Ehsan Rahimy, MD

managing cases of high-risk PDR and DME, exploring new therapies and synergistic combinations with anti-VEGF and steroids for longer-lasting responses.

Managing Patients With High-Risk PDR and DME

This is a video synopsis of a discussion involving Ehsan Rahimy, MD, a retina specialist at the Palo Alto Medical Foundation and adjunct faculty at Stanford University School of Medicine. Dr. Rahimy addresses the management of a patient with high-risk proliferative diabetic retinopathy (PDR) and diabetic macular edema (DME) who has shown limited response to anti-vascular endothelial growth factor (anti-VEGF) therapy.

He discusses the need for a flexible treatment approach and mentions the possibility of switching to different agents such as aflibercept or faricimab based on the patient's response. Dr. Rahimy emphasizes the importance of close monitoring and quick adjustments in treatment, including the consideration of adding steroid therapy like Ozurdex (dexamethasone implant) for cases exhibiting signs of inflammation on optical coherence tomography (OCT).

Dr. Rahimy highlights the significance of phenotypic markers in determining treatment strategies, suggesting the use of wide-field fluorescein angiography (FA) to assess vascular leakage and guide therapy decisions. He also discusses the potential role of longer-term steroid options like a fluocinolone implant for patients with a good response to initial steroid treatment.

Furthermore, Dr. Rahimy emphasizes the importance of integrating panretinal photocoagulation (PRP) laser therapy for patients with high-risk PDR, particularly those who may be non-compliant with office visits. He stresses the need for patient education regarding the intensive nature of treatment and the potential consequences of non-adherence, especially for patients at risk of significant vision loss.

In summary, Dr. Rahimy provides insights into a comprehensive and dynamic approach to managing complex cases of diabetic retinopathy, highlighting the importance of personalized treatment plans and proactive monitoring to optimize patient outcomes.

Video synopsis is AI-generated and reviewed by HCPLive® editorial staff.

Videos

Ehsan Rahimy, MD, outlines strategies for managing cases of high-risk PDR and DME, exploring new therapies and synergistic combinations with anti-VEGF and steroids for longer-lasting responses.

challenges faced by DME patients showing suboptimal response to standard anti-VEGF treatment, reduce injection burden while preventing vision loss

Managing DME Patients Unresponsive to Anti-VEGF

This is a video synopsis of a discussion involving Ehsan Rahimy, MD, a retina specialist at the Palo Alto Medical Foundation and adjunct faculty at Stanford University School of Medicine. Dr. Rahimy presents a case scenario of a 50-year-old African American male with poorly controlled type 2 diabetes and diabetic macular edema (DME) unresponsive to anti-vascular endothelial growth factor (VEGF) therapy.

The patient exhibits high-risk proliferative diabetic retinopathy (PDR) with visual acuities of 20/80 in the right eye and 20/200 in the left eye. Despite receiving bevacizumab and ranibizumab injections, there is no improvement in vision or central subfield thickness (CST). Dr. Rahimy emphasizes the urgency in managing this patient due to their young age and high visual acuity needs.

He discusses the shift in treatment approach towards achieving dryness earlier in the disease course, highlighting the importance of minimizing injection burden for patients. Dr. Rahimy underscores the complexity of diabetic retinopathy management and the need to optimize treatment responses while reducing the number of treatments to improve patient adherence and compliance.

The case illustrates the challenges and evolving strategies in managing DME in patients with poorly controlled diabetes, emphasizing the imperative for ophthalmologists to prioritize early and effective intervention to mitigate vision loss and enhance patient outcomes in diabetic eye disease.

An expert retina specialist discusses challenges faced by DME patients showing suboptimal response to standard anti-VEGF treatment, emphasizing the need to reduce injection burden while preventing vision loss.

challenges in managing longstanding nAMD patients rotating through anti-VEGF treatments, newer therapies like aflibercept 8mg and faricimab.

Managing a Treatment Experienced Patient with nAMD

This is a video synopsis of a discussion involving Ehsan Rahimy, MD, a retina specialist at the Palo Alto Medical Foundation and adjunct faculty at Stanford University School of Medicine. Dr. Rahimy presents a case scenario involving an 80-year-old Caucasian male with chronic wet age-related macular degeneration (AMD).

The patient, who underwent cataract surgery 13 years prior to the AMD diagnosis, has been receiving injections for both eyes for several years, initially with bevacizumab and later switched to aflibercept. Despite treatment, OCT measurements indicate persistent intraretinal fluid and pigment epithelial detachment. Dr. Rahimy emphasizes the significance of addressing persistent fluid in long-term injection patients.

He discusses tightening injection intervals if fluid persists, considering factors like patient compliance. If fluid persists despite interval adjustments, switching to newer agents such as faricimab or a higher dose of aflibercept is considered. Dr. Rahimy underscores the importance of patient preference in selecting treatment options, noting the availability of multiple options reflecting scientific advancements in retina care.

Dr. Rahimy's insights highlight the evolving landscape of AMD treatment and the importance of tailoring management strategies to individual patient needs. The availability of multiple therapeutic options offers flexibility and optimism for improved outcomes in AMD management, marking significant progress in the field over the past decade.

Ehsan Rahimy, MD, discusses challenges in managing longstanding nAMD patients rotating through anti-VEGF treatments, highlighting the promise of newer therapies like aflibercept 8mg and faricimab.

Retina expert shares his strategy for managing a patient recently diagnosed with nAMD who started on bevacizumab, transitioning to more efficacious therapy.

Beyond Step Edits: Treatment Strategy After Bevacizumab in nAMD

This is a video synopsis of a discussion involving Ehsan Rahimy, MD, a retina specialist at the Palo Alto Medical Foundation and adjunct faculty at Stanford University School of Medicine. Dr. Rahimy explores various scenarios for managing patients with wet age-related macular degeneration (AMD) or diabetic macular edema (DME).

In one scenario, if a patient with 20/30 vision and a central subfield thickness (CST) of 350 microns shows stability in subjective and objective vision without recurrent fluid, Dr. Rahimy advocates for a treat-and-extend approach. He gradually extends treatment intervals from four to twelve weeks, noting some patients even extend up to 16 to 18 weeks post-COVID era, with various agents like aflibercept or ranibizumab.

Another scenario entails encountering resistance to extension after initial success. Dr. Rahimy discusses patient preferences for shorter treatment intervals despite favorable outcomes, while others are motivated to extend intervals. In such cases, he considers switching to branded agents like aflibercept or faricimab to achieve increased durability and extend intervals up to three or four months.

Lastly, Dr. Rahimy addresses scenarios where patients exhibit persistence of fluid despite treatment, indicating a lack of response to bevacizumab. Despite potential vision improvement, achieving complete dryness remains the goal before extending intervals. Early therapy switching may be necessary to attain optimal anatomical outcomes.

Dr. Rahimy's insights underscore the nuanced approach required in managing patients with AMD or DME, considering factors such as treatment response, patient preferences, and the pursuit of optimal anatomical outcomes.

Retina expert shares his strategy for managing a patient recently diagnosed with nAMD who started on bevacizumab, discussing criteria for transitioning to more efficacious therapy.

Ehsan Rahimy, MD

Articles