Epimacular Brachytherapy: New Advancements in the Treatment of Retinal Disease

Epimacular Brachytherapy:
New Advancements in the Treatment of Retinal Disease
(Archived Webcast)
CME Overview

Activity Date: June 10, 2011

Expiration Date: June 10, 2012

Activity Location: Internet

Target Audience: Ophthalmologists
This activity is intended for ophthalmologists with an interest in epimacular brachytherapy and other cutting edge therapies in the treatment of retinal disease.

Accreditation
Lippincott Continuing Medical Education Institute, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation
Lippincott CME Institute, Inc., designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Commercial Support
This CME activity is supported in part by an educational grant from Neovista.

In-Kind Support
LCMEI received in-kind support from Retinal Physician magazine in the form of reduced advertising rates.

Statement of Need
AMD is the major cause of central vision loss and a leading cause of blindness in the elderly in the developed world.1 Over the past 6 years, multiple new diagnostic and therapeutic techniques have been developed that will significantly alter long-term visual outcomes in these patients.

Because of the rapidly changing advances in technology in the treatment and management of AMD and other retinal diseases, many retina specialists are unaware of the newly published and unpublished data. Many who are aware don't know how to evaluate the new findings and apply them to daily practice. Ophthalmologists need to learn how to evaluate these recent clinical trial results concerning innovative treatment options for AMD.

Fueling the developments of new treatment strategies in AMD is a greater understanding of its pathophysiology and genetic makeup. Currently, most retina specialists are administering anti-VEGF therapy to AMD patients as needed.2

Epimacular Brachytherapy
While intravitreal injections of anti-VEGF agents have been the standard of care for AMD, epimacular brachytherapy, or beta radiation, is showing greater promise. Like anti-VEGF therapy, beta radiation affects the abnormal blood vessels of wet AMD by slowing the development of new vessels and reducing inflammation, allowing the macula to return to its normal position. Unlike standard therapy with anti-VEGF agents, physicians perform beta radiation only once, and patients receive just two doses of an anti-VEGF drug instead of more frequent injections.3

Safety and Efficacy
In this CME activity, experts in the field of retinal disease will discuss the safety and efficacy of radiation therapy in the treatment of retinal disease; the radiation risk to the retina and other intraocular structures, such as the lens and optic nerve, as well as the risk to patients, ancillary staff, and doctors. Retina specialists will assess the current evidence regarding radiation retinopathy, cataract formation, and inherent risks of PPV related to epimacular brachytherapy. They also will evaluate current research that supports the use of radiation, and discuss what disease subtypes best respond to a radiation treatment approach.

Patient Selection
In addition, retina specialists will show learners how to evaluate which patients are the best candidates for radiation therapy and which are not. They will review current needs in the treatment of neovascular AMD, and evaluate epimacular brachytherapy studies to determine if they are positioned to address these needs. Plus, they will assess when to use epimacular brachytherapy in treatment naïve and previously treated patients and for which types of lesions (ie, classic lesions).

Radiation Therapy Procedure
Experts also will discuss whether 20g, 23g, or 25g is the preferred vitrectomy surgical technique. They will evaluate the necessity of creating a PVD, as well as the pros and cons of full or partial vitreous removal. Moreover, retina specialists will examine whether or not vitrectomies affect subsequent drug pharmacokinetics, and if a partial vitrectomy is the solution.

Addressing Physician Competencies
This activity will help physicians address the following competencies:

Core Competencies adopted by the American Board of Ophthalmology as the basis for Maintenance of Certification4

  • Evidence of professional standing
  • Evidence of a commitment to lifelong learning and self-assessment

Core Competencies adopted by the American Board of Medical Specialties5

  • Patient care
  • Medical knowledge

Core Competencies adopted by the Institute of Medicine6

  • Provide patient-centered care
  • Employ evidence-based practice

Faculty Credentials and Disclosure Information
Unless otherwise noted below, the speaker's spouse/life partner (if any) has nothing to disclose.

Pravin U. Dugel, MD (Moderator)
Clinical Associate Professor of Ophthalmology
Doheny Eye Institute, Keck School of Medicine
University of Southern California, Los Angeles
Managing Partner, Retinal Consultants of Arizona
Founding Member, Spectra Eye Institute
Sun City, AZ

Dr. Dugel has disclosed that he was/is the consultant/advisor to Abbott Medical Optics, Alcon, Arctic DX, Bausch & Lomb, Genentech, Macusight, Neovista.

Frank H. J. Koch, MD
Clinical Professor and Head of Retina and Vitreous Department
University of Frankfurt
Frankfurt, Germany

Dr. Koch has disclosed that he is/was a consultant/advisor to Insight Instruments, Inc., and Stuart.

Anat Loewenstein, MD, MHA
Director, Department of Ophthalmology
Tel Aviv Sourasky Medical Center
Tel Aviv, Israel

Dr. Loewenstein has nothing to disclose.

Joe O'Sullivan, MD, FRCPI, FFRRC, SI FRCR
Clinical Senior Lecturer (Cons) (JA)
The Northern Ireland Cancer Centre
Belfast, Ireland

Dr. O'Sullivan has nothing to disclose.

Mr Paulo E. Stanga, MD
Consultant Ophthalmologist and Vitreomacular Surgeon
Manchester Royal Eye Hospital
Manchester, United Kingdom

Dr. Stanga has disclosed that he is/was the recipient of grant/research funding from Neovista.

Lars Wagenfeld, MD
Retinal Specialist
Universitatsklinikum Hamburg-Eppendorf
Hamburg, Germany

Dr. Wagenfeld has nothing to disclose.

LCMEI Staff
All LCMEI staff members in a position to control the content of this CME activity have disclosed that they and their spouse/life partners (if any) have no financial relationships with, or financial interests in, any commercial companies pertaining to this educational activity.

Identification and Resolution of Conflicts of Interest
Lippincott CME Institute, Inc., has identified and resolved any faculty conflicts of interest regarding this educational activity.

Off-label Use/Unapproved Drugs or Products
The faculty has disclosed that the U. S. Food and Drug Administration has not approved the use of radiation therapy for the treatment of retinal disease and will disclose it to the audience. Use of any commercial product should be undertaken only after confirmation of information by consulting the FDA-approved indications, labeling and other authoritative information.

Disclaimer
Clinicians should ensure that all diagnostic and therapeutic modalities are prescribed and used appropriately, based on accepted standards of care. Use of any drugs, devices, and imaging techniques should be guided by approved labeling/full prescribing information, best available evidence, and professional judgment.

Faculty have been instructed that their content should be fair balanced and based on best available evidence. The information presented in this activity is the responsibility of the faculty and does not reflect the opinions of the provider or supporter.

Learning Objectives
After participating in this CME activity, ophthalmologists should be better able to:

  1. Assess the pharmacology of the therapeutic agents to achieve increased visual acuity in AMD patients.
  2. Develop strategies to enhance AMD treatment, and incorporate newer approaches to improve patient care.
  3. Interpret data presented from recent clinical trials to improve visual outcomes.

Getting the Most out of the Activity
As you prepare to participate in this activity, please reflect on your practice and your patients with retinal diseases and identify clinical challenges you hope to have addressed.

While participating in the conference, identify ways you can use newly acquired knowledge, strategies, and skills to enhance patient outcomes and your own professional development.

Method of Physician Participation
To earn CME/CE credit, a participant must register, view the entire activity online, and complete the evaluation questionnaire. A certificate will be available for print once a participant completes and submits the post exam with a passing score. Send questions to or request further information regarding CME/CE credit from the Office of Continuing Education, Lippincott Continuing Medical Education Institute, Inc., Two Commerce Square, 2001 Market Street, 3rd floor, Philadelphia, PA 19103; fax: (215) 827-5614.

System Requirements:
The minimum Hardware and Software requirements to run this application:

WINDOWS 98/2000/XP
Internet Explorer 5.0 and above
Opera 7.0
Firefox 1.0
Netscape 7.2 and above

MAC
Internet Explorer 5.2.3 and above
Opera 7.54
Firefox 1.0.4
Netscape 7.2 and above
Safari 1.2.4

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LCMEI has security measures in place to protect the loss, misuse and alteration of the information under our control. LCMEI does not share or sell any individual's contact information, financial information, or unique identifiers to any commercial supporter, advertiser or third party without the specific permission of the individual.

If you have any questions about this privacy policy, you can contact: Karen Overstreet, Executive Director, Lippincott Continuing Medical Education Institute, Inc. at Karen.Overstreet@wolterskluwer.com.

Educational Outcomes Analysis Plan
Lippincott CME Institute, Inc., will provide learners with an evaluation questionnaire that will allow them the means to assess the activity's quality, whether the goals of the activity were met, fairness and balance, and the effect on physician clinical practice behavior of the educational activity. A follow-up survey will be sent to participants a few months after the conference. Lippincott CME Institute, Inc., will compile and analyze the evaluation data, share the data with the conference planners, and utilize that data in the development of future CME activities.

References

  1. All About Vision. "Age-related Macular Degeneration." http://www.allaboutvision.com/conditions/amd.htm. "Macular degeneration treatment." http://www.allaboutvision.com/conditions/amd-treatments.htm.
  2. Rosenfeld PJ, Shapiro H, Tuomi L, Webster M, Elledge J, Biodi B, et al. MARINA AND ANCHOR Study Groups. Characteristics of patients losing vision after 2 years of monthly dosing in the phase III ranibizumab clinical trials. Ophthalmology. 2010;[Epub ahead of print].
  3. Dugel PU, Bennett MD. Macular epiretinal brachytherapy in treated age-related macular degeneration patients: MERITAGE 1, preliminary VA outcomes. Paper presented at The American Academy of Ophthalmology Retina Subspecialty Day; October 2009; San Francisco, CA.
  4. American Board of Ophthalmology. Visit http://www.abop.org/maintain/req.asp
  5. American Board of Medical Specialties. Visit http://www.abms.org/Maintenance_of_Certification/ABMS_MOC.aspx.
  6. The Institute of Medicine's Health Professions Education Report. Visit http://www.nap.edu/catalog.php?record_id=10681.



I have read the guidelines outlined.