Big News on the Retina Front

HOT TOPIC

Two Aflibercept Biosimilars Receive FDA Approval

In a significant milestone, the FDA has approved two biosimilar products: aflibercept-jbvf (Yesafili, Biocon) and aflibercept-yszy (Opuviz, Biogen) as the first interchangeable biosimilars to aflibercept injection 2 mg (Eylea, Regeneron).

Aflibercept works by inhibiting vascular endothelial growth factor, which is crucial in preventing abnormal blood vessel growth within the eye. As interchangeable biosimilars, Yesafili and Opuviz are expected to produce the same clinical results in patients as Eylea. This development will provide retinal specialists with additional treatment options for managing age-related macular degeneration (AMD) and other retinal diseases.

My Two Cents

As more patients are diagnosed earlier with severe retina conditions such as AMD and diabetic retinopathy and have gained access to proper eye care, the need for more affordable treatment options remains paramount. As is often the case, I went down a rabbit hole on the internet trying to find more information on this topic. While doing so, I stumbled across these interesting facts:

From 2018 to 2022, use of Part B drugs for the treatment of AMD increased by 17% despite a decline in the number of traditional Medicare fee-for-service beneficiaries overall. Total payments increased by 29% due to growth in Eylea use.
Medicare Shared Savings Program (MSSP) Accountable Care Organizations (ACOs) spent $1.4 billion on injectable medications for wet AMD in 2022. Wet AMD drugs accounted for more than 1% of total ACO expenditures for most MSSP ACOs. Ten percent of ACOs spent 2% to 4% of their budget on these therapies.

OUTSIDE THE LANE

Cannabis Poisoning Occurring More Frequently in Older Adults

As various countries around the world (and individual states within the United States) continue to legalize cannabis, its different forms are becoming more popular, including edible varieties. One unexpected effect is that more seniors are ending up in emergency departments due to cannabis overdoses. In fact, cannabis poisonings among older adults have tripled since legalization. These poisonings have been linked to the recent increased access to marijuana products, including edibles.

Edibles, which are food and drink products infused with cannabis, pose different risks compared with smoked cannabis. Unlike smoking, edibles take longer to produce intoxicating effects, between 30 minutes and 2 hours. This delayed onset can lead some people to consume too much product, resulting in poisoning or severe injury. Additionally, edibles can cause longer-lasting effects, depending on factors such as the amount ingested, whether they’re consumed on an empty stomach, and concurrent use of medications or alcohol.

It was also discovered that seniors who have previously used marijuana are just as likely to experience cannabis poisoning as those who haven’t. The delayed drug effect of edibles—roughly 3 hours—catches people off guard. Those accustomed to the quick high from smoking may inadvertently ingest excessive doses of edibles before peak effects manifest.

Symptoms of cannabis poisoning include confusion, psychosis (including hallucinations), anxiety or panic attacks, rapid heartbeat, chest pain, nausea, and vomiting. During the study period, there were 2,322 emergency department visits for cannabis poisoning among older adults with an average age of 69. (Read more here.)

My Two Cents

Honestly, I was always under the impression that marijuana was relatively harmless, so this information was eye opening to me. I hadn’t considered the “edible effect” on older Americans. In our patient population, although marijuana isn’t a proven way to treat glaucoma, we still may have older patients who try to take this “natural” approach and find themselves in a less-than-ideal situation, as described above. Yet another reason to say no to drugs!

CAN YOU RELATE

This past week, my son, our puppy (Buddy), and I had our family pictures taken. This was a monumental occasion that involved a lot of planning, and it was somewhat anxiety-inducing. It got me thinking about my patients’ experience in my clinic. To us, an eye exam is a routine procedure that many couldn’t imagine causing an ounce of anxiety—just as our photographer likely views each photo session.

Art + Soul Revived

But sometimes, we must sit back and remember how apprehensive many patients are about coming in to see us. Some individuals haven’t seen an eye doctor in years (or perhaps ever), and other may have had a negative experience at their last experience. They may be nervous because a family member or friend received bad news about their eyes, and they are worried they’ll also receive bad news. Others may not want to get “yelled at” for overwearing their contact lenses.

We should strive to make our offices as comfortable and welcoming as possible for each patient, so they understand that we are on their side and only have their best interests at heart. My photographer went out of her way to make my son and puppy comfortable with the experience, and it was immensely appreciated.