2014 NY COURSE DIRECTOR CARL C. AWH, MD COURSE CO-DIRECTORS DAVID R. CHOW, MD TAREK S. HASSAN, MD CME ACCREDITATION AND CREDIT DESIGNATION

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1 2014 NY DECEMBER 4-6, 2014 NEW YORK, NY COURSE DIRECTOR CARL C. AWH, MD COURSE CO-DIRECTORS DAVID R. CHOW, MD TAREK S. HASSAN, MD p CME ACCREDITATION AND CREDIT DESIGNATION This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of William Beaumont Hospital and Medical Conference Planners, Inc. William Beaumont Hospital is accredited by the ACCME to provide continuing medical education for physicians. William Beaumont Hospital designates this live activity for a maximum of AMA PRA Category 1 Credit(s). Physicians should claim only the credit commensurate with the extent of their participation in the activity. Credit breakdown: Fri = 7.25, Sat = 7.00 A FELLOWS FORUM, INC. PRODUCTION

Faculty Carl Awh, MD Course Director Jean

2014 Meeting Neil Bressler, MD Editor-in-Chief,

Society 2014 Annual Meeting David Chow, MD

Moderator, Journal Editor Panel Pravin Dugel,

Grossniklaus, MD, MBA Jackson Memorial Lecture

William Harbour, MD The Paul Henkind Memorial

Meeting Tarek Hassan, MD Course Co-Director

Olsen, MD Executive Editor, AJO Carl Regillo,

Meeting Kourous Rezaei, MD Moderator, Best of

2 Faculty Carl Awh, MD Course Director Jean Bennett, MD, PhD, FARVO Keynote Speaker ARVO 2014 Meeting Neil Bressler, MD Editor-in-Chief, JAMA Ophthalmology Alexander Brucker, MD J. Donald M. Gass Award Lecture Retina Society 2014 Annual Meeting Editor-in-Chief, RETINA Peter Campochiaro, MD The RRF Award of Merit Retina Society 2014 Annual Meeting David Chow, MD Course Co-Director Donald D Amico, MD Moderator, Journal Editor Panel Pravin Dugel, MD Dean Eliott, MD Philip Ferrone, MD Hans Grossniklaus, MD, MBA Jackson Memorial Lecture AAO 2014 Annual Meeting J. William Harbour, MD The Paul Henkind Memorial Lecture and Award, Macula Society 2014 Annual Meeting Tarek Hassan, MD Course Co-Director Peter Kaiser, MD Szilárd Kiss, MD Timothy Olsen, MD Executive Editor, AJO Carl Regillo, MD Founders Award Lecture ARDS 2014 Annual Meeting Kourous Rezaei, MD Moderator, Best of RETINAWS Andrew Schachat, MD Gertrude Pyron Award Lecture ASRS 2014 Annual Meeting Editor-in-Chief, Ophthalmology Hendrik Scholl, MD, MA W. Richard Green Lecture Macula Society 2014 Annual Meeting Jerry Shields, MD Schepens Lecture AAO 2014 Annual Meeting

PROGRAM Thursday DECEMBER 4 5:30PM-8:30PM Registration Westin New York Times Square, Bar 10 6:00PM-8:00PM Welcome Reception Westin New York Times Square, Bar 10 8:00PM Dinner on own Friday DECEMBER 5

Exhibits Westin New York at Times Square Gershwin Ballroom, 4th Floor 7:30AM-9:45AM SESSION 1 Majestic Ballroom, 5th Floor 7:30AM-7:45AM Opening Remarks Carl C.

Olsen, MD Executive Editor, AJO 8:55AM-9:05AM 9:05AM-9:35AM Best of Retina from RETINA Alexander J.

3 PROGRAM Thursday DECEMBER 4 5:30PM-8:30PM Registration Westin New York Times Square, Bar 10 6:00PM-8:00PM Welcome Reception Westin New York Times Square, Bar 10 8:00PM Dinner on own Friday DECEMBER 5 6:45AM-5:30PM Registration Westin New York at Times Square Majestic Ballroom Foyer, 5th Floor 6:45AM 7:25AM Breakfast Westin New York at Times Square Gershwin Ballroom, 4th Floor 6:45AM-3:50PM Exhibits Westin New York at Times Square Gershwin Ballroom, 4th Floor 7:30AM-9:45AM SESSION 1 Majestic Ballroom, 5th Floor 7:30AM-7:45AM Opening Remarks Carl C. Awh, MD Course Director 7:45AM-8:15AM Best of Retina from JAMA Ophthalmology Neil M. Bressler, MD Editor-in-Chief, JAMA Ophthalmology 8:15AM-8:25AM 8:25AM-8:55AM Best of Retina from AJO Timothy W. Olsen, MD Executive Editor, AJO 8:55AM-9:05AM 9:05AM-9:35AM Best of Retina from RETINA Alexander J. Brucker, MD Editor-in-Chief, RETINA 9:35AM-9:45AM 9:45AM-10:15AM Break 10:15AM-12:25PM SESSION 2 10:15AM-10:55AM ASRS 2014 GERTRUDE D. PYRON AWARD LECTURE Fourteen-Thousand Decisions and Counting Tales from an Editor and Best of Retina from Ophthalmology Andrew P. Schachat, MD Editor-in-Chief, Ophthalmology Dr. Schachat was Editor of Ophthalmology for ten years and prior to that, Associate Editor of the Archives of Ophthalmology, now JAMA Ophthalmology, for many years. He is and remains an Editor of Ryan s Retina. During his tenure, Dr. Schachat made over 14,000 accept/revise/reject decisions at Ophthalmology. The presentation reviews characteristics of good and less good manuscripts with a focus on improved reporting of clinical manuscripts. 10:55AM-11:05AM 11:05AM-11:50AM Journal Donald J. D Amico, MD (Moderator) Neil M. Bressler, MD, Timothy W. Olsen, MD, Alexander J. Brucker, MD, Andrew P. Schachat, MD (Panelists) B E S T O F R E T I N A N Y 3

Evidence exists that patients followed in AREDS with the combination of high complement factor H (CFH) and low agerelated maculopathy susceptibility 2 (ARMS2) genetic risk had a deleterious response

4 11:50AM-12:20PM Update on Genetics and AREDS Supplements Carl C. Awh, MD This presentation will review recent publications and research relevant to the use of genetic testing to guide selection of nutritional supplements for patients with AMD. Evidence exists that patients followed in AREDS with the combination of high complement factor H (CFH) and low agerelated maculopathy susceptibility 2 (ARMS2) genetic risk had a deleterious response to the AREDS formulation. Analysis of AREDS data suggests that this relationship is due primarily to the zinc component of the AREDS formulation, a hypothesis supported by independent research regarding the role of zinc in the pathogenesis of AMD. 12:20PM-12:30PM 12:30PM-2:00PM Lunch and Industry Presentations 2:00PM-3:20PM SESSION 3 2:00PM-2:30PM AAO 2014 RETINA SUBSPECIALTY DAY CHARLES L. SCHEPENS LECTURE Management of Posterior Uveal Melanoma: Past, Present and Future Jerry A. Shields, MD PURPOSE: To review management of ciliary body and choroidal melanoma (posterior uveal melanoma; PUM) over the last century with emphasis on changing concepts. DESIGN: Retrospective review PARTICIPANTS: Review of personal experience over 40 years and pertinent literature on management of PUM. INTERVENTION: Diagnosis and therapy for posterior uveal melanoma. MAIN OUTCOME MEASURES: Patient survival. RESULTS: In the early 1900s, most patients presented with a large symptomatic melanoma,that necessitated enucleation, and the systemic prognosis was poor. In the 1970s, controversy erupted regarding the role of enucleation for PUM. Some authorities advocated prompt enucleation while others proposed that enucleation promoted metastasis, known as the Zimmerman hypothesis. Others recommended observation, withholding treatment until tumor growth was documented. During the 1970s there was a trend toward eye-saving procedures, including laser photo - coagulation, surgical removal of tumor, and techniques of radiotherapy. Despite local treatment success, systemic prognosis remained guarded with approximately 40% mortality overall. However, there was convincing evidence that smaller tumors offered a significantly better prognosis. Currently, there is a movement toward earlier identification and treatment of small melanomas using clinical factors predictive of malignant potential, in keeping with similar philosophy regarding other cancers. Further understanding of melanoma cyto - genetics and molecular pathways have helped to recognize patients at risk for metastasis. At-risk patients are offered systemic therapeutic trials to prevent metastasis. We anticipate that the future management of PUM will focus on detection of clinical and imaging clues for earliest diagnosis, prompt local tumor treatment, and systemic targeted therapies for microscopic metastasis or prevention of metastasis. Personalized evaluation of patient-specific melanoma molecular path - way signature could potentially allow for therapeutic intervention at a site specific to the pathway abnormality that leads to the development of melanoma. CONCLUSION: Management of PUM has made major strides over the past century from the days of enucleation for massive, fatal tumor to early detection of smallest tumors with a more favorable prognosis. Current and future targeted specific tumor pathway interruption using systemic agents could improve survival. 2:30PM-2:40PM 2:40PM-3:10PM RETINA SOCIETY 2014 RRF AWARD OF MERIT IN RETINA RESEARCH Development of Treatments for Retinal/Choroidal Vascular Diseases Peter A. Campochiaro, MD PURPOSE: The pathway for development of new treatments for retinal/choroidal vascular diseases is well-established and validated. The purpose is to present the pathway and illustrate how it is used. METHODS: The first step is development of an animal model that mimics key aspects of the disease process and is feasible and practical to use. It is then necessary to develop candidate targets, a process that often involves piecing together bits of circumstantial evidence often from patients with the disease process. It is then necessary to develop a specific antagonist to the candidate target and if possible, a knockout of the gene that codes for the target. The next step is to use the specific antagonist and/or knockout in the animal model to determine if the candidate target is critical for development of the disease phenotype. After choosing a route of administration and formulation, safety and biodistribution must be established. The design of early phase clinical trials is an art, because while the major goal is to test safety, it is advantageous to test for an efficacy signal. Mid-phase proof-of-concept clinical trials are critical to make a go/no go decision and to inform design of registration trials. Successful registration trials validate the target and validate the animal model that was used in preclinical trials. RESULTS: Once a target is validated, new strategies to neutralize the target more completely and for longer periods are tested in the validated model bringing the process full circle. The circle is repeated many times to optimize neutralization of the validated target and to try to identify new targets. 4 B E S T O F R E T I N A N Y

When good animal models are not available, it is sometimes necessary to truncate the circle and use patients with the disease as the model provided there is good safety data for the specific

3:10PM-3:20PM 3:20PM-3:50PM Break 3:50PM-5:40PM SESSION 4 3:50PM-4:20PM ARVO 2014 KEYNOTE LECTURE Seeing the Light with Retinal Gene Therapy: Behind-the-Scenes Perspectives Jean Bennett, MD, PhD,

5 When good animal models are not available, it is sometimes necessary to truncate the circle and use patients with the disease as the model provided there is good safety data for the specific antagonist and there are good efficacy outcome measures. CONCLUSIONS: Many examples to illustrate these points will be provided. 3:10PM-3:20PM 3:20PM-3:50PM Break 3:50PM-5:40PM SESSION 4 3:50PM-4:20PM ARVO 2014 KEYNOTE LECTURE Seeing the Light with Retinal Gene Therapy: Behind-the-Scenes Perspectives Jean Bennett, MD, PhD, FARVO Gene therapy has restored sight in patients with a form of Leber s Congenital Amaurosis (LCA), an inherited blindness that begins at birth. This presentation will describe the safety and efficacy results after gene therapy in 12 subjects, born with LCA. The subjects were treated at The Children s Hospital of Philadelphia in one eye and all eligible subjects have had re-administration to the contralateral eye. The presentation will also describe how this data has been used to initiate a Phase 3 study aimed at obtaining US Food and Drug Administration approval of this intervention. Finally, the presentation will share a behindthe-scenes perspective on the prospects and challenges of develop ing gene therapy for other forms of inherited blindness. While LCA is a rare blinding disease, the results from these studies could pave the way for development of other gene-based treatments for more common forms of blindness and for other inherited diseases. 4:20PM-4:30PM 4:30PM-5:00PM Future Management of Wet AMD: Update on Clinical Trials 2014 Peter K. Kaiser, MD This talk is an update on the latest clinical trials in exudative age-related macular degeneration. From promising drugs entering the pipeline, to drugs in or finishing phase 3, the top prospects will be discussed. 5:00PM-5:10PM 5:10PM-5:30PM Stem Cell Therapy for Atrophic AMD: Phase 1 Results Dean Eliott, MD A phase 1 study was conducted to assess the safety of subretinal injection of stem cells for dry macular degeneration with geographic atrophy and for Stargardt s disease. There were no ocular or systemic adverse events related to the stem cells. Patient characteristics, surgical procedure and results will be presented. 5:30PM-5:40PM 5:40PM-6:45PM Reception 6:45PM Dinner on own Saturday DECEMBER 6 6:45AM-5:30PM Registration 6:45AM-7:25AM Breakfast 6:45AM-3:50PM Exhibits 7:30AM-9:40AM SESSION 5 7:30AM-7:40AM Announcements Carl C. Awh, MD 7:40AM-8:10AM MACULA SOCIETY 2014 GREEN LECTURE AND AWARD Macular Degeneration: From Mechanism to Therapy Hendrik P.N. Scholl, MD, MA Until recently, slow neurodegeneration of the retina and macula secondary to genetic mutations have been considered incurable. Molecular genetic studies in the last two decades have revealed the underlying molecular cause in a substantial fraction of patients. The mammalian eye has been at the forefront of therapeutic trials based on gene replacement, stem cell and pharmacotherapy in humans with retinal degenerations. This is at least partly due to the accessibility of the human eye and the opportunity to study this part of the brain in great detail with non-invasive methods. Spectral-domain optical coherence tomography (sd-oct) and adaptive optics (AO) reflectance imaging allow to visualize retinal structure at the cellular and even subcellular level while functional tests such as fundus-controlled (or micro-) perimetry allow to map the sensitivity of the retina with high resolution. It has thus become possible to correlate structure and function of the central retina with high precision and to obtain multi-modal imaging of the retina. B E S T O F R E T I N A N Y 5

age-related macular degeneration (namd) with intravitreal, pan-vegf inhibitors.

6 8:10AM-8:20AM 8:20AM-8:50AM ARDS 2014 FOUNDERS AWARD LECTURE Anti-VEGF Maintenance Therapy for Neovascular AMD Carl D. Regillo, MD The functional and anatomic outcomes achieved in the pivotal ranibizumab phase III trials with monthly injections set the standard for comparison for the treatment of neovascular age-related macular degeneration (namd) with intravitreal, pan-vegf inhibitors. There is now level I evidence from the CATT and IVAN studies that demonstrated noninferiority of bevacizumab compared to ranibizumab in this setting. Aflibercept has demonstrated equivalency to ranibizumab in its phase III VIEW studies when dosed monthly and bimonthly in the maintenance phase of therapy. Although all three agents have been shown to perform well to treat namd when dosed in a frequent and fixed fashion, the drugs are typically administered in a more individual ized manner in clinical practice worldwide. Individualizing anti-vegf therapy for namd includes the as needed (PRN) and the treatand-extend (TAE) approaches. The former has been tested in several large scale, comparative trials and the results over two years of using pan-vegf blockers PRN have not shown to be non-inferior to continuous, frequent dosing. The TAE style of therapy has evolved into the most frequently used treatment approach in the US and is gaining in popularity else - where. Although there are no studies available that directly compare TAE to either PRN or fixed regimens, there is mounting evidence from retrospective and prospective studies to support its use. Evidence to date using the various treatment strategies in namd will be reviewed. 8:50AM-9:00AM 9:00AM-9:40AM Late Breaking News 9:40AM-10:10AM Break 10:10AM-12:45PM SESSION 6 10:10AM-11:25AM Best of RETINAWS Kourous A. Rezaei, MD RETINAWS at the Best of Retina 2014 show cases the most interesting surgical videos and experiences that were presented by retina surgeons around the world during the RETINAWS courses in A panel of experts will discuss the presented surgeries and also share their own most educational surgical experience from the year of :25AM-11:55AM RETINA SOCIETY 2014 J. DONALD M. GASS AWARD LECTURE In Memoriam of the Art of Scleral Buckling Alexander J. Brucker, MD PURPOSE: In memoriam of the art of scleral buckling. METHODS: An historic review of retinal detachment surgery. RESULTS: From the initial description of the Helmholtz ophthalmoscope, the repair of retinal detachments has been based upon the principle of: Find the hole, treat the hole and close the hole. The skill set of finding the retinal defect, documenting the location of retinal breaks, planning the type of scleral buckle procedure necessary for the closing of the defects, and then flattening of the detachment often with external drainage of subretinal fluid was learned over many years of training and experience. The technique of indirect ophthalmoscopy with scleral depression, drainage of subretinal fluid and the placement of just the right buckle became an art form rather that a rote surgical procedure. Today that skill set is being lost. The repair of retinal detachments is now an intraocular procedure which requires a new set of skills. CONCLUSIONS: While the end result of retinal detachment surgery is the flattening of the retina with restoration of vision, there is less and less controversy con cerning the use of vitreous surgery as a primary method for the repair of most retinal detachments. The result is the loss of the experience necessary to learn when and how to perform scleral buckling surgery. For that we now pay tribute. 11:55AM-12:05PM 12:05PM-12:35PM Retinal Imaging From the Posterior Pole to the Far Periphery Szilárd Kiss, MD The revolution and evolution in retinal imaging of both the posterior pole and the far periphery included the expansion of ultra wide field imaging into the realm of indocyanine green angiography and the commercial availability of OCT angiography. With the greater understanding of the important contribution of the peripheral retina, ultra wide field imaging is becoming the standard of care in many retinal disorders, especially retinal vein occlusion and diabetic retinopathy, and even in many ocular inflammatory conditions. With the expanded availability of OCT angiography, we have 6 B E S T O F R E T I N A N Y

already begun to unearth interesting (and previously unknown) details about the retinal vasculature in the posterior pole this will undoubtedly only continue to expand in the coming year.

Future J. William Harbour, MD Uveal melanoma is the most common primary intraocular malignancy and has a strong propensity for fatal metastasis.

7 already begun to unearth interesting (and previously unknown) details about the retinal vasculature in the posterior pole this will undoubtedly only continue to expand in the coming year. 12:35PM-12:45PM 12:45PM-2:00PM Lunch and Industry Presentations 2:00PM-3:20PM SESSION 7 2:00PM-2:30PM MACULA SOCIETY 2014 PAUL HENKIND MEMORIAL LECTURE AND AWARD Uveal Melanoma The Present and the Future J. William Harbour, MD Uveal melanoma is the most common primary intraocular malignancy and has a strong propensity for fatal metastasis. Recent advances in the molecular genetics of uveal melanoma are revolutionizing our understand - ing of this cancer and the care of patients. The development of a new molecular classi - fication of uveal melanoma based on a widely available 15-gene expression profile now allows patients at high risk of metastasis to be identified early so that individualized management can be offered. The recent discovery of major driver mutations in uveal melanoma provide a rational basis for development of new targeted therapies. Taken together, these advances are transforming our understanding and management of uveal melanoma with the ultimate goal of improving patient outcomes. 2:30PM-2:40PM 2:40PM-3:10PM AAO 2014 JACKSON MEMORIAL LECTURE Retinoblastoma: 50 Years of Progress Hans E. Grossniklaus, MD, MBA Progress made in understanding the genetic basis, molecular pathology, and treatment of retinoblastoma was reviewed since the previous Jackson lecture on the topic was published 50 years ago. The literature regard - ing retinoblastoma was reviewed since Advances in understanding the biology and treatment of retinoblastoma provided context through the author s clinical, pathological and research experiences. Retinoblastoma was first identified in the 1500s and defined as a unique clinico - pathologic entity in Until the mid-1900s, knowledge advanced sporadically, with tech - nological developments of ophthalmoscopy and light microscopy, and with the introductions of surgical enucleation, chemotherapy and radiation therapy. During the last 50 years, research and treatment have progressed at an unprecedented rate due to innovations in molecular biology and the development of targeted therapies. Nearly all patients with retinoblastoma in developed countries can now be cured of their primary cancer a remarkable achieve - ment for a childhood cancer that once was uniformly fatal. Much of this success is owed to deciphering the role of the Rb gene, and the benefits of targeted therapies, such as chemoreduction with consolidation as well as intra-arterial and intravitreal chemotherapies. Going forward, the main challenge will be ensuring that access to care is available for all children, particularly those in developing countries. 3:10PM-3:20PM 3:20PM-3:50PM Break 3:50PM-5:30PM SESSION 8 3:50PM-4:20PM Latest and Greatest in Pharmacologic Treatment of Diabetic Retinopathy and Diabetic Macular Edema Pravin U. Dugel, MD I will be showing Medicare based data previously not presented regarding the cure rate for DME with our current treatment strategies. I will then discuss the positioning of newly approved steroid delivery devices. Finally, I will present new data on a new Tie 2 activator with a unique delivery formulation. 4:20PM-4:30PM 4:30PM-5:30PM Late Breaking News 5:30PM Adjourn 5:30PM-6:30PM Closing Reception 6:30PM Dinner on own B E S T O F R E T I N A N Y 7

8 THIS CME ACTIVITY IS SUPPORTED BY AN EDUCATIONAL GRANT FROM: Regeneron Pharmaceuticals, Inc. Exhibitors BEST OF RETINA 2014 GRATEFULLY ACKNOWLEDGES GENEROUS CONTRIBUTIONS FROM THE FOLLOWING COMPANIES: DIAMOND Allergan, Inc. PLATINUM Genentech, Inc. GOLD Regeneron Pharmaceuticals, Inc. SILVER Alcon Laboratories, Inc. Arctic Group of Companies Bausch + Lomb Dutch Ophthalmic, USA Insight Instruments, Inc. OCULUS Surgical, Inc. Optos, Inc. Synergetics, Inc. ThromboGenics, Inc.

Advanced Vitreoretinal Techniques & Technology Symposium

14th ANNUAL Advanced Vitreoretinal Techniques & Technology Symposium JULY 25-27, 2014 SWISSÔTEL CHICAGO CHICAGO, IL CME ACCREDITATION AND CREDIT STATEMENT This activity has been planned and implemented