EW Weekly, April 24, 2020

Getting back to practice

Last week, AAO CEO David Parke II, MD, issued a statement on the need to “consider the process of reopening ophthalmic care” after AAO had recommended postponement of non-essential ophthalmic care in mid-March in response to the COVID-19 pandemic. At that time, ASCRS concurred with AAO’s recommendation for a national halt of non-emergent ophthalmic surgeries and clinic visits; ASCRS also now agrees with AAO’s latest statement regarding reopening. Dr. Parke wrote that “while the Academy made a national recommendation to curtail ophthalmic practice, the decisions to reopen more normal practice will be local and regional. They will be based on local and state governments, on public health authorities interpreting local patterns of disease, on testing availability, on institutional policies and ultimately on individual ophthalmologists.” ASCRS is preparing a Virtual Meeting for May 16–17, which the society noted will likely coincide with the reopening of many U.S. ophthalmic practices. This meeting will include a focus on transitioning back to work with the two-part symposium “Turning the Lights Back On.” The meeting will also include a keynote speech from former FDA Commissioner Scott Gottlieb, MD, and a selection of clinical symposia and instructional courses in a live stream format. Paper sessions, posters, films, and a selection of pre-recorded instructional courses will be available on-demand with full slides, video, and audio. There will also be opportunities for interaction with industry through corporate-sponsored educational sessions and a full digital exhibit hall. For those already registered for the 2020 ASCRS Annual Meeting, registration will automatically be transferred to the 2020 ASCRS Virtual Meeting. Visit annualmeeting.ascrs.org for updates and information.


New understanding for vision loss associated with long-term hydroxychloroquine use

Hydroxychloroquine has been in the headlines lately as a possible treatment for COVID-19, but recent research on the drug provides insights into how long-term use, a decade or more, typically for rheumatological conditions, can lead to vision loss. The research from the Ocular Cell Culture Laboratory of New York Eye and Ear Infirmary of Mount Sinai identified in vitro cellular mechanisms that affect the retinal pigment epithelial cells. According to the research published in the International Journal of Ophthalmology, cells were treated with hydroxychloroquine, hydroxychloroquine with salbutamol (a β2-adrenergic receptor agonist considered a protective agent), hydroxychloroquine with salbutamol and a protein kinase A (PKA) inhibitor (PKA blocks the protective action of the salbutamol), or nothing at all. Cellular activity and viability were measured after 24 hours. According to the research, the cells treated with salbutamol (without the PKA inhibitor) maintained metabolic function and cell damage from hydroxychloroquine toxicity was prevented. The research sheds light on the pathway of hydroxychloroquine-associated retinopathy. According to the news release, researchers are testing protective effects of β2-adrenergic medications in an animal model.


Novartis acquires software startup for amblyopia treatment

Novartis acquired Amblyotech, a software company, to develop a video game that would help treat amblyopia. The treatment, according to the company’s news release, would be a first-in-class device created in collaboration with Ubisoft and McGill University. An early clinical study using the technology, which includes 3D glasses to train the eyes to work together, showed improved vision in children and adults. According to the news release, Novartis plans to conduct a pivotal study with the technology and will eventually seek FDA approval.


Tentative FDA approval for new allergic conjunctivitis eye drop

Alembic Pharmaceuticals announced tentative FDA approval of its Abbreviated New Drug Application for its drop—alcaftadine ophthalmic solution, 0.25%—indicated for itching associated with allergic conjunctivitis. According to a news release from the company, alcaftadine is an H1 histamine receptor antagonist that can help prevent ocular itching due to allergies.


Eyecelerator Live Stream series continues

Eyecelerator, the ASCRS and AAO partnership for innovation, continued its live stream sessions this week as part of the series “Ophthalmology 2.0: ReBooting the Ophthalmology Marketplace Post-COVID-19.” Wednesday’s live stream—RePlan: Financial Survival and Growth Opportunities Post-Pandemic—featured a keynote from Wells Fargo Senior Analyst Larry Biegelsen. Discussion was moderated by Jim Mazzo, global president, Ophthalmic Devices, Carl Zeiss Meditec, and Elizabeth Yeu, MD, Virginia Eye Consultants. The panel for this live stream included Laurent Attias, SVP of Corporate Development Strategy, BD&L and M&A, Alcon, Jay Duker, MD, chairman, Department of Ophthalmology, Tufts Medical Center, Nancy Lurker, CEO and president, EyePoint Pharmaceuticals, Bruce Maller, CEO and founder, BSM Consulting, Tom Mitro, COO and president, Aerie Pharmaceuticals, Vance Thompson, MD, Vance Thompson Vision, and Mr. Biegelsen. The next live stream, on Wednesday, April 29 from 11 a.m.–12:30 p.m. PDT, will focus on “ReInvent: Speeding the Recovery of Ophthalmology with Digital Innovations.” More information on the Eyecelerator Live Stream series can be found here.


COVID-19: News You Can Use

ASCRS continues its COVID-19: News You Can Use series, a repository of information including links, tips, and resources to help navigate the fluid COVID-19 landscape. The e-newsletter is published as new information relevant to its members emerges.


Research highlights
  • New research is showing a proof-of-concept for gene therapy as a treatment for glaucoma in an experimental mouse model and human donor tissue. A study by Jiahui Wu, PhD, and coinvestigators reduced aqueous humor production from the ciliary body by using the adeno-associated virus ShH10 serotype to deliver CRISPR-Cas9 gene-editing technology to disrupt the gene aquaporin 1. Researchers were able to detect the gene editing in mice that received this intravitreal injection, and there were no increases in corneal or retinal thickness between the mice that received the injection vs. controls. The researchers also observed an IOP reduction and prevention of ganglion cell loss in mice with induced ocular hypertension that received the gene editing. “Clinical translation of this approach to patients with glaucoma may permit long-term reduction of IOP following a single injection,” the study authors concluded. The research is published in the journal Molecular Therapy.
  • Long-term use of rigid gas permeable contact lenses did not have an effect on keratoconus progression, according to research published in the British Journal of Ophthalmology. Satoko Araki and colleagues evaluated the records of 405 patients with keratoconus, including those with mild-to-moderate disease with at least 3 years’ worth of follow-up with Scheimpflug-based imaging each visit. Twenty-two patients (31 eyes) were included who wore rigid gas permeable lenses and 15 patients (20 eyes) who didn’t wear contacts served as controls. Multivariable non-linear regression analysis assessed the change in tomographic parameters over the follow-up period and the difference between the two groups and showed no significant difference between the two in terms of anterior and posterior radius of curvature and the thinnest corneal pachymetry reading.
  • Researchers have demonstrated that skin cells can be directly turned into rod cells, skipping the step of creating stem cells from the skin cells first. According to a press release about the research, this latter step of creating pluripotent stem cells can take 6 months; the direct reprogramming of the cells in the current study into functional photoreceptors ready for transplantation takes 10 days. The research by Biraj Mahato, PhD, and coauthors included mouse- and human-derived skin cells that, after administration of “five small molecules,” according to the research, chemically induced skin fibroblast cells to turn into rod photoreceptor-like cells. The research is published in the journal Nature.

This issue of EyeWorld Weekly was edited by Stacy Jablonski and Vanessa Caceres.

EyeWorld Weekly (ISSN 1089-0319), a digital publication of the American Society of Cataract and Refractive Surgery (ASCRS), is published every Friday, distributed by email, and posted live on Friday.

Medical Editors: Eric Donnenfeld, MD, Chief Medical Editor; Rosa Braga-Mele, MD, Cataract Editor; Clara Chan, MD, Cornea Editor; Nathan Radcliffe, MD, Glaucoma Editor; and Vance Thompson, MD, Refractive Editor

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