UPCOMING NOVEMBER EVENTS
CE/CME ACCREDITED VIRTUAL COURSES
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OPHTHALMIC SURGERY GRAND GROUNDS (OSxGR) |
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PRACTICE UPDATES
WHAT'S NEW AT COLORADO RETINA ASSOCIATES
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HOLIDAY BASKETS FOR SENIORS FOOD DRIVE
With COVID still sweeping the nation, much of the senior population will be spending the holidays in isolation this year, without the company of their families.
As part of our commitment and connection to Colorado's seniors we decided to partner with the Colorado Gerontological Society (CGS) for their annual Holiday Basket Project. Our team will be hosting an in-clinic donation food drive, to provide low-income seniors a holiday gift basket filled with essential groceries, a present, and hygiene products. Together we will bring food security, holiday cheer, and meaningful social connection to the in-need elderly!
From November 9th until December 18th we are accepting designated canned and boxed food items to be dropped off at any CRA office. We understand that many can not facilitate an in-person drop off, so if you would like to contribute to our efforts we're also welcoming Online donations for the purchase of perishable foods and needed basket items.
Our goal is to “adopt” 50 local seniors and raise an additional $1,250 in cash donations. This allows us to provide FIFTY seniors with a real holiday experience and cover the additional 30% increase that the Holiday Basket Project is experiencing compared to previous years, due to COVID-19.
Join us, together we can help our Colorado senior community get through what can be a tough and lonely season, all while spreading holiday joy!
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CASE OF THE MONTH
REAL CASES OF YOUR REFERRED PATIENTS
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33 Y/O WITH RPE65 GENE MUTATION
AUTHOR: ALAN KIMURA, MD
Genetics has not only increased our understanding of the risk of having an inherited retinal disease (IRD) but has also led to a striking medical breakthrough --the first FDA-approved gene therapy for an IRD. Patients with a rare form of early-onset retinitis pigmentosa, or Leber’s congenital amaurosis (LCA), face a challenging future of progressive visual loss without treatment. Sixty to seventy different genes can cause night blindness, constricted visual fields and subsequently difficulties with mobility. Mutations in the RPE65 gene can now be repaired with one surgery, injecting the reparative DNA sequence to the affected retinal cells.
Our Case of the Month is a 33 y/o female complaining of poor night vision for most of her life and bumping into things, especially when it is dark. Her vision is sufficient for office work, though she notes increasing difficulty. The fundus exam of night-blinding disorders can vary widely, and she showed subtle, but definite pigmentary atrophy, documented with fundus photography and autofluorescence imaging. Electroretinography confirmed weaker function of the rod photoreceptors (night vision) more than the cones (detail vision). State of the art, digital, full-field perimetry documented the constricted visual fields consistent with her tripping and bumping into things.
Modern, accurate, inexpensive commercial genetic testing specializing in IRDs was recommended. Her results confirmed bi-allelic, pathogenic mutations in the RPE65 gene. Only ~3000 patients with RPE65 gene mutations are estimated to exist in the US, so Colorado Retina’s regional referral network serves a broad, multi-state population. We connected her to an approved center for gene therapy to treat her RPE65 gene mutation using voretigene neparvovec-rzyl. This miraculous gene therapy is the product of two decades of laboratory, pre-clinical and clinical research. One month after surgery she notes better vision in the dark, allowing her to see faces and read the menu when dining outdoors for dinner. She likewise is noticing more co-workers and friend in her peripheral vision now.
CRA’s robust IRD Department accepts referrals for IRDs across the nation, staffed with the best IRD subspecialty, fellowship-trained clinicians and diagnostic technicians, using state-of-the art equipment. Unique to Colorado Retina, we offer our patients a variety of non-medical support services, including low vision, genetic testing with certified genetic counselors, and mental health support services.
IRD DEPARTMENT CONTACT INFO:
Direct: (303) 261-1600 ext. 3719
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FEATURED NEWS ARTICLES
PRESS RELEASES & RESOURCES FROM OUR VITREORETINAL SPECIALISTS
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VICTRECTOMY
WITHOUT
INTRAVENOUS ANESTHESIA
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AT A GLANCE
- Although cataract surgery anesthesia techniques have evolved in recent decades, anesthesia for vitreoretinal surgery has remained mostly static.
- With appropriate patient and case selection, PPV without IV anesthesia has the potential to reduce costs, improve patient satisfaction, decrease OR turnover time, and increase the feasibility of in-office PPV.
- The authors describe a technique for sub-Tenon block without anesthesiology support that has to date been employed successfully in a mix of vitreoretinal surgeries.
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Authors:
Murtaza Adam, MD
- Vitreoretinal Specialist, Colorado Retina
- madam@retinacolorado.com
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Financial disclosure: Consultant for Allergan/AbbVie, EyePoint Pharmaceuticals, Genentech, Novartis, Regeneron
Erica Podesto, BA
- OMS-III, Rocky Vista University, Parker, CO
Seen in: Retina Today, Oct. 2020 Issue
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Pars plana vitrectomy (PPV) is typically performed with the assistance of an anesthesiologist either with monitored anesthesia care (MAC) or general anesthesia (GA), combined with a local ocular block. Numerous factors, including the patient’s medical history, comorbidities, anxiety, dementia, medication or illicit drug history, along with surgical complexity, expected case time, and language barriers, can all influence the anesthesia modality selected for a particular case. For all cases supported by an anesthesiologist, patients are required to fast for at least 8 hours before surgery, and intravenous (IV) line placement is mandatory. With local block administration and anesthesiologist support, PPV with this approach has a proven track record of patient comfort and safety.
While vitreoretinal surgeons have been performing cases with the same anesthesia approach for decades, our anterior segment colleagues have been rapidly evolving their approaches to anesthesia for cataract surgeries. Recent studies involving cataract surgery with topical anesthesia and oral sedation without an anesthesiologist have reported excellent outcomes with reduced costs, low intraoperative complication rates, and increased patient satisfaction.
Although vitreoretinal cases likely cannot achieve the efficiency and comfort of a 5-minute cataract surgery with topical anesthesia, we believe that PPV can be safely and comfortably performed without IV anesthesia for a significant proportion of patients. In this article we share our rationale and methodology for, and our initial experience with, a technique to perform PPV without IV sedation.
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RETINAL VEIN OCCLUSION ASSOCIATED WITH COVID-19
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A 59-year-old man was referred to our clinic with blurred vision in his right eye concurrent with cough and abdominal pain.
COVID-19 infection was suspected, but polymerase chain reaction testing was not performed because he was not ill enough for hospital admission, which at the time was required for testing. Several weeks later, his systemic symptoms resolved, and he was tested for COVID-19 antibodies. He was positive for SARS-CoV-2 immunoglobulin G and negative for immunoglobulin M.
The patient’s medical history was significant for a 5-year history of microscopic colitis. His only medication was aspirin 81 mg/day.
An eye examination revealed 20/20-1 VA OD, with normal IOP and slit-lamp examination. His right fundus showed a mild CRVO (Figures 1 and 2). His left eye visual acuity and examination were normal. OCT imaging did not show macular edema (Figure 3), and therefore he was not treated.
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Authors:
Brian C. Joondeph, MD, MPS
- Vitreoretinal Specialist, CRA
- bjoondeph@retinacolorado.com
- Financial disclosure: None
Nuha Kapatayes
- Ophthalmic Technician, CRA
- Financial disclosure: None
Seen in: Retina Today, Sept 2020
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CLINICAL RESEARCH
UPCOMING AND ACTIVE FDA-APPROVED CLINICAL RESEARCH TRIALS
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FOUNDATION FIGHTING BLINDNESS + COLORADO RETINA
Pro-EYS STUDY
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The Foundation Fighting Blindness has launched a natural history study (NCT04127006) for people with retinitis pigmentosa (RP) caused by mutations in the gene EYS called the Rate of Progression in EYS Related Retinal Degeneration (Pro-EYS). The goals of the international, four-year study include estimating the rate of disease progression and evaluating the usefulness of various outcome measures for future clinical trials for emerging therapies.
Colorado Retina's Clinical Research Department was selected as 1 of 26 qualified study locations from around the US to participate in the Rate of Progression in EYS Related Retinal Degeneration (Pro-EYS) study, an honor and national acknowledgment for our research team. This new project is meant to characterize the natural history of disease progression in patients with EYS mutations in order to accelerate the development of outcome measures for clinical trials. Sensitive, reliable outcome measures of retinal degeneration will greatly facilitate development of treatments for retinitis pigmentosa due to EYS mutations. Together these approaches are expected to have an impact on understanding EYS-related retinal degeneration, developing experimental treatment protocols, and assessing their effectiveness.
The findings from this study will be published and widely disseminated so that we can share what we learn with therapy developers from around the world. As an organization, we are proud to have built the infrastructure for imaging, electrophysiologic and psychophysical testing, coupled with a dedicated space and staff, and the genetic testing capabilities that enable our practice to contribute to the growing global research effort to find cures for these untreatable Inherited Retinal Diseases (IRD).
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OPTIC PHASE 1 TRIAL OF ADVM-022
INTRAVITREAL GENE THERAPY FOR WET AMD
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Colorado Retina is excited to participate in this multi-center, open-label, Phase 1, dose-ranging trial designed to assess the safety and tolerability of a single intravitreal (IVT) administration of ADVM-022 in patients with wet AMD. The primary endpoint of this Phase 1 trial is the safety and tolerability of ADVM-022 after a single IVT administration. Secondary endpoints include changes in best-corrected visual acuity (BCVA), measurement of central retinal thickness (CRT), as well as the need for anti-VEGF rescue injections. Each patient enrolled will be followed for a total of two years. Based on reported outcomes thus far, an additional AMD trial is planned to start in mid-2021. |
Please contact Colorado Retina's Research Department for more information about screening, eligibility or clinical research related questions.
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COLORADO RETINA ASSOCIATES, P.C.
MAIN PHONE: (303) 261-1600
FAX: (303) 261-1601
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