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

2. 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.

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

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

5. 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

6. FA + ICG 2/2015

7. FA + ICG 2/2015

8. OCT OD

9. 2/2015
Eylea
4/2015
Ozurdex
5/2015
8/2015
6/2015

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

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

12. 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

13. BRAVO

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

15. VIBRANT

16. VIBRANT

17. GENEVA

18. GENEVA

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

20. 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

21. Thank you