation in the activity. Credit breakdown: Fri = 7.25, Sat = 7.00
Carl Awh,MDCourse Director
Jean Bennett, MD, PhD, FARVOKeynote SpeakerARVO 2014 Meeting
Neil Bressler,MDEditor-in-Chief, JAMA Ophthalmology
Alexander Brucker,MDJ. Donald M. Gass Award LectureRetina Society 2014 Annual MeetingEditor-in-Chief, RETINA
Peter Campochiaro,MDThe RRF Award of MeritRetina Society 2014 Annual Meeting
David Chow,MDCourse Co-Director
Donald D’Amico,MDModerator, Journal Editor Panel
Pravin Dugel,MD Dean Eliott,MD Philip Ferrone,MD Hans Grossniklaus,MD, MBAJackson Memorial LectureAAO 2014 Annual Meeting
J. William Harbour,MDThe Paul Henkind MemorialLecture and Award, MaculaSociety 2014 Annual Meeting
Tarek Hassan,MDCourse Co-Director
Peter Kaiser,MD Szilárd Kiss,MD Timothy Olsen,MDExecutive Editor, AJO
Carl Regillo,MDFounders Award LectureARDS 2014 Annual Meeting
Kourous Rezaei,MDModerator, Best of RETINAWS
Andrew Schachat,MDGertrude Pyron Award LectureASRS 2014 Annual MeetingEditor-in-Chief, Ophthalmology
Hendrik Scholl,MD, MAW. Richard Green LectureMacula Society 2014 Annual Meeting
Jerry Shields,MDSchepens LectureAAO 2014 Annual Meeting
Faculty
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PROGRAM
ThursdayDECEMBER 4
5:30PM-8:30PM
RegistrationWestin New York Times Square, Bar 10
6:00PM-8:00PM
Welcome ReceptionWestin New York Times Square, Bar 10
8:00PM
Dinner on own
FridayDECEMBER 5
6:45AM-5:30PM
RegistrationWestin New York at Times SquareMajestic Ballroom Foyer, 5th Floor
6:45AM – 7:25AM
BreakfastWestin New York at Times SquareGershwin Ballroom, 4th Floor
6:45AM-3:50PM
ExhibitsWestin New York at Times SquareGershwin Ballroom, 4th Floor
7:30AM-9:45AM
SESSION 1Majestic Ballroom, 5th Floor
7:30AM-7:45AM
Opening Remarks
Carl C. Awh, MDCourse Director
7:45AM-8:15AM
Best of Retina from JAMA Ophthalmology
Neil M. Bressler, MDEditor-in-Chief, JAMA Ophthalmology
8:15AM-8:25AM
Audience and Panel Discussion
8:25AM-8:55AM
Best of Retina from AJO
Timothy W. Olsen, MDExecutive Editor, AJO
8:55AM-9:05AM
Audience and Panel Discussion
9:05AM-9:35AM
Best of Retina from RETINA
Alexander J. Brucker, MDEditor-in-Chief, RETINA
9:35AM-9:45AM
Audience and Panel Discussion
9:45AM-10:15AM
Break
10:15AM-12:25PM
SESSION 210:15AM-10:55AM
ASRS 2014 GERTRUDE D. PYRONAWARD LECTURE
Fourteen-ThousandDecisions and Counting –Tales from an Editorand Best of Retina from Ophthalmology
Andrew P. Schachat, MDEditor-in-Chief, Ophthalmology
Dr. Schachat was Editor of Ophthalmologyfor ten years and prior to that, AssociateEditor of the Archives of Ophthalmology,now JAMA Ophthalmology, for many years.He is and remains an Editor of Ryan’s Retina.During his tenure, Dr. Schachat made over14,000 accept/revise/reject decisions atOphthalmology. The presentation reviewscharacteristics of good and less goodmanuscripts with a focus on improvedreporting of clinical manuscripts.
10:55AM-11:05AM
Audience and Panel Discussion
11:05AM-11:50AM
Journal Panel Discussion
Donald J. D’Amico, MD (Moderator)Neil M. Bressler, MD, Timothy W. Olsen,MD, Alexander J. Brucker, MD, Andrew P. Schachat, MD (Panelists)
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11:50AM-12:20PM
Update on Genetics andAREDS Supplements
Carl C. Awh, MD
This presentation will review recent publica-tions and research relevant to the use ofgenetic testing to guide selection of nutri-tional supplements for patients with AMD.Evidence exists that patients followed inAREDS with the combination of highcomplement factor H (CFH) and low age-related maculopathy susceptibility 2 (ARMS2)genetic risk had a deleterious response tothe AREDS formulation. Analysis of AREDSdata suggests that this relationship is dueprimarily to the zinc component of theAREDS formulation, a hypothesis supportedby independent research regarding the roleof zinc in the pathogenesis of AMD.
12:20PM-12:30PM
Audience and Panel Discussion
12:30PM-2:00PM
Lunch and Industry Presentations
2:00PM-3:20PM
SESSION 32:00PM-2:30PM
AAO 2014 RETINA SUBSPECIALTY DAY CHARLES L. SCHEPENS LECTURE
Management of PosteriorUveal Melanoma: Past, Present and Future
Jerry A. Shields, MD
PURPOSE: To review management of ciliarybody and choroidal melanoma (posterioruveal melanoma; PUM) over the last centurywith emphasis on changing concepts.
DESIGN: Retrospective review
PARTICIPANTS: Review of personalexperience over 40 years and pertinent literature on management of PUM.
INTERVENTION: Diagnosis and therapy forposterior uveal melanoma.
MAIN OUTCOME MEASURES: Patient survival.
RESULTS: In the early 1900s, most patientspresented with a large symptomaticmelanoma,that necessitated enucleation,and the systemic prognosis was poor. In the1970s, controversy erupted regarding therole of enucleation for PUM. Some author-ities advocated prompt enucleation whileothers proposed that enucleation promotedmetastasis, known as the Zimmermanhypothesis. Others recommended obser-vation, withholding treatment until tumorgrowth was documented.
During the 1970s there was a trend towardeye-saving procedures, including laser photo -coagulation, surgical removal of tumor, andtechniques of radiotherapy. Despite localtreatment success, systemic prognosisremained guarded with approximately 40% mortality overall. However, there wasconvincing evidence that smaller tumorsoffered a significantly better prognosis.
Currently, there is a movement towardearlier identification and treatment of smallmelanomas using clinical factors predictiveof malignant potential, in keeping withsimilar philosophy regarding other cancers.Further understanding of melanoma cyto -genetics and molecular pathways havehelped to recognize patients at risk formetastasis. At-risk patients are offeredsystemic therapeutic trials to prevent metastasis. We anticipate that the futuremanagement of PUM will focus ondetection of clinical and imaging clues forearliest diagnosis, prompt local tumortreatment, and systemic targeted therapiesfor microscopic metastasis or prevention of metastasis. Personalized evaluation ofpatient-specific melanoma molecular path -way signature could potentially allow fortherapeutic intervention at a site specific tothe pathway abnormality that leads to thedevelopment of melanoma.
CONCLUSION: Management of PUM hasmade major strides over the past centuryfrom the days of enucleation for massive,fatal tumor to early detection of smallesttumors with a more favorable prognosis.Current and future targeted specific tumorpathway interruption using systemic agentscould improve survival.
2:30PM-2:40PM
Audience and Panel Discussion
2:40PM-3:10PM
RETINA SOCIETY 2014 RRF AWARD OF MERIT IN RETINA RESEARCH
Development of Treatmentsfor Retinal/ChoroidalVascular Diseases
Peter A. Campochiaro, MD
PURPOSE: The pathway for development ofnew treatments for retinal/choroidal vasculardiseases is well-established and validated.The purpose is to present the pathway andillustrate how it is used.
METHODS: The first step is development ofan animal model that mimics key aspects of the disease process and is feasible andpractical to use. It is then necessary todevelop candidate targets, a process thatoften involves piecing together bits ofcircumstantial evidence often from patientswith the disease process. It is then necessaryto develop a specific antagonist to thecandidate target and if possible, a knockoutof the gene that codes for the target. Thenext step is to use the specific antagonistand/or knockout in the animal model to determine if the candidate target iscritical for development of the diseasephenotype.
After choosing a route of administration andformulation, safety and biodistribution mustbe established. The design of early phaseclinical trials is an art, because while themajor goal is to test safety, it is advantageousto test for an efficacy signal. Mid-phaseproof-of-concept clinical trials are critical tomake a go/no go decision and to informdesign of registration trials. Successful registration trials validate the target andvalidate the animal model that was used inpreclinical trials.
RESULTS: Once a target is validated, newstrategies to neutralize the target morecompletely and for longer periods are testedin the validated model bringing the processfull circle. The circle is repeated many timesto optimize neutralization of the validatedtarget and to try to identify new targets.
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When good animal models are not available,it is sometimes necessary to truncate thecircle and use patients with the disease asthe model provided there is good safetydata for the specific antagonist and thereare good efficacy outcome measures.
CONCLUSIONS: Many examples to illustratethese points will be provided.
3:10PM-3:20PM
Audience and Panel Discussion
3:20PM-3:50PM
Break
3:50PM-5:40PM
SESSION 43:50PM-4:20PM
ARVO 2014 KEYNOTE LECTURE
Seeing the Light with Retinal Gene Therapy:Behind-the-Scenes Perspectives
Jean Bennett, MD, PhD, FARVO
Gene therapy has restored sight in patientswith a form of Leber’s Congenital Amaurosis(LCA), an inherited blindness that begins atbirth. This presentation will describe thesafety and efficacy results after gene therapyin 12 subjects, born with LCA. The subjectswere treated at The Children’s Hospital ofPhiladelphia in one eye and all eligiblesubjects have had re-administration to thecontralateral eye.
The presentation will also describe how thisdata has been used to initiate a Phase 3study aimed at obtaining US Food and DrugAdministration approval of this intervention.Finally, the presentation will share a behind-the-scenes perspective on the prospects andchallenges of develop ing gene therapy forother forms of inherited blindness. WhileLCA is a rare blinding disease, the resultsfrom these studies could pave the way fordevelopment of other gene-based treat-ments for more common forms of blindnessand for other inherited diseases.
4:20PM-4:30PM
Audience and Panel Discussion
4:30PM-5:00PM
Future Management of Wet AMD: Update on Clinical Trials 2014
Peter K. Kaiser, MD
This talk is an update on the latest clinicaltrials in exudative age-related maculardegeneration. From promising drugsentering the pipeline, to drugs in or finishing phase 3, the top prospects will be discussed.
5:00PM-5:10PM
Audience and Panel Discussion
5:10PM-5:30PM
Stem Cell Therapy for Atrophic AMD: Phase 1 Results
Dean Eliott, MD
A phase 1 study was conducted to assessthe safety of subretinal injection of stemcells for dry macular degeneration withgeographic atrophy and for Stargardt’sdisease. There were no ocular or systemicadverse events related to the stem cells.Patient characteristics, surgical procedureand results will be presented.
5:30PM-5:40PM
Audience and Panel Discussion
5:40PM-6:45PM
Reception
6:45PM
Dinner on own
SaturdayDECEMBER 6
6:45AM-5:30PM
Registration
6:45AM-7:25AM
Breakfast
6:45AM-3:50PM
Exhibits
7:30AM-9:40AM
SESSION 57:30AM-7:40AM
AnnouncementsCarl C. Awh, MD
7:40AM-8:10AM
MACULA SOCIETY 2014 GREEN LECTURE AND AWARD
Macular Degeneration: From Mechanism to Therapy
Hendrik P.N. Scholl, MD, MA
Until recently, slow neurodegeneration ofthe retina and macula secondary to geneticmutations have been considered incurable.Molecular genetic studies in the last twodecades have revealed the underlyingmolecular cause in a substantial fraction ofpatients. The mammalian eye has been atthe forefront of therapeutic trials based ongene replacement, stem cell and pharma-cotherapy in humans with retinaldegenerations. This is at least partly due tothe accessibility of the human eye and theopportunity to study this part of the brain ingreat detail with non-invasive methods.
Spectral-domain optical coherence tomog-raphy (sd-OCT) and adaptive optics (AO)reflectance imaging allow to visualize retinalstructure at the cellular and even sub-cellular level while functional tests such asfundus-controlled (or micro-) perimetryallow to map the sensitivity of the retinawith high resolution. It has thus becomepossible to correlate structure and functionof the central retina with high precision andto obtain multi-modal imaging of the retina.
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8:10AM-8:20AM
Audience and Panel Discussion
8:20AM-8:50AM
ARDS 2014 FOUNDERS AWARD LECTURE
Anti-VEGF MaintenanceTherapy for Neovascular AMD
Carl D. Regillo, MD
The functional and anatomic outcomesachieved in the pivotal ranibizumab phase IIItrials with monthly injections set the standardfor comparison for the treatment of neovas-cular age-related macular degeneration(nAMD) with intravitreal, pan-VEGF inhibitors.There is now level I evidence from the CATTand IVAN studies that demonstrated non-inferiority of bevacizumab compared toranibizumab in this setting.
Aflibercept has demonstrated equivalency to ranibizumab in its phase III VIEW studieswhen dosed monthly and bimonthly in themaintenance phase of therapy. Although allthree agents have been shown to performwell to treat nAMD when dosed in afrequent and fixed fashion, the drugs aretypically administered in a more individual izedmanner in clinical practice worldwide.
Individualizing anti-VEGF therapy for nAMDincludes the as needed (PRN) and the treat-and-extend (TAE) approaches. The formerhas been tested in several large scale,comparative trials and the results over twoyears of using pan-VEGF blockers PRN havenot shown to be non-inferior to continuous,frequent dosing.
The TAE style of therapy has evolved into the most frequently used treatment approachin the US and is gaining in popularity else -where. Although there are no studiesavailable that directly compare TAE to eitherPRN or fixed regimens, there is mountingevidence from retrospective and prospectivestudies to support its use. Evidence to dateusing the various treatment strategies innAMD will be reviewed.
8:50AM-9:00AM
Audience and Panel Discussion
9:00AM-9:40AM
Late Breaking News
9:40AM-10:10AM
Break
10:10AM-12:45PM
SESSION 610:10AM-11:25AM
Best of RETINAWS
Kourous A. Rezaei, MD
RETINAWS at the Best of Retina 2014 showcases the most interesting surgical videosand experiences that were presented byretina surgeons around the world during theRETINAWS courses in 2014. A panel ofexperts will discuss the presented surgeriesand also share their own most educationalsurgical experience from the year of 2014.
11:25AM-11:55AM
RETINA SOCIETY 2014 J. DONALD M. GASS AWARD LECTURE
In Memoriam of the Art of Scleral Buckling
Alexander J. Brucker, MD
PURPOSE: In memoriam of the art of scleral buckling.
METHODS: An historic review of retinaldetachment surgery.
RESULTS: From the initial description of theHelmholtz ophthalmoscope, the repair ofretinal detachments has been based uponthe principle of: Find the hole, treat the holeand close the hole. The skill set of finding
the retinal defect, documenting the locationof retinal breaks, planning the type of scleralbuckle procedure necessary for the closingof the defects, and then flattening of thedetachment often with external drainage ofsubretinal fluid was learned over many yearsof training and experience. The technique of indirect ophthalmoscopy with scleraldepression, drainage of subretinal fluid andthe placement of just the right bucklebecame an art form rather that a rotesurgical procedure. Today that skill set isbeing lost. The repair of retinal detachmentsis now an intraocular procedure whichrequires a new set of skills.
CONCLUSIONS: While the end result ofretinal detachment surgery is the flatteningof the retina with restoration of vision, thereis less and less controversy con cerning theuse of vitreous surgery as a primary methodfor the repair of most retinal detachments.The result is the loss of the experiencenecessary to learn when and how toperform scleral buckling surgery. For that we now pay tribute.
11:55AM-12:05PM
Audience and Panel Discussion
12:05PM-12:35PM
Retinal Imaging –From the Posterior Pole to the Far Periphery
Szilárd Kiss, MD
The revolution and evolution in retinalimaging – of both the posterior pole and thefar periphery – included the expansion ofultra wide field imaging into the realm ofindocyanine green angiography and thecommercial availability of OCT angiography.With the greater understanding of theimportant contribution of the peripheralretina, ultra wide field imaging is becomingthe standard of care in many retinal disorders,especially retinal vein occlusion and diabeticretinopathy, and even in many ocular inflam-matory conditions. With the expandedavailability of OCT angiography, we have
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already begun to unearth interesting (andpreviously unknown) details about theretinal vasculature in the posterior pole –this will undoubtedly only continue toexpand in the coming year.
12:35PM-12:45PM
Audience and Panel Discussion
12:45PM-2:00PM
Lunch and Industry Presentations
2:00PM-3:20PM
SESSION 72:00PM-2:30PM
MACULA SOCIETY 2014 PAUL HENKIND MEMORIAL LECTURE AND AWARD
Uveal Melanoma – The Present and the Future
J. William Harbour, MD
Uveal melanoma is the most commonprimary intraocular malignancy and has astrong propensity for fatal metastasis. Recentadvances in the molecular genetics of uvealmelanoma are revolutionizing our understand -ing of this cancer and the care of patients.
The development of a new molecular classi -fication of uveal melanoma based on a widelyavailable 15-gene expression profile nowallows patients at high risk of metastasis tobe identified early so that individualizedmanagement can be offered. The recentdiscovery of major driver mutations in uveal melanoma provide a rational basis fordevelopment of new targeted therapies.Taken together, these advances are trans-forming our understanding and managementof uveal melanoma with the ultimate goal of improving patient outcomes.
2:30PM-2:40PM
Audience and Panel Discussion
2:40PM-3:10PM
AAO 2014 JACKSON MEMORIAL LECTURE
Retinoblastoma: 50 Years of Progress
Hans E. Grossniklaus, MD, MBA
Progress made in understanding the geneticbasis, molecular pathology, and treatment of retinoblastoma was reviewed since theprevious Jackson lecture on the topic waspublished 50 years ago. The literature regard -ing retinoblastoma was reviewed since 1963.Advances in understanding the biology and treatment of retinoblastoma providedcontext through the author’s clinical, patho-logical and research experiences.
Retinoblastoma was first identified in the1500s and defined as a unique clinico -pathologic entity in 1809. Until the mid-1900s,knowledge advanced sporadically, with tech -nological developments of ophthalmoscopyand light microscopy, and with the introduc-tions of surgical enucleation, chemotherapyand radiation therapy. During the last 50 years, research and treatment haveprogressed at an unprecedented rate due to innovations in molecular biology and thedevelopment of targeted therapies.
Nearly all patients with retinoblastoma indeveloped countries can now be cured oftheir primary cancer – a remarkable achieve -ment for a childhood cancer that once was uniformly fatal. Much of this success isowed to deciphering the role of the Rbgene, and the benefits of targeted therapies,such as chemoreduction with consolidationas well as intra-arterial and intravitrealchemotherapies. Going forward, the mainchallenge will be ensuring that access tocare is available for all children, particularlythose in developing countries.
3:10PM-3:20PM
Audience and Panel Discussion
3:20PM-3:50PM
Break
3:50PM-5:30PM
SESSION 83:50PM-4:20PM
Latest and Greatest inPharmacologic Treatment of Diabetic Retinopathy andDiabetic Macular Edema
Pravin U. Dugel, MD
I will be showing Medicare based data previously not presented regarding the “curerate” for DME with our current treatmentstrategies. I will then discuss the positioningof newly approved steroid delivery devices.Finally, I will present new data on a new Tie 2 activator with a unique delivery formulation.
4:20PM-4:30PM
Audience and Panel Discussion
4:30PM-5:30PM
Late Breaking News
5:30PM
Adjourn
5:30PM-6:30PM
Closing Reception
6:30PM
Dinner on own
THIS CME ACTIVITY IS SUPPORTED BY AN EDUCATIONAL GRANT FROM:
Regeneron Pharmaceuticals, Inc.
ExhibitorsBEST OF RETINA 2014 GRATEFULLY
ACKNOWLEDGES GENEROUS CONTRIBUTIONS FROM THE FOLLOWING COMPANIES:
DIAMOND
Allergan, Inc.
PLATINUM
Genentech, Inc.
GOLD
Regeneron Pharmaceuticals, Inc.
SILVER
Alcon Laboratories, Inc.
Arctic Group of Companies
Bausch + Lomb
Dutch Ophthalmic, USA
Insight Instruments, Inc.
OCULUS Surgical, Inc.
Optos, Inc.
Synergetics, Inc.
ThromboGenics, Inc.