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54 Cards in this Set
- Front
- Back
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What are some non modifiable risk factors of AMD? |
*more in white *older people *Genetics |
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What are some modifiable risk factors for AMD? |
***Smoking *** * High Fat, glycemic index (inc risk) * Omega-3 and Increased Carotinoids (DEC risk)
Physical health (high BMI/Syt HTN/ elevated CRP) |
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What was the results in the AREDS 1 study? |
That the AREDS formulation regressed moderate to Severe AMD by about 25% BUT did nothing for mild to no AMD patients |
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True or false, AREDS 2 study shows information for just intermediate to severe AMD and NO Mild AMD? |
True!!! |
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What was the purpose of AREDS 2 study? |
Added Lutein and Zeaxnthin and Omega 3 to the original formula |
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What is AREDS 2 formulation |
AREDS +Lutein and Zeaxanthin NO Omega 3 or B-carotein |
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Should patients that formerly smoked take a Beta-Carotein supplement? |
NO- study shows there’s an increased risk of lung cancer |
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Which AREDS is better for SMokers? |
AREDS 2 because it does not include Beta Carotein |
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AREDS 2 Formulation |
(Preservision) 2 CAPSULES A DAY Zinc 80mg (THEY INCREASED THE AMOUNT OF ZINC) Lutein 10mg Zeaxanthin VIT C&E Copper |
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Which one of these is NOT apart of AREDS 2? Zinc,copper, Zeaxanthin, VIT D&E and Lutein? |
VIT D is not apart of AREDS 2 Only C and E |
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What is the brand new drug that is FDA approved to treat Geographic atrophy? |
Pegcetacoplan (syfovre) MOA- binds to compliment 3 and controls down stream compliment pathway |
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What is Pegcetacoplan (Syfovre) |
the 1st FDA DRUG APPROVED TO TREAT GEOGRAPHIC ATROPHY |
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OAK and Derby study |
Pegcetcoplan study that showed the drug works overtime lead to the FDA approval |
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Why is Laser surgery CI for SubFoveal lesions? |
Because it will cause direct vision loss. Also areas that were layered had a high frequency of recurrence!! |
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What is Photodynamic therapy? |
injection of Photosensitizing agent (Visudyne) which collects on areas with low density Lipoproteins. A non thermal laser with a specific wavelength activates the dye causing a reactive oxygen thrombus formation which will occlude the vasculature |
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What is the first FDA approve tx for SubFoveal Choroidal neovascularization? |
Photodynamic therapy (689nm) *Verteporfin (Visudyne) |
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What is a big risk with PDT? |
There’s a 1-5% chance the patient can lose a large amount of VA within the first week. ***MUST AVOID SUN EXPOSURE*** |
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What is a huge thing you need to avoid when doing PDT therapy? |
SUN EXPOSURE for about a week |
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When do we normally use PDT today? |
Idiopathic Polypoidal Vasculopathy Choroidal Central serous chorioretinopathy |
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What is Macugen |
First aptamer to demonstrate high affinity for VEGF165 Repeated every 4-6weeks |
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What exactly does Macugen do? |
Binds to the VEGF165 and stops it from binding to the cell receptor |
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Is Macugen (pegaptanib) FDA approved for all lesions types in Exudative AMD |
YES IS ALLL TYPES!!!! OCULT OR ANYTHING |
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True or false, There is only off label use for Avastin (bevacizumab) |
True!! |
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What is a major Workhorse anti-VEGF therapy? |
Ranibizumab (Lucentis) *very short half life* |
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Aflibercept (Eylea) |
Long half life so not as many injections! |
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Brolocizumab (BeoVu) |
***associated with inflammation induced VA loss*** |
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Faricimab (Vabysmo) |
Has 2 pathways *ANG-2 and VEG F Potentially fewer injections over time (up to 4 months) |
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WHAT IS THE MARINA TRIAL? |
Compares Ranibizumab Vs Sham |
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What is the Anchor Trial? |
Lucentis vs PDT |
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When should we expect vision to Plateu after Ranibizumab? |
Around 4 months |
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What is the big disadvantages of Ranibizumab? |
VA plateu at 4 months Costs and inconvenience (3X Monthly injections) |
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What are the FDA approvals for Ranibizumab |
Exudative AMD-Monthly or 3x Monthly Macular Edema with retinal Vein Occlusion DME and DR (monthly) Myopic CNVM (monthly up to 3x) |
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Avastin |
Basically Ranibizumab is a small structure located on the entire Structure of Avastin **FDA approved for Colorectal cancer** **OF LABEL USE for INTRAVITREAL ink in Exudative ARMD |
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True or false, AVASTIN is the most used drug for injections but it all OFF LABEL? |
True |
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True or false, Avastin is just as effective and Safe as Ranibizumab but costs less?CA |
True 2000 for Lucentis (FDA appro) 100 For Avastin (off Label) |
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What is the CATT trial? |
a trial comparing Ranibizumab and Bevacizumab **conclusion was Avastin was non inferior to Lucentis** |
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What is the Pronto Trial? |
A study on Lucentis to determine whether or not the medication needs to be injected so frequently |
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What was the outcome to the Pronto Trial? |
Studies showed that the medications works better when given monthly but some patients respond differently and don’t need to get the monthly injections. This ended up leading to Physicians approach to Treat and Extend |
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What is Treat and extend? Where did it come from |
Came from the Pronto trials Treat and extend = 3 monthly injections and no new growth then come back in 6 weeks, No evidence after 6 weeks, have them come back in 8 weeks |
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What’s the treat and extend regimen? |
Get 1st 3 monthly -> 6 weeks no evidence after 6-> 8 weeks + evidence after 6-> 4 weeks |
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Ranibizumab implant (Susimo) |
An implant that helps pts not have to go in all the time *was recalled* ***pt who already have it implanted, can keep getting it refilled though*** |
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True or false, pt who want Susvimo implant can have it installed? |
False, it was recalled, BUT people who already have it can continue to get it refilled |
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Aflibercept (eylea) |
*long half life FDA approved for -Wet AMD (3Xmo then q2mo) -ME following RVO (qmo) -DME/DR (5mo then q2m) -retinopathy of prematurity |
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What is the only medication FDA approved to treat Retinal Prematurity? |
Eylea |
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What is the AMD drug that has two mechanisms? |
Faricizumab (Vabysmo) |
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Famicizumab (vabysmo) |
-AMD (4mo the q3-4 mo) |
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What three drugs are used treat Macular edema and BRVO/CRVO? |
Lucentis FDA approved Eylea FDA approved Avastin NOT FDA approved but used off label |
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True or false, All the AMD drugs are FDA approved to treat DME? |
False, everything but Avastin But it is still used to treat all vascular issues |
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Anti-VEGF drugs can quickly clear up and NEO so you don’t have to use them very long? |
False, they will clear Neo up quickly but if you stop, the neo will come back |
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Why do surgeons use Anti-VEGF drugs before vitrectomy in DR patients? |
Because there could be Vessle growth into the vitreous sow when they go to remove them, they will start to bleed. They basically want to shrink the Vessles before they cut them to minimize bleeding |
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What is the only Anti-VEGF drug approved for ROP? |
Eylea |
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Which vascular issue is Eylea not approved for? |
Eylea is approved for all |
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What vascular issue is Ranibizumab (Lucentis) not approved for? |
ROP |
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What vascular issues are Beovue and Vabysmo approved for? |
DME Exudative AMD |
