EURETINA 2024 attendees gathered for a pivotal symposium focused on a familiar foe—neovascular AMD.
Experts showcase cutting-edge imaging technologies, offering new insights into retinal disease management.
Tributes and Awards Highlight EURETINA 2024 Opening Ceremony
by Matt Herman
The 24th Congress of the European Society of Retina Specialists (EURETINA 2024) officially kicked off late on Day 1 with the official opening ceremony. Tributes to departed EURETINA President Prof. Ramin Tadayoni poured in throughout the session, including a special EURETINA Lecture dedicated to one of his biggest passions: pathological myopia.
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EURETINA President Prof. Anat Loewenstein opened the EURETINA 2024 Opening Ceremony, EURETINA Lecture and August Deutman Awards session with comments thanking the more than 8,000 delegates attending the conference—and reflecting on an unprecedented year for innovation and scholarship in retinal medicine.
A series of tributes to the late former EURETINA President Prof. Ramin Tadayoni followed. Prof. Tadayoni’s passing earlier this year shocked the European and global retina community, but his legacy as both an educator and researcher were on full display throughout an emotionally charged afternoon session.
Retina luminaries and colleagues of Prof. Tadayoni, from current president
Prof. Loewenstein to Prof. Martin Zinkernagel (Switzerland) and more, shared stories both professional and personal about the indelible impact Prof. Tadayoni had on retinal medicine and the tightknit community surrounding it.
EURETINA Lecture
After a moment of silence in honor of Prof. Tadayoni, Prof. Loewenstein introduced this year’s EURETINA Lecture awardee—Prof. Kyoko Ohno-Matsui, who presented on Pathologic Myopia: New Horizons Through Cutting-Edge Imaging Technologies.
Prof. Tadayoni’s pioneering work and influence on the study of pathologic myopia loomed large throughout the talk, as Prof. Ohno-Matsui began with a tribute to what she described as Prof. Tadayoni’s legacy of passion and innovation in pathologic myopia.
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“I had a close friendship with Ramin, who shared my passion for pathologic myopia,” she said. “His dedication to understanding the disease, his fairness towards fellow researchers and his remarkable humility will always stay with me.”
Prof. Ohno-Matsui then dived into the cutting-edge of imaging technology—and how novel imaging modalities are changing how modern clinicians and researchers look at pathologic myopia.
Skyrocketing myopia rates and the identification of pathologic myopia as a major cause of blindness worldwide has made the topic more critical than ever, she said, citing major studies like the Tajimi Study (Japan) and the Los Angeles Latino Eye Study (USA).1,2
Whether the blindness from pathologic myopia results from myopic maculopathy, myopic traction maculopathy, or from glaucoma or myopic optic neuropathy, there is really only one culprit according to Prof. Ohno-Matsui. “The cause of developing the above complications is eye deformity caused by posterior staphyloma,” she said.
One of Prof. Ohno-Matsui then went deeper into myopic maculopathy, discussing grading of the disease from no maculopathy (category 1) all the way to macular atrophy (category 4). One key revelation here is that she sees two distinct progressive patterns in the disease; from diffuse atrophy (category 2) to patch atrophy (category 3), and from myopic macular neovascularization to macular atrophy (category 4).
She then turned to how observations like these can be combined with imaging to transform the lives of patients either with, or at risk of developing, pathologic myopia. Ultra-widefield optical coherence tomography (UW-OCT) has been particularly revelatory.
“Wide-field OCT is a great tool to visualize the special relationship between posterior staphyloma and myopic retina complications,” she said while discussing a case of macular retinoschisis in myopic traction maculopathy.
Prof. Ohno-Matsui also discussed technologies like 3D MRI, which she used
to test a theory about the relationship between axial elongation and posterior staphyloma—using a baking New Year’s rice cake as a visual aid.
In this conceptualization, the rice cake swells uniformly when baking (normal growth)—but when the central part pops out (staphyloma), something interesting happens to the surrounding part.
“In 3D MRI images of the eye with deep spectrometry, we found that the eyeball outside of the staphyloma often flattens,” she said. This is just one of the many things that 3D MRI can be used for, but Prof. Ohno-Matsui did caution that this powerful technology is not yet feasible as a screening tool.
Another imaging modality explored is polarization-sensitive OCT (PS-OCT), whose colorful images of collagen fiber direction and birefringence in the sclera have led to intriguing ideas about pathologic myopia that could upend conventional thinking.
“[PS-OCT images] may suggest that some pathologies may be a consequence of uneven distribution and the dislocation of inner sphere fibers,” she said. “The inner sclera and outer sclera might also play different roles in maintaining the eye shape,” she noted.
All-in-all, such image-driven observations may lead to improved results at a critical time for understanding the real consequences of increasing myopia rates—and increasing populations of those with pathologic myopia.
“One of the main goals now is to control these staphylomas before they lead to visual impairment,” she said in conclusion.
2024 EURETINA awardees
The latter half of the session saw a series of awards given out for excellence in retina, including the new Ramin Tadayoni Award, established by EURETINA and Oculis (Zug, Switzerland), a company which saw Prof. Tadayoni serve as Chief Scientific Officer. The awards presented were as follows: Ramin Tadayoni Award
Dr. Andrea Govetto (Italy), for developing a computational model of fluid flow and retinal tissue deformation in macular edema.
EURETINA Retinal Medicine Clinical Research Award
Dr. Maximilian Pfau (Switzerland); Enhanced Vision and Imaging Tests for Enabling Treatment Trials in Early and Intermediate AMD
Dr. Javier Zarranz-Ventura (Spain); Prediction of Treatment Needs Using a Hybrid Artificial Intelligence-based Management Assistant (ALMA) tool in Neovascular Age-related Macular Degeneration
EURETINA August Deutman Awards
Best ePoster
1st Place: Stefano Mercuri (Italy); Genotype-phenotype Correlations in a Cohort of Genetically Determined Retinitis Pigmentosa (RP) Italian Patients with Rho Gene Mutations
2nd Place: Hoda Shamsnajafabadi (United Kingdom); CRISPR-Cas Mediated Base Editing Approaches for CRB1 Related Retinal Dystrophy
3rd Place: Keean Nanji (Canada); The Impact of COVID-19 on a Real-World Treat and Extend Regimen with Aflibercept for Neovascular Age-Related Macular Degeneration
Best Free Paper
1st Place: Baruch Kupperman (USA); Post Hoc Analyses of Responder Status in Phase 3 Studies of Ciliary Neurotrophic FactorProducing Revakinagene Taroretcel in People with Macular Telangiectasia Type 2
Best Video
1st Place: Juan Giralt (Spain); Pars Plana 27-gauge Vitrectomy for Posteriorly Dislocated Posterior Chamber Phakic Intraocular Lenses (IPCL)
2nd Place: Katarzyna Chwiejczak (United Kingdom); Retinal Detachment Secondary to Acute Retinal Necrosis
3rd Place: Margarida Dias (Portugal); From Hopes to Hurdles: Macular Detachment after Luxturna.
References
1.
Iwase A, Suzuki Y, Araie M, et al; Tajimi Study Group, Japan Glaucoma Society. The prevalence of primary open-angle glaucoma in Japanese: the Tajimi Study. Ophthalmology. 2004;111(9):1641-8.
Tackling AMD Injection Burden at EURETINA 2024
by Diana Truong
On Day 1 of the 24th Congress of the European Society of Retina Specialists (EURETINA 2024), attendees gathered for a pivotal symposium focused on a familiar foe—neovascular AMD.
With anti-VEGF therapies widely acknowledged for their effectiveness, the pressing question now is, “Where do we go from here?” The answer, according to leading experts, lies in alleviating the heavy injection burden on both patients and clinicians.
“If we take a step back and think about the role of anti-VEGF for neovascular
AMD, I’m sure all of you would agree with me that it has proven to be very effective in improving visual acuity outcomes,” said Prof. Sobha Sivaprasad (United Kingdom).
Yet, as effective as these therapies are, they come at a cost—frequent injections. In a EURETINA 2021 survey, 67% of respondents identified injection frequency as the highest unmet need,
while 68% emphasized the demand for treatments with extended durability.
The focus of this year’s symposium centered on that challenge. “We need drugs that can be used as an extended treatment regimen,” Prof. Sivaprasad emphasized. And so, the pursuit of longer-lasting solutions continues to be at the forefront of AMD treatment innovation.
Bispecifics and higher doses
The dual mechanism of action of certain anti-VEGFs, and higher dosing, could make medications more durable. Prof. Sivaprasad highlighted faricimab, a bispecific monoclonal antibody that inhibits both VEGF-A and angiopoietin-2 (Ang-2), stabilizing blood vessels and reducing inflammation. The TENAYA and LUCERNE trials demonstrated the durability of faricimab, with nearly 80% of patients achieving at least 12-week dosing by year two.1
Citing the real-world extension of faricimab injection intervals from four to seven weeks in a study with highburden patients, Prof. Sivaprasad noted, “This is the most difficult group of patients to treat, so that’s really remarkable that we have proven durability in the real world as well.”2
She also discussed aflibercept 8mg, which delivers a higher molar dose for extended VEGF suppression. The PULSAR study revealed that 80% of aflibercept-treated patients could maintain 12-week intervals.3
All about delivery
Sustained drug delivery strategies also have the potential to reduce treatment burden. Dr. Nancy Holekamp(USA) showcased a slew of exciting developments in this sector, such as the DutaFab (Dutalys; Vienna, Austria) implant. “It’s very small, and the idea is you can pack a lot of it into this drug delivery implant,” she noted. “Clinical trials are exploring refilling the implant every 12 months.”
Another notable advancement is suprachoroidal injections, such as CLS-AX (Clearside Biomedical; Georgia, USA), which delivers tyrosine kinase inhibitors (TKIs). This officebased injection is designed for six to nine months of durability.
Additionally, gene therapy continues to hold promise. ABBV-RGX-314 (AbbVie; Illinois, USA) gene therapy, delivered subretinally, has shown early success in reducing injection frequency, offering patients a potentially longerlasting treatment option.
Genetic medicine
Dr. Arshad M. Khanani (USA) started off his lecture by explaining, “This is not a gene replacement therapy. This is a biofactory approach to express a gene for an anti-VEGF in order to address the unmet need of durability.”
He presented, for the first time, the extended results of the 4D-150 (4DMT; California, USA) PRISM clinical trial. This intravitreal genetic medicine uses an optimized vector to penetrate the
internal limiting membrane (ILM) and transduce all layers of the retina.
The results showed that 70% of patients remained injection-free at over 52-week follow-up using a KaplanMeier estimate. Sustainability was seen in terms of anatomic control as well as visual acuity gains.
Ray of light
Stereotactic radiotherapy (SRT) is an outpatient-based therapy which delivers 60 rays in a single 15-minute session, targeting the macula with three overlapping beams. Prof. Timothy Jackson (United Kingdom) investigated the use of SRT for neovascular AMD in a pivotal, noncommercial, randomized, doublemasked and sham-controlled trial.
The results were promising. “The radiotherapy group had 10.7 injections, the sham group had 13,” Prof. Jackson noted, which translated to a 22% reduction in anti-VEGF injections. However, while the reduction was significant, the visual acuity outcomes were comparable between the groups, with minimal differences reported.4
Safety was a key focus, with Prof. Jackson explaining that the study monitored adverse events, including microvascular abnormalities. Interestingly, “those who had microvascular abnormalities actually spent very little time in the hospital,” he remarked, highlighting an unexpected finding.
As the trial continues into its third and fourth years, more long-term data will shed light on SRT’s efficacy for neovascular AMD.
References
More unmet needs
While reducing the injection burden is a critical goal in treating neovascular AMD, it is far from the only unmet need, as highlighted in the Q&A session. Dr. Holekamp urged caution, explaining, “I don’t want to give the impression that reducing the injection burden is going to reduce the total burden because these patients still need to be monitored.”
Even with long-term drug delivery systems, frequent monitoring remains essential, especially since many patients experience other eye health issues. Dr. Holekamp pointed to a potential solution on the horizon, “The Home OCT just got FDA approval in the United States… home monitoring may be a very good pairing for these long-term drug delivery systems.”
Prof. Anat Loewenstein, serving as the session’s moderator, shifted the focus to another key challenge: improving visual acuity. “I think the other unmet need is the unmet need of better final visual acuity,” she stated, asking panelists what innovations we might see at EURETINA 2025.
Prof. Jackson added to her statement, emphasizing the need for bolder approaches. “Virtually every other trial is looking at non-inferiority in terms of visual acuity,” he noted, except for the OPT-302 (Opthea; South Yarra, Australia) trials. He advocated for braver exploration of new technologies that could not only reduce injections but also improve patients’ vision—an outcome that remains elusive in current AMD treatment paradigms.
1. Khanani AM, Kotecha A, Chang A, et al. TENAYA and LUCERNE: Two-year results from the Phase 3 neovascular age-related macular degeneration trials of faricimab with treat-and-extend dosing in year 2. Ophthalmology. 2024;131(8):914-926.
2. Sim SY, Chalkiadaki E, Koutsocheras G, et al. Real-world 1-year outcomes of treatment-intensive neovascular age-related macular degeneration switched to faricimab. Ophthalmol Retina. 2024:S2468-6530(24)00355-5.
3. Lanzetta P, Korobelnik JF, Heier JS, et al. Intravitreal aflibercept 8 mg in neovascular age-related macular degeneration (PULSAR): 48-week results from a randomised, double-masked, noninferiority, phase 3 trial. Lancet. 2024;403(10432)1141-1152.
4. Jackson TL, Desai R, Wafa HA, et al. Stereotactic radiotherapy for neovascular age-related macular degeneration (STAR): a pivotal, randomised, double-masked, sham-controlled device trial. Lancet. 2024;404(10447):44-54.
Advances in Ocular Imaging
Highlights of the
International Retinal Imaging society (IntRIS) Symposium at EURETINA 2024
by Tan Sher Lynn
Day 1 of the 24th Congress of the European Society of Retina Specialists (EURETINA 2024) kicked off with a showcase of cutting-edge imaging technologies, offering new insights into retinal disease management.
Recent advancements in imaging technology have revolutionized the management of retinal diseases. According to Prof. Tien Y. Wong (China & Singapore), artificial intelligence (AI) in retinal imaging currently encompasses the detection and screening of retinal diseases, ranging from common, single diseases (e.g., diabetic retinopathy and agerelated macular degeneration) to multiple diseases, including rare
eye conditions (e.g., inherited retinal diseases, myopic macular degeneration). AI is also used in integrated image-language models for retinal disease management, utilizing retinal images to screen for systemic diseases, detecting specific retinal features, providing decision support for treatment, predicting prognosis and treatment outcomes and monitoring risks.
“There have been significant advancements in AI for medicine, starting with deep learning and now with generative AI and large language models (e.g., ChatGPT), as well as foundational models (FMs). The most progress in AI in ophthalmology has been made in retinal imaging, particularly in color fundus photography (CFP) and optical coherence tomography (OCT) for the detection, screening and prediction of common retinal diseases,” he said.
He noted that future progress will need to address clinical implementation and adoption challenges, such as patient and physician trust, randomized controlled trials (RCTs), clinical process integration and change, financial models, ethical and legal issues, and many other ‘non-technical’ concerns.
Assessing blood flow in retinal microaneurysms with OCTA VISTA
Retinal microaneurysm (MA) is often the earliest clinically visible sign of diabetic retinopathy (DR). Monitoring the local blood flow speed within MAs could provide valuable insights into changes occurring within them. A reduction in blood flow speed is
linked to fluid accumulation in the retinal inner layers surrounding MAs, according to Dr. Nadia Waheed (USA).
Dr. Waheed and colleagues did a study to quantify the blood flow speed of retinal vasculature using OCT angiography with variable interscan time analysis (VISTA).
“Our study found no relationship between blood flow speed and the volume of MAs. However, MAs with low intraluminal reflectivity had faster blood flow speeds than those with medium and high intraluminal reflectivity. MAs with low and homogeneous reflectivity exhibited faster blood flow speeds than other MAs. VISTA OCTA with 3D masking is useful for assessing the blood flow speed of MAs over a multi-mm field of view in DR patients,” she said.
Unveiling function and structure in AMD with adaptive optics
Prof. Dr. med. Frank G. Holz (Germany) discussed advancements in understanding the structure-function relationship in age-related macular degeneration (AMD) through enhanced imaging techniques. He highlighted the need for more granular assessments beyond conventional methods like
perimetry, introducing adaptive optics scanning laser ophthalmoscopy (AO-SLO) as a tool for precise retinal imaging and psychophysical testing.
Prof. Holz explained how this technology allows detailed observation of photoreceptor mosaics and retinal sensitivity in precursor lesions, such as incomplete retinal pigment epithelial and outer retinal atrophy (i-RORA), and complete RPE and outer retinal atrophy (C-RORA). His study showed significant differences in retinal sensitivity between affected and control areas, with implications for early intervention and trial design. He also noted challenges such as fixation stability and limitations in current testing methods.
“SLO-imaging allows detailed visualization of abnormal photoreceptor morphology in intermediate and early stages of AMD. There are significant spatially resolved functional impairment at iRORA and cRORA lesions compared to in-eye control lesions. And we have small scale functional testing with fine retinotopic precision,” he concluded.
New insights into polypoidal lesions via multimodal imaging
Meanwhile, Prof. Gemmy Cheung (Singapore) discussed how advances in multimodal imaging have enhanced our ability to resolve details within polypoidal lesions. She highlighted that while ICGA shows pooling within the ‘bulge’ indicating a lumen, recent OCTA observations reveal a complex internal architecture within the bulge, suggesting a need for clearer definitions of ‘dilatation’ in the literature.
“With the PLEX Elite SS-OCTA, we achieve higher resolution and magnification, allowing for precise separation of polypoidal lesions from the surrounding vascular network. This technology also enables 3D reconstruction, offering detailed views from multiple angles. Unlike ICGA, which displays a simple bulge, OCTA provides a more intricate view of the structure within the polypoidal lesion,” she said.
She explained that while ICGA presents a flat X-Y axis view with a bulge, OCT provides some depth. With 3D imaging, the polypoidal lesion is now understood as a complex network of vascular coils with smaller dilatations, rather than a simple lump.
“These recent findings have prompted us to reassess the structure of polypoidal lesions and how our understanding of them is evolving with technological advancements,” Prof. Cheung concluded.
New insights from pathology to clinic in AMD
Last but not least, Dr. Christine Curcio’s (USA) talk explored the integration of histology and eyetracked OCT to better understand the cellular-level progression of AMD. She highlighted that drusen, the primary intraocular risk factor for AMD, are linked to both geographic atrophy and type 3 macular neovascularization (MNV), involving hypoxia and metabolic insufficiency. Histology provides a high-resolution snapshot, while eye-tracked OCT offers a dynamic view of drusenoid pigment epithelial detachments (PEDs) and their progression.
Dr. Curcio noted that while histology shows a static view, OCT’s continuous imaging reveals changes over time, allowing for a more detailed analysis of the drusen and associated atrophy. She explained that drusen growth is linked to the impaired transit of lipoproteins and subsequent collapse due to retinal pigment epithelium (RPE) dysfunction. Recent findings suggest that as drusen collapses, RPE cells are displaced, leading to atrophy, which OCT now shows in greater detail. “Perhaps we should consider targeting drusen biology for prevention or early intervention,” she said.
Dr. Curcio emphasized that a combination of high-resolution histology and dynamic OCT imaging enables a deeper understanding of AMD progression, highlighting the importance of integrating these methods for improved diagnostic and therapeutic strategies
