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Addressing unmet needs in DME

Watch Time: 27 mins

Faculty Presenters: Prof. Michael Koss, Dr Alan Berger

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This activity has been sponsored by Roche. Roche provided financial support and has had input into the selection of the faculty and the detailed project scope. This activity is provided by Touch Medical Communications (TMC) for touchOPHTHALMOLOGY.

Diabetic Macular Oedema View Time: 27 mins

touchEXPERT BRIEFING Addressing unmet needs in DME

Watch leading experts discussing the multifactorial nature of DME, and the real-world limitations and burden of existing treatment approaches

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Prof. Michael Koss
Augenzentrum Nymphenburger Höfe, Munich, Germany
The multifactorial nature of DME

Prof. Koss highlights the multifactorial nature of DME including mediators beyond VEGF, and the limitations of targeting a single mediator.

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Interview Questions

In this interview, we asked Prof. Koss the following questions:

  • Why is DME considered a multifactorial disease?
  • What are the key mediators implicated in the pathology of DME?
  • What is currently understood about the contribution of Ang 2 to the pathology of DME?
  • Why is it important to look at several different mediators in DME?
  • What are the current limitations associated with anti-VEGF therapies?
About Prof. Michael Koss

Michael Koss is a partner in a surgically based private practice in Munich. He was previously the head of the retina unit of the Department of Ophthalmology at Heidelberg University following completion of his retinal fellowship at Goethe University in Frankfurt am Main. He is specialised and published in the field of combination treatment for retinal vascular diseases. He is also a current Fellow of the European and German Board of Ophthalmology and serves as an editor for Graefes Archives of Ophthalmology.

Disclosures:
Consultant to Apellis, Lumithera, B&L, Arri Medial and Roche.

 
Dr Alan Berger
Department of Ophthalmology and Vision Sciences, University of Toronto & St. Michael's Hospital, Toronto, Ontario, Canada
Current DME standard of care limitations

Dr Berger describes the current standard of care for DME and its limitations, in addition to a typical patient’s anti-VEGF dosing schedule and strategies to improve treatment adherence.

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Interview Questions

In this interview, we asked Dr Berger the following questions:

  • What are the current standard of care treatments for DME?
  • Why do most patients with DME struggle to maintain long-term vision gains with anti-VEGF treatment?
  • Please can you describe a typical anti-VEGF injection dosing schedule you would generally use to treat a patient with DME?
  • Are there any strategies you use to improve adherence to DME treatment?
About Dr Alan Berger

Alan Berger is assistant professor at the University of Toronto and an ophthalmologist at St. Michael’s Hospital. He received his Doctor of Medicine (MDCM) from McGill University. His principal clinical and research interests are in vitreoretinal diseases and surgery. He has authored numerous peer-reviewed scientific journal articles and has written 6 book chapters, in addition to giving over 250 lectures and presentations at local, national and international meetings.

Disclosures:
Consultant for and receive honoraria from Novartis Ophthalmics Canada, Bayer Canada and Roche Canada.

 
Dr Alan Berger
Department of Ophthalmology and Vision Sciences, University of Toronto & St. Michael's Hospital, Toronto, Ontario, Canada
The DME patient journey

Dr Berger outlines the typical patient journey for DME, the impact of comorbidities and the burden of frequent anti-VEGF treatment visits, in addition to the potential of a less frequent dosing schedule to reduce burden.

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Interview Questions

In this interview, we asked Dr Berger the following questions:

  • How would you describe the DME patient experience?
  • What are the most common comorbidities DME patients have, and how does it impact their treatment?
  • In your experience, what aspects of DME therapy do patients and caregivers find most burdensome?
  • How does the current frequency of anti-VEGF treatment visits affect your clinical practice?
  • What impact would a less frequent dosing schedule have on reducing treatment burden?
About Dr Alan Berger

Alan Berger is assistant professor at the University of Toronto and an ophthalmologist at St. Michael’s Hospital. He received his Doctor of Medicine (MDCM) from McGill University. His principal clinical and research interests are in vitreoretinal diseases and surgery. He has authored numerous peer-reviewed scientific journal articles and has written 6 book chapters, in addition to giving over 250 lectures and presentations at local, national and international meetings.

Disclosures:
Consultant for and receive honoraria from Novartis Ophthalmics Canada, Bayer Canada and Roche Canada.

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Overview & Learning Objectives
Overview

Current standard of care treatment for DME using anti-VEGF therapy is limited by targeting a single disease mediator,1–3 less consistent real-world vision gains compared with clinical trials,4–6 and the burden of treatment for patients and caregivers.7 We interviewed leading experts about emerging mediators of DME pathology, the reasons for the gap between controlled trials and clinical practice, and what aspects of treatment are most burdensome to patients and caregivers, in addition to what strategies can be used to improve outcomes.

Learning Objectives

After watching this activity, participants should be better able to:

  • To describe the multifactorial nature of DME beyond the VEGF pathway.
  • To understand why there is an efficacy ceiling and a disconnection between real-world outcomes and clinical trials.
  • To recognise the burden for the patients and healthcare systems of current treatment options including high frequency of injections to maintain vision gains.
References
References
  1. Urias EA, Urias GA, Monickaraj F, et al. Novel therapeutic targets in diabetic macular edema: Beyond VEGF. Vision Res 2017;139:221-7.
  2. Das A, McGuire PG, Rangasamy S. Diabetic Macular Edema: Pathophysiology and Novel Therapeutic Targets. Ophthalmology 2015;122(7):1375-94.
  3. Browning DJ, Stewart MW, Lee C. Diabetic macular edema: Evidence-based management. Indian J Ophthalmol 2018;66(12):1736-50.
  4. Ciulla TA, Pollack JS, Williams DF. Visual acuity outcomes and anti-VEGF therapy intensity in diabetic macular oedema: a real-world analysis of 28 658 patient eyes. Br J Ophthalmol 2021;105(2):216-21.
  5. Sivaprasad S, Ghanchi F, Kelly SP, et al. Evaluation of standard of care intravitreal aflibercept treatment of diabetic macular oedema treatment-naive patients in the UK: DRAKO study 12-month outcomes. Eye (Lond) 2022;36(1):64-71.
  6. Van Aken E, Favreau M, Ramboer E, et al. Real-World Outcomes in Patients with Diabetic Macular Edema Treated Long Term with Ranibizumab (VISION Study). Clin Ophthalmol 2020;14:4173-85.
  7. Sivaprasad S, Oyetunde S. Impact of injection therapy on retinal patients with diabetic macular edema or retinal vein occlusion. Clin Ophthalmol. 2016;10:939-46
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