PIE POST (Virtual ASRS 2020 Edition) - DAY 1

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ISSUE

posterior segment • innovation • enlightenment

07 | 24 | 20

PIE M A G A ZINE ’ S D A ILY CONGR E S S NE W S ON T HE P O S T E RIOR S E GME N T

ASRS 2020 Virtual

HIGHLIGHTS monitoring of 04 Remote AMD patients is needed more than ever...

Bringing the World of Retina to You

how ophthalmic 06 See companies like AbbVie

by Hazlin Hassan

are taking advantage of telemedicine tech in the wake of the pandemic. delegates, don’t 10 ASRS you all wish you were in Seattle this weekend?

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Seattle, Washington … wish we were here!

W

elcome to the American Society of Retina Specialists virtual 38th Annual Scientific Meeting (ASRS 2020)! Held — for the first time — right where you are (be it in the living room, backyard or office), all the latest retina updates are streaming live from July 24 to 26.

The new virtual meeting is a result of continued public safety concerns related to COVID-19.

As such, the ASRS Board of Directors made the difficult decision to move the meeting from Seattle, Washington to the Internet. But fret not — it will now take place virtually.

“The saying ‘extraordinary times call for extraordinary measures’ has certainly taken on renewed meaning in recent months, and the American Society of Retina Specialists has responded by assembling a truly extraordinary virtual meeting for you this July,” said Dr. Philip Ferrone, program chair of the 38th ASRS Virtual Annual Meeting.

The largest retina organization in the world, the ASRS has more than 3,000 members in all 50 U.S. states and 63 countries.

This year’s meeting will offer unparalleled coverage of today’s most compelling developments in retina

science, clinical information and thought leadership, said Dr. Ferrone.

There are 136 abstracts and companion recorded podium talks available Cont. on Page 3 >>

DEFINITION

silhou* noun

An anticipated “hello” that does not occur when one attempts to say hi to a virtual attendee’s faceless silhouette and receives no reply. #digitalexpos *New virtual conference definitions,

by Media MICE

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24 July 2020 | Issue #1

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PIE magazine’s Daily Congress News on the Posterior Segment

>> Cont. from Page 1

online prior to the live meeting panel discussions, which participants can access starting July 24.

In addition, participants will also have access to a rich array of papers-ondemand, films and posters to peruse at their leisure —plus, the conference platform will remain open for 100 days after the meeting closes.

The live meeting platform will also house the meeting’s Virtual Exhibit Hall, showcasing new products and innovations in retina. This will also remain open for 100 days following the event.

Some of the many fascinating highlights of the ASRS include symposia on topics like retinal cell therapies and updates in artificial intelligence (AI), augmented reality and robotics.

There are many other exciting sessions lined up for delegates, presenting the latest data and research on topics such as inflammatory and infectious diseases; retinal vascular disease; advanced retinal imaging; hereditary retinal diseases and genetics; pediatric retina; surgical techniques; treatments for diabetic retinopathy; retinal detachment; ocular oncology; and many more. Strategies on how to manage socioeconomic issues will also be shared during the meeting.

Here is a sneak peek at some of the key events of ASRS 2020:

Day 1: Friday, July 24 Retinal Cell Therapies Symposium This session will feature presentations by Steven Becker, Ph.D., on “New Imaging Modalities for Monitoring Retinal Diseases” and Russell Van Gelder, M.D., Ph.D., on “Barriers Facing Cell Replacement Therapies.”

Technology Symposium: Updates in Artificial Intelligence (AI), Augmented Reality and Robotics Speakers include Linda Lam, M.D., who will talk about the “Augmented Reality Device Oculenz — Role in Improving Functional Vision in Patients with AgeRelated Macular Degeneration” and Aaron Lee, M.D., who will speak on

With all conferences turning virtual... make sure your mobile devices are powered and running!

“Multicenter, Head-to-Head, Real-world Validation Study of Artificial Intelligence Diabetic Retinopathy Screening Systems.”

Day 2: Saturday, July 25 Diabetic Retinopathy Symposium 1 This symposium will feature a presentation by Dante Pieramici, M.D., on “Five-Year Outcomes After Initial Aflibercept, Bevacizumab or Ranibizumab Treatment for Diabetic Macular Edema (Protocol T)” and “Incidence of New Diabetic Macular Edema in Fellow Eyes of Patients in the VISTA and VIVID Studies” by Sumit Sharma, M.D., among others.

Pediatric Retina, ROP Symposium 1 Delve into interesting topics including “Retinopathy of Prematurity Screening Using a Novel Method of Advanced Image Processing” and “Deep Machine Learning” by Omar Punjabi, M.D. and “Results of Perimetry at Age of 10 Years in Severe ROP Eyes Receiving Laser or Anti-VEGF Treatment as Primary Monotherapy” by Alay Banker, M.D.

Day 3: Sunday, July 26 Wet-AMD Symposium 1 This session will see “Primary Analysis Results of the Phase 3 Archway Trial of the Port Delivery System with Ranibizumab (PDS) For Patients with Neovascular AMD” delivered by Peter Campochiaro, M.D. and “Intravitreal Gene Therapy for Neovascular AMD with ADVM-022: Results of the Phase 1 OPTIC Trial” presented by Charles Wykoff, M.D., Ph.D., along with other groundbreaking insights.

Wet-AMD Symposium 2 Discussions during this meeting include “RGX-314 for Neovascular AMD: Ongoing Phase I/IIa Results for Cohorts 1-5” by Arshad Khanani, M.D., and “Number of Injections and Time to Dry Analysis of Brolucizumab Versus Aflibercept in Patients with Neovascular AMD: 96-week Data From HAWK and HARRIER,” by Carl Regillo, M.D. And that’s just a snippet of what to expect — so, be sure not to miss out. See you at the virtual annual meeting!

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Saving Sight with Remote Monitoring

by Brooke Herron

T

he COVID-19 pandemic has encouraged ophthalmologists and industry professionals to be more technologically savvy than ever before. This means remote monitoring has become an increasingly attractive option for retinal disease monitoring when in-office visits are not permitted.

Of course, there can be a learning curve when introducing any new technology or resources.

Therefore, to help vitreoretinal surgeons get a better understanding of remote monitoring (during the pandemic and beyond), the Intravitreal Expert Group (IVEG) recently held a webcast featuring tips from six international retina KOLs.

Who benefits from remote monitoring?

Short answer: Just about everyone.

Patients make fewer in-office visits, but have confidence that their disease is monitored. Physicians are alerted and see patients when changes occur.

Additionally, the overall burden is lessened on society when vision loss is prevented, resulting in better quality of life and fewer potential (costly) treatments.

However, like with any new technology, there are some barriers to overcome.

These involve aspects like cost, efficacy (sensitivity and specificity), security, liability, lack of familiarity, lack of infrastructure and patient usability, to name a few. However, as the panel of experts explained, these challenges are

outweighed by the benefits of remote monitoring — and that’s saving sight and stopping disease progression.

The panelists agreed that remote monitoring benefits patients with chronic disease like age-related macular degeneration (AMD) the most.

“With AMD, when you get vision loss, it’s irreversible. So, our treatments need to be proactive and we need to treat before the disease progresses,” said Jordi Monés, MD, PhD, director, Institut de la Màcula, Barcelona, and director and founder of the Barcelona Macula Foundation, Spain. “This kind of monitoring will save sight because we

will anticipate recurrences earlier and patients will go to the office when there are subtle changes — before they’ve noticed changes in vision.”

He continued: “For diabetics, it’s not that crucial because DME (diabetic macular edema) is a bit reversible, so if you lose a bit of vision you can recover it, but for wet AMD it is essential not to lose vision.”

Real-world results In the United States, Nancy Holekamp, MD, director of retina services at Center for Macular Degeneration Pepose Vision

PIE magazine’s Daily Congress News on the Posterior Segment

Institute in Chesterfield, Missouri, said that the ForeseeHome AMD Monitoring Program (Notal Vision, Virginia, USA) is FDA-cleared for the early detection of wet AMD. “I have quite a few patients on ForeseeHome, but one key point is that it’s validated for patients who have never had wet AMD — so, it’s not being currently used for following active disease management in AMD,” she explained. “So, I have patients with bilateral high-risk macular drusen on the ForeseeHome and we’re looking for that earliest conversion to wet macular degeneration.”

So, how does it work in the U.S.? Dr. Holekamp said that since it’s a device, she writes a prescription. It hooks up to a cell modem and patients are asked to monitor 5 of 7 days. That data goes to a central monitoring site, called the Notal Vision Diagnostic Center, and then she is notified if an alert (or change) occurs. At that point, the patient is scheduled for an in-office visit.

at Royal Victoria Hospital and Queens University of Belfast, Northern Ireland, U.K., said she’s most excited about the development of home OCT. “Without a doubt, it has to be home OCT because that’s ideal for more than one particular type of patient,” said Dr. Chakravarthy. “You can extend it to a variety of patients, even within the AMD population.”

So, which markers of disease progression should home OCT target? The panelists agreed that an increase in fluid is a key factor — although any subtle change means a patient should come in.

“Basically, any change in a retina that is supposed to be stable is something unusual… and any change means that the patient should come in and be checked,” said Ramin Tadayoni, MD, PhD, chairman and professor of ophthalmology at the University of Paris, France.

Dr. Holekamp agreed: “It’s a changemeter: I know if there is any change

there could be trouble, and that change is most likely an increase in fluid.

“For me, personally, I want to know which compartment the fluid is in and I think intraretinal fluid is the most damaging to vision,” she continued. “So, if I see the patient has fluid, then that’s the patient I want to see right away. And that’s the patient where I might have the most impact with a prompt anti-VEGF injection.”

Dr. Ho is also encouraged by home OCT: “It has amazing capabilities and we’ve seen them — we’ve had our own eyes scanned and the detailed resolution is similar to the big box, benchmark OCT in our offices. With those technologic capabilities, you’re looking for change, subtle changes, compartments, and these home devices have these capabilities.”

Clearly, the COVID-19 pandemic has thrust the ophthalmic community into a virtual world (some of us kicking and screaming) — but we’re here now … and it’s time to make the most of it.

According to Allen Ho, MD, director of retina research at Wills Eye Hospital and professor of ophthalmology at Thomas Jefferson University School of Medicine, Philadelphia, U.S., the Foresee Home is also a way to maintain a connection with his patients.

“I’m not looking at reports every day, it’s AI-enabled and a cloud-based diagnostic system. Importantly, if there is a discrepancy in a patient that is using this routinely, the system is closing the loop by notifying the patient and notifying the practice,” shared Dr. Ho. In a world with limited resources, he said that he would prescribe remote monitoring to those at greatest risk, for example, patients already receiving injections in their fellow eye. “The indications are almost better for those with dry AMD in both eyes because you want to see them less frequently, but you also want to monitor them,” he shared.

“If you start with better vision, like every study has shown, that invariably, you do better over time.”

Excitement over home OCT Regarding home monitoring devices, Usha Chakravarthy, MD, PhD, professor of ophthalmology and vision science

Remote monitoring must be user-friendly to be effective.

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Ophthalmology Should Bite into the “Big Mac” of Knowledge

by Andrew Sweeney

D

o you know why McDonald’s grew to become the most quintessential fast food brand in the world? Let’s be honest, it’s not because their burgers and chicken nuggets taste the best (though we admit there’s no accounting for taste). It’s because the company’s founders were willing to experiment with new ideas and take risks.

This is the attitude the ophthalmology industry needs to adopt in the wake of the coronavirus pandemic. McDonald’s may have pioneered the drive-thru for fast food, but we are increasingly witnessing its utilization in an unforeseen way. Drive-thru coronavirus testing facilities, where individuals can be tested safely for coronavirus while adhering to social distancing rules, are popping up all over the world. This is a concept that ophthalmology is increasingly likely to adopt.

Craving ophthalmological chicken nuggets

and a number of other medical fields, including oncology.

Over the course of the pandemic we have frequently written about the advantages of telemedicine. It may sound odd, but distanced drive-thru treatment falls under that banner. Allowing patients to be treated safely, under social distancing conditions, is one way how the ophthalmic industry could continue to develop.

Mr. Galloway believes ophthalmological companies will increasingly need to optimize their ophthalmic workflow.

Using drive-thru style treatment facilities is just the tip of the proverbial vanilla shake; every aspect of ophthalmic practice should be considered. All of this requires original thinking and determination.

This was discussed in a video call between PIE magazine CEO Matt Young and Craig Galloway, associate director of retina services in the global eyecare marketing division of AbbVie.

“In the U.K., you can drive up, get a temperature check and then you’re out the other side, one in and one out.

Then the location is wiped down and disinfected. There are certain clinics on the south coast in the U.K. which are billed as a drive-thru clinic, that’s where everyone’s mind is going to go,” shared Mr. Galloway.

A large, multinational pharmaceutical company founded in Los Angeles, California, USA, AbbVie produces a wide variety of products for ophthalmology

PIE magazine’s Daily Congress News on the Posterior Segment

“It’s a good idea because we have completely new challenges for clinics and how to efficiently maximize appointments. If you’re trying to get 30 or 40 people to visit in a day to have an injection, you will face challenges and backlogs,” he added.

Britain versus the USA (Round Two) Mr. Galloway expanded on the British theme by pointing to ongoing work at Moorfields Eye Hospital (London, U.K.).

One of the most famous ophthalmology facilities in the world, the hospital is well-regarded for its innovation. To Mr. Galloway, the hospital represents why the United Kingdom is performing well — by embracing new techniques — in comparison with the United States.

“There’s a really exciting space at Moorfields Eye Hospital in the U.K. where they have an innovation floor — they actually study optimal workflows and how to implement them. Moorfields is doing a lot to connect this with the community at large,” Mr. Galloway said.

“In the U.S., on the other hand, there are very clear rules on what platforms you could and couldn’t use because of the cameras’ resolution and other related features,” he added.

the diagnosis straight away and receives the first treatment in an hour’s time, and then they go home. So essentially, you’ve combined two appointments into one ... no wonder we’re seeing more of that.”

The coronavirus pandemic represents an opportunity for a clean break — one where formally clear and rigid rules can be replaced or rewritten. This applies to ophthalmic businesses and practices across the world, including the U.S. and the U.K. Mr. Galloway believes a good example of this trend is how patient processing is managed, especially for tests and scans.

Certainly, we look forward to seeing how companies like AbbVie continue to contribute to the ophthalmic market, as well as the other new best practices emerging in the industry.

He reports that all clinicians are going to have to think more intelligently about machine placement and testing locations. The McDonald’s style drivethru treatment stations are a good example, but more needs to be done.

The industry needs to learn from some of the new best practices.

“There are a number of clinics now that are combining diagnosis with primary stage treatment,” continued Mr. Galloway. “With OCT, the patient gets

Editor’s Note: The American Society of Retina Specialists virtual 38th Annual Scientific Meeting (ASRS 2020) held online from July 24 to 26 will showcase some of these best practices. Keep your eyes peeled for some tasty news packages coming your way from the Media MICE team and PIE magazine.

INDUSTRY UPDATE

Alcon Showcases Latest Innovations at ASRS 2020

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lobal eye care leader Alcon will present key data and the latest product updates at the American Society of Retina Specialists virtual 38th Annual Scientific Meeting (ASRS 2020). This includes new data on the HYPERVIT® Dual Blade Vitrectomy Probe; the latest updates to the NGENUITY® 3D Visualization System; as well as COVID-19 resources and additional retina research.

These updates will be covered during both poster presentations and at Alcon’s virtual booth at ASRS 2020.

New Data on the HYPERVIT Dual Blade Vitrectomy Probe New data presented at ASRS 2020, highlights the performance benefits of HYPERVIT, including reduced pulsatile motion and more effective cutting, which enhances stability and control during microincision vitrectomy.

One upcoming poster presentation by Dr. Martin Charles looks at Dual Cutting 20,000cpm Probe Aspiration of Retained Lens Fragment. The data shows how the HYPERVIT 20,000 cpm probe may provide more continuous engagement, more effective cutting and less repulsion of both soft and hard cataracts than single-cutting 7,500cpm probes.

“During retina surgery, having a controlled workspace with minimal movement helps drive efficiency,” said Dr. Charles. “HYPERVIT enables me to get closer to the membrane right above the retina with a more stable movement, closer to the port and more precise pulsatile motion. In the study we are presenting at the meeting, the findings confirm the advanced performance of this probe and why it’s a more efficient option for retina surgery.”

Another poster — Analysis of Vitreous Motion During 25+Ga Dual Cutting 20,000 cpm Probe Aspiration — by Dr. Dina Abulon shows that HYPERVIT 20,000cpm probes may provide more optimal vitreous aspiration near the port than previous generation single-cutting probes, such as the ULTRAVIT® 10,000cpm probe.

New NGENUITY 1.4 improves workflow in the operating room Alcon is also set to launch the NGENUITY 1.4 upgrade at ASRS 2020. This includes color optimization and a streamlined DATAFUSION setup, and a unified CONSTELLATION workflow, which allows retina surgeons to track key surgical parameters in real-time during surgery.

This improvement to workflow, coupled with enhanced visualization, should allow surgeons more flexibility in operating room spacing and set up — especially now, during the COVID-19 pandemic.

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every 15 days, followed by 400μm every month for 4 months, to avoid proliferative vitreoretinopathy (PVR).

That slippery dislocated lens Dr. Oshima’s second case involved a patient with a dislocated lens and used some newer, fancier techniques. One was called “Barbeque Technique”, where he inserted forceps inside the crystalline lens and then removed the lens with the cutter. (He noted he used a 25-gauge sclerotome at 10,000 cuts per minute during this procedure.) Once the lens was removed, Dr. Oshima used the Yamane technique for the intrascleral fixation of the intraocular lens — a sight that participants agreed was spectacular to see.

Challenging Retinal Cases in Vitreoretinal Surgery

by Tan Sher Lynn

T

o provide optimal outcomes for patients, sharing knowledge and experience from challenging cases is of utmost importance for surgeons — especially when it comes to difficult vitreoretinal procedures. Therefore, during the RETINAWESOME III virtual meeting on June 20, retinal specialists congregated (albeit online) to share their valuable insight on treating conditions including macular holes, ocular trauma, retinal detachment, diabetic retinopathy (DR) and more...

Tricky retinal detachments The first case study presented by Keynote Speaker Dr. Yusuke Oshima (Japan) involved a junior high school student with Coat’s disease and retinal detachment. He explained the procedure, noting that the fibrosis and epiretinal membrane were removed from the retinal surface and an internal limiting membrane peel was performed.

Then, using a wide-angle vitrectomy viewing system, Dr. Oshima found an angioma in the posterior pole at the retinal periphery; he inserted a buckle (240 band) around the eye

for indentation and to support the retinal periphery. Following, laser and cryotherapy was used to treat the hemangioma. Dr. Oshima added that although perfluorocarbon and intraocular gas were used, silicone oil was not needed during this procedure.

Next, Dr. Marcelo Murillo Sasamoto (Bolivia) presented a case on pediatric retinal detachment which was treated by combining large radial retinotomy and circumferential retinectomy. “Nowadays, I call the technique ‘Tetris Retinectomy’ because it follows the form of the video game,” explained Dr. Sasamoto. “We start the surgery with keratotomy to see what’s going on with the retina. The edge of the retinal detachment is then treated to remain flat and ready to laser.”

The ‘Tetris’ technique is used to change tangential traction after post inflammatory retinectomy — this multidistribution of force vectors helps avoid a retinal redetachment. Dr. Sasamoto said that although this was a really tough case, it ended very well: Postoperatively, the patient received three intravitreal injections of methotrexate (1200μm)

Continuing the topic of dislocated IOLs, Dr. Gustavo Huning (Brazil) discussed the scleral pocket technique, which he learned from Dr.Theodoros Potamitis (Cyprus). He explained that in this technique, “trocars are inserted through these pockets and then I did an anterior vitrectomy. The haptics are released under the pockets because they are safe — and doing so made the haptics more stable. We then suture the pockets to close them.”

To determine the distance between the limbus and IOL he shared: “I decided that the conjunctiva is the region where I will do the pocket. The inserting plane is 4mm from the limbus and I enter the pars plana 2mm from the limbus. The total length of the pocket is 2mm.”

On persistent fetal vasculature Zeroing in on pediatric eyes was Dr. Yoshihiro Yonekawa (USA). His case detailed a 23-gauge plaque dissection of anterior persistent fetal vasculature in a 2-week old boy (who was referred for leukocoria). When he looked into the eye, there was a massive membrane and fibrotic tissue over the pupillary plane.

PIE magazine’s Daily Congress News on the Posterior Segment

To cut through the thick membrane, an MBR blade was used to create the initial plane; scissors were later employed when the cutter was not able to penetrate the solid mass. Dr. Yonekawa finished off the case with air and sutures. The patient was fitted with a fake contact lens and did well postoperatively, he reported.

“In children, the most important thing is to rule out retinoblastoma by taking a good B-scan, looking at the family history, and also the other eye,” said Dr. Yonekawa.

The future is now: Bionic eyes The artificial retinal implant, Argus II, was then discussed by Dr. Robert Devenyi (Canada) for its merits in treating patients who are blind due to retinitis pigmentosa (RP). To date, he has performed nearly 20 of these procedures, which helps restore functional vision in patients with degenerative eye disease.

He shared that surgeons need to use care when implanting the device: “There are 600 electrodes on the retinal prosthesis, so one has to be very careful not to use regular instruments as they will damage the electronics — only instruments with silicone tips can be used to handle the electronic components,” he explained, adding that the most stressful part of the surgery is that there is only one chance to affix the titanium tack to the central macula.

And although this procedure has the potential to advance and provide further visual enhancement for patients (including facial and color recognition), he said that the company was unable to do so at the present time as it was an expensive endeavor, with each implant costing $190,000.

Diving into macular holes Treating macular holes is often complicated. Indian ophthalmologist Dr. Vaibhav Sethi shared details from one case where he performed a macular ILM peel using triamcinolone to better visualize the posterior pole at the macula. To delineate the vitreomacular traction (VMT), he used diluted triamcinolone to stain the broad VMT. Cortical vitreous was trimmed around the VMT, thus avoiding anterior-posterior

traction. Then, a cleavage plane was made around the temporal part of the optic disc to release the VMT, which was stained with brilliant blue under fluid, and the ILM flap was created.

The next case from Dr. Saad Waheeb (Saudi Arabia) concerned a patient with focal exposure to a handheld laser, which caused a lesion at the macula.

During his presentation, he showed how he was able to detach the tough and adherent hyaloid. One month postoperatively, the patient’s vision was 20/40.

Ouch: Scleral ruptures Brazilian ophthalmologist Dr. André Jucá then relayed his insights from a case of scleral perforation (with chronic severe pain) in an eye with previous scleral buckle surgery. To identify these late and unusual complications of buckle surgery, he said, “This patient had buckle surgery done 10 years ago and was now complaining of pain, so we decided to remove the buckle,” he explained.

“We didn’t see any sign of infection, but when we removed the buckle, we discovered a big hole at the sclera.

We decided to cut it out and suture it.

Going through the images, we realized that there was a dark area in the center which I missed. In this area, there’s no sclera, just tendon and conjunctiva blocking everything. This is a sign to take note of that scleral rupture or necrosis may be present,” he concluded.

You don’t belong here, IOFBs Intraocular foriegn bodies (IOFBs) can cause all sorts of sight threatening complications.

One such case presented by Dr. Vasco Bravo (Brazil) involved a patient with eye trauma (iron in his eye), as well as associated cataract. This called for team work.

“Performing UBM (ultrasound biomicroscopy), we could see that the intraocular foreign body was very, very close to the wall and pars plana ... and anteriorly placed,” he said. Together with a cataract specialist colleague, they removed the cataract and IOFB using phacoemulsification, plus perfluorocarbon-assisted IOFB removal

with backflush help.

Dislocated IOLs can become their own worst nightmare (hello, IOFB).

Thankfully, Prof. Dr. Wai Ching Lam (Hong Kong) has been there before.

He described one such case where he performed a simple scleral technique to elegantly secure the IOL into the sulcus in a stable manner, using 10-0 prolene sutures.

“This is possible as the whole capsule is very intact and it holds up against the capsular retention ring. This is just one option of securing a dislocated intraocular lens implant — in this case, it happened to have a full capsule with some residual material, and a capsular retention ring,” he said. Dr. Lam added that to keep the IOL in place for suturing, his assistant used a cutter to hold the lens against the iris.

Finally, Dr. Hudson Nakamura (Brazil) showed a case of severe intraocular injury with IOFB from a gunshot wound. He used CT images, B-scans and postoperative retinography to show the foreign bodies and to provide the roadmap for surgery. Special forceps were used to remove the IOFBs, and when a retinal detachment was found, he used PFO to reattach it. Dr. Nakamura then used endolaser at the far periphery (under silicone oil) and noted that the patient had a good postoperative outcome.

As virtual meetings go, this was of course, a fruitful one. These challenging cases inspired discussion and learning, while showcasing the evolution of best practices and techniques … all to help improve and restore sight in these devastating vitreoretinal cases.

Editor’s Note: RETINAWESOME III, Challenging Retinal Cases in Vitreoretinal Surgery, was held on 20th June 2020 and was spearheaded by Dr. Hudson Nakamura of Brazil. Reporting for this story took place during RETINAWESOME III. Visit the RETINAWESOME YouTube Channel for more information and videos.

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Welcome to Being “Sleepless in Seattle”

by Joanna Lee

You’re not awake in Seattle if you haven’t had your coffee.”

What else could one expect from the city that is home to Starbucks and numerous other coffee joints? Perhaps a hot cuppa makes for a little warm pleasure whenever rain chooses to fall — which is often, at more than 156 days a year, and thus cementing Seattle’s wet reputation and nickname: “Rain City.”

This city is also a backdrop to popular cultural references like the Meg Ryan and Tom Hanks flick (Yes, that would be Sleepless in Seattle!).

Situated in the Pacific Northwest, Seattle is not only surrounded by water, but also by mountains (Cascades) and lush forests, lending to another nickname: the “Emerald City.”

Aside from spawning America’s 90’s grunge scene (say “hello, hello” to

Nirvana, Pearl Jam and Soundgarden) and tech companies and start-ups (Amazon, AirBnB, Microsoft, etc.), Seattle is also home to the American Society of Retina Specialists virtual 38th Annual Scientific Meeting (ASRS 2020).

Although this year unexpectedly saw ASRS 2020 going virtual, there’s still room to take a break and celebrate the uniqueness of this city. Here are some places of interest you must not miss if you ever get a chance to stop by Seattle.

Pike Place Market The world-famous market is really a bustling, colorful hive of activities comprising farmers, small businesses and the local community. It’s operated since 1907, making it the United State’s oldest public market. Catch a glimpse of the popular and entertaining fish-throwing men, pick up some fresh

produce or take a whiff of an assortment of flowers, as you wander around this historic market. Look out for Rachel the Pig, a life-sized piggy bank and drop some change to donate to the market’s social services program. JapaneseAmerican pre-war traders have also been commemorated in a mural above the market’s entrance. Plus, seafood restaurants are aplenty, so do go there hungry.

Space Needle It’s worth a thrilling visit to this icon if you’re ever in Seattle. This 605-ft. landmark offers a 360-degree view of the city including Mt. Rainier (amidst the Cascade mountain range), Puget Sound, the Olympic Mountains and other recognizable spots. The sight-seeing experience is unforgettable when viewing scenery through the all-glass floor on

PIE magazine’s Daily Congress News on the Posterior Segment

Homemade Seattle Style Hot Dog with Cream Cheese and Onions.

the lower level, as well as through the remarkable floor-to-ceiling glass on the upper level. That would be one sky-high selfie to remember.

Cool museums and art spaces Get up close to local legend Jimi Hendrix, pop music and sci-fi at the Museum of Pop Culture. Near the Space Needle is Seattle Art Museum’s Olympic Sculpture Park, ideal for a waterfront stroll amid the city’s greenery and modern art by contemporary artists. One should also not miss Chihuly Garden and Glass, as the stunning venue of glass art masterpieces and a legacy of Dale Chihuly’s glass craft — a bright spot in Seattle’s sullen skies, for sure. For thoughtful gems and well-curated art, visit the Frye Art Museum for a fulfilling time of artistic appreciation.

The Chihuly Garden and Glass exhibit illuminates the night as the world famous Space Needle towers above.

Take a tour of Seattle’s underground beneath the basements of Pioneer Square to learn about its colorful past.

If you need a sight for sore eyes, take the Elliott Bay Water Taxi ride from downtown to West Seattle to take in a fun overview of some of the gorgeous sights around Seattle. This is best done on a sunny day!

In highlighting these places, we wish for Seattle’s quick recovery from COVID-19. Many of its arts and cultural activities are still virtual, although some restaurants have reopened with social distancing policies in place.

Finally, take a bite of Seattle (with recipes) Speaking of food, even if we can’t be in Seattle right now, we figured there’s

A fish Monger at Pike Place Market catching a fish for tourists late in the day.

no better way to get a taste of Seattle than to take a bite of its gastronomical delights. Heard of the “Seattle dog?”

This classic consists of a smoky hot dog sausage with sautéed onions, cabbages … and get this — a slathering of cold, cream cheese! It’s easy to recreate in your kitchen with barbeque or brown sauce, mustard or Sriracha. (Add chips on the side and you’re good to go. Eat it while watching an ASRS virtual session, maybe?)

Another cool dish is Seattle teriyaki, a fusion dish of meat glazed in teriyaki sauce and testament to the city’’s Japanese-American influence and history.

Look online for a recipe from none other than the “godfather of Seattle teriyaki,” Toshihiro Kasahara.

Bon appetit!

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24 July 2020 | Issue #1

INDUSTRY UPDATE

Bausch + Lomb Introduces PINNACLE 360 at ASRS 2020

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eading global eye health company Bausch + Lomb (Bridgewater, New Jersey, USA) will introduce its PINNACLE 360™ 25-gauge Scleral Fixation Forceps at the American Society of Retina Specialists virtual 38th Annual Scientific Meeting (ASRS 2020).

The PINNACLE 360 Scleral Fixation Forceps were developed in conjunction with Arizona retina specialist Daniel Adelberg, M.D. These forceps aid in the placement of scleral-sutured posterior chamber intraocular lenses (IOLs), a procedure that has played an important role in the treatment of aphakic eyes without capsule support. “The PINNACLE 360 Scleral Fixation Forceps have allowed me to refine the technique necessary to execute challenging IOL fixation procedures,� said Dr. Adelberg. “I am proud to have partnered with the

Bausch + Lomb team to develop this new instrument, which delivers the same features and quality which I’ve come to rely on from this line, while filling a significant unmet need in my OR.�

Additionally, this instrument may be applicable for other surgeries in the anterior segment in the future, according to Dr. Adelberg. “The introduction of the PINNACLE 360 25-gauge Scleral Fixation Forceps is another example of our continued commitment to providing retinal surgeons with an extensive offering of precision instruments that feature unique benefits and play important roles in their surgical procedures,� added Chuck Hess, vice president and general manager, U.S. Surgical, Bausch + Lomb.

For more information, visit www. bauschretina.com.

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INDUSTRY UPDATE

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ILM Staining Dye, U.S. FDA Approved

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arlier this year, DORC (Exeter, New Jersey, USA) received approval from the U.S. Food and Drug Administration (FDA) for its New Drug Application for TissueBlueTM (or Brilliant Blue G Ophthalmic Solution) 0.025% — making it the first FDA-approved dye for use as an aid in ophthalmic surgery by selectively staining the internal limiting membrane (ILM).

TissueBlue (which is branded as ILM Blue in markets outside of the U.S.) selectively stains the internal limiting membrane (ILM) for more effective visualization and peeling. During surgery, the dye is injected onto the retinal surface, which clearly stains the ILM and makes it easy to distinguish from the unstained retina and thus, facilitates removal.

According to DORC, TissueBlue provides a safe and effective replacement to the compounded or off-label staining agents previously used in the U.S. In fact, TissueBlue uses pharmaceutical grade dye material — which offers a higher level of purity than lower-grade dyes, making this formulation unique in the U.S. Plus, the dye is available in a terminally sterilized, prefilled syringe for improved convenience, consistent formulation and to ensure sterile delivery to the eye.

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Indeed, American retina surgeons are looking forward to the benefits of TissueBlue.

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magazine posterior segment • innovation • enlightenment

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“FDA approval of TissueBlue is great for U.S. retina specialists who have longawaited an FDA- approved ILM dye that combines a very strong safety profile and excellent staining characteristics,� said John S. Pollack, M.D., a partner with Illinois Retina Associates in Chicago. “Adding to TissueBlue‘s appeal, is its low dispersion characteristic, associated with the addition of Polyethylene Glycol, and the convenience and added security of its packaging in a sterile, prefilled syringe. This is a very welcome development,� he continued.

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As mentioned by Dr. Pollack, TissueBlue contains Polyethylene Glycol.

This provides the density required by surgeons to ensure targeted application to the retina.

TissueBlue’s approval was a result of seven years of intensive work between DORC and the U.S. retina community, according to DORC International CEO Thierry Leclercq. “DORC is delighted to announce the approval of TissueBlue, a landmark product approval for the U.S. surgical retina market,� said Mr. Leclercq. “We are delighted to be meeting this unmet need of U.S. retina surgeons.�

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