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    Review of the year 2013: Retina 2013

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    Prof. Dr Albert J. Augustin
    2013 has been an important year in retina therapy, with increased information released on nutritional supplements for AMD patients, widened indications for anti-VEGFs and the approval of treatment for symptomatic vitreomacular adhesion (sVMA). However, there was not really significant changes for surgery.

    So, to evaluate the year thoroughly we have spoken with Professor Albert Augustin and Professor Einar Stefánsson to see what they believe have been exciting opportunities and what has proved challenging for them. They also offer up their thoughts on what should be big news in 2014.

    Opportunities and challenges of the year

    Anti-VEGFs


    Professor Einar Stefánsson, MD, PhD
    With an ageing population the numbers of patients requiring treatment for age-related degenerative diseases (such as AMD) are rising and challenging practices worldwide. "The ever increasing number of intravitreal injections is the greatest challenge for my department," highlighted Prof. Stefánsson. "This is putting the operating rooms under stress reducing the number of cataract operations and placing a great load on both OP and clinics."

    However, the addition of aflibercept (Eylea/formerly VEGF Trap-eye, Bayer Healthcare, Leverkusen, Germany) has been an exciting opportunity for Prof. Stefánsson who states that this option will possibly allow for a reduction in the injection frequency. "Perhaps the biggest opportunity of the year lies with aflibercept, which allows significant reduction in the frequency of intravitreal injections for exudative AMD," he said. "I am excited about the possibilities with this new therapy and look forward to more options for combination treatments for macular diseases."

    Prof. Augustin stressed the importance of the increased indications for these therapeutic options, which now span from AMD to DME, RVO and myopic CNV. "Indications for anti-VEGF treatments have widened a lot recently. In addition, inflammation has been identified as being an important player in many diseases such as DME, AMD and RVO," said Prof. Augustin. "This may lead us away from monotherapy to combination strategies."

    He was, however, a little less certain of the benefits of aflibercept. "Switchers from one drug to another are currently being evaluated. However, we still do not know if aflibercept is the more powerful option as a result of the blocking of an additional cytokine," added Prof. Augustin. "In summary, retinal therapy is moving to more durable approaches. Besides that individualized therapies based on a genetic evaluation are coming up!"

    Nutritional therapy

    The AREDS2 clinical results were eagerly anticipated at the beginning of this year as the long-term efficacy of the adpated AREDS formulation was revealed. These results demonstrated that adding lutein and zeaxanthin while eliminating beta-carotene was efficacious and safe, however, the role of zinc was unclear.

    "The long-term use of AREDS supplements appears safe and protective against advanced AMD," asserted Prof. Augustin. "Omega-3-fatty acids and beta-carotene clearly do not reduce the risk of progression to advanced AMD, and furthermore, the validity of zinc remains unclear. However, adding lutein and zeaxanthin in place of beta-carotene may further improve the formulation."

    Prof. Stefánsson agreed with the findings stating that he advises his patients following the guidelines laid out by the clinical studies. "The main principles of the benefits of these nutritional supplements seem to hold true," he said.

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    Professor Albert J. Augustin

    Professor Albert J. Augustin, MD is Professor and Chairman of the Department of Ophthalmology, Klinikum Karlsruhe, Karlsruhe, ...

    Professor Einar Stefansson
    Einar Stefánsson MD PhD is Professor of Ophthalmology and Faculty Chair at the Department of Ophthalmology, University of Iceland, ...

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