Medical retina revolves primarily around imaging and pharmaceuticals. Fortunately, both spaces continue to evolve.
The Diabetic Retinopathy Severity Scale is a powerful tool for predicting worsening of diabetic retinopathy and correlating with visual function even in the absence of diabetic macular edema and proliferative disease.
However, quantitative data from optical coherence tomography angiography is proving to be a far better prognostic tool. On page 20, Steven S. Saraf, MD, and Kasra A. Rezaei, MD, discuss the value of OCTA in DR and make a strong case that it will fundamentally change how we classify and manage the disease.
OCTA affords tremendous opportunities to improve prognostication and inform our management decisions. However, current-generation commercial software, in my experience, is not yet adequate for widespread clinical application. I use OCTA regularly in research, but I have yet to incorporate it into the care of most of my clinic patients. I look forward to continued progress.
Anti-VEGF monotherapies have clearly set a high bar for managing exudative retinal diseases. Consistent dosing in the presence of ongoing exudation translates into remarkable visual and anatomic benefit at a population level. Nevertheless, efficacy and durability limitations exist. On page 16, our Clinical Conversation, using Diabetic Retinopathy Clinical Research Network Protocol U data as the backdrop, explores the value of corticosteroids in the management of DME.
Looking ahead, on page 31 we explore the retina pharmaceutical pipeline, which appears remarkably strong despite major failures in the last year.
To me, targeting angiopoietin-2 (Ang-2) appears particularly promising. At the Angiogenesis and Macula Society meetings in February, data from three Phase II trials evaluating combined VEGF-A and Ang-2 blockade were reported. Two DME trials, RUBY1 and BOULEVARD,2 reported that combined VEGF-A and Ang-2 blockade led to better anatomic outcomes and more robust improvements in DR severity than anti-VEGF-A monotherapy.
Furthermore, the Phase II BOULEVARD trial met its primary endpoint showing efficacy of combined VEGF-A/Ang-2 blockade, leading to significantly more visual gain through six months. Certainly, more data is needed. I look forward to the Phase III trials.
1. Brown D. Ang2 inhibition combined with anti-VEGF suppression (aflibercept) in diabetic macular edema. Paper Presented at Angiogenesis, Exudation and Degeneration; February 10, 2018; Miami, Florida.
2. Dugel P. Anti-VEGF/anti-angiopoietin-2 bispecific antibody RG7716 in diabetic macular edema: results from the Phase 2 BOULEVARD clinical trial. Paper Presented at Angiogenesis, Exudation and Degeneration; February 10, 2018; Miami, Florida.