To Treat Or Not To Treat… Amir Hadayer, M.D. University of Louisville School of Medicine Department of Ophthalmology & Visual Sciences November 2015 1

Presentation CC: Blurry vision OS for over 1 year HPI: 70 year old man presented with decrease VA OS for over 1 year. He was diagnosed with BRVO and CME OS and underwent intraocular injections with Eylea and Ozurdex.

History POHx: mild cataracts PMHx: arthritis, hip replacement, hearing loss Meds: aspirin, steroid cream, multivitamins NKDA

Ophthalmic Exam 20/20 BCVA 20/100 Full VF Intact EOM 3 mm Pupils 16 IOP 19

CME, telangiectatic vessels, HE’s Ophthalmic Exam Intact L/L Quiet Conjunctiva Clear Cornea D&Q A/C Iris 1-2+NS, 1+CC Lens 1-2+NS WNL Fundus CME, telangiectatic vessels, HE’s

FA + ICG 2/2015

FA + ICG 2/2015

OCT OD

2/2015 Eylea 4/2015 Ozurdex 5/2015 8/2015 6/2015

Date BCVA OS 2/2015 20/100 4/2015 20/160 5/2015 6/2015 8/2015 20/125

Assessment / Plan 70 M, s/p BRVO OS. S/p 4 intravitreal injections. VA is stable. OCT shows CME. Observe vs. inject?

Discussion OCT stratus became available in clinical practice in 2002 Revolutionized diagnosis and treatment plans Questions for discussion: Is a dryer macula healthier? What is our “dryness” target? Cysts vs. edema

BRAVO

BRAVO > 15 Letters Gain 0.5 Lucentis 0.3 Lucentis Sham 6 months 61% 55% 29% 12 months 60% 56% 44%

VIBRANT

VIBRANT

GENEVA

GENEVA

Less than Monthly Treatments Indirect evidence from DME and AMD With fewer injections VA improves less This effect may be irreversible

Discussion OCT stratus became available in clinical practice in 2002 Revolutionized diagnosis and treatment plans Questions for discussion: Is a dryer macula healthier? What is our “dryness” target? Cysts vs. edema

Thank you