EyeCon 2023: Learn the ADCs of managing ocular toxicities in patients with cancer

Mile Brujic, OD, FAAO, shared his knowledge on antibody drug conjugates (ADCs) and their effect on eye care alongside Jennifer Loh, MD, during the EyeCon 2023 conference, December 1-2, at the Marriott Sanibel Harbour Resort and Spa in Sanibel, Florida. Brujic also presented "Innovation in Your Practice" with Adam Ramsey, OD, of Socialite Vision in Palm Bean Gardens, Florida.

Video transcript

Note: This transcript has been lightly edited for clarity.

Emily Kaiser Maharjan:
Hello, I'm here with Dr Mile Brujic, who presented at the Optometry Times EyeCon this past weekend. Welcome, Dr Brujic.

Mile Brujic, OD, FAAO:
Yeah, welcome. So nice to be here with you and sharing with you about the weekend's events.

Kaiser Maharjan:
Yeah, of course, it's always a pleasure to have you. So you presented, "Managing ocular toxicities in patients with cancer: Understanding ADCs," with Dr Jennifer Loh. Can you tell me more about the topics discussed?

Brujic:
Yeah, and I think this is an important one, because it's just, it's not discussed a lot, because it's new territory for eye care providers. So I'll give you a brief summary here.

Antibody drug conjugates [ADC] are a new category of medications for cancer patients. And there's several that are being used, some in ovarian cancer, some for breast cancer. But the reason why we're discussing this and talking about it is they work through a real unique mechanism of action. And it's an antibody that's actually targeted to specific receptors on cancer cells. So they're more specific for these cancer cells. And they actually contain their chemotherapeutic agent bound to the antibody. So it's inactive until it binds to that cancer cell. And again, it's typically very specific for that cancer cell. When the cancer cell takes that antibody in, it then cleaves the essentially toxic portion to that cell inside of the cell, and then it does its damage.

Now, interestingly, there are some side effects that have actually been reduced with this category of medications. But we've seen in eye care actually a bump in ocular toxicities. And what we see associated with it is something called MECs or microcystic epithelial changes on the surface of the eye. And that's really what the whole conversation was about.

Kaiser Maharjan:
Fantastic. And can you tell me a little bit about why this is such an important topic to discuss at a meeting like this?

Brujic:
Yeah. 100%. So right now, these these medications that only been available for about a year to 2 years, so we're learning as we're going. And one of the specific protocols we have in place at this point is to see these patients who are being treated with these ADCs or antibody drug conjugates, approximately every 6 weeks, which is every other treatment cycle. Because normally these individuals are receiving infusions every 3 weeks.

But the thing that's most important is that there's a protocol in place at this point that's been well-established with the oncology and the eye care community. And that is for people that are on these antibody drug conjugates to start using topical corticosteroids or prednisolone acetate 1% 6 times a day, starting the day before their infusion, then continuing that course for 4 days total. So 3 days after that. And then they dropped down to QID dosing regimen for 4 days after that, and then they stop the medication. So there is a specific protocol in place, which means that we just need to be seeing these patients a little bit more frequently, initially, during that first 6 month time period.

Kaiser Maharjan:
Fantastic. That's super interesting. Thank you for sharing. You also presented on innovations. Can you tell me more about that?

Brujic:
Yeah. So our space in eye care has just been, I'll say it very bluntly, overwhelmed with new technologies. And there has been so many things that we've been introduced to that are fundamentally changing clinical practice. There are new tear diagnostics, where we can sample or test tear samples to become more directed in terms of the way that we're caring for dry eye patients. There's new treatments for geographic atrophy, this condition, this type of macular degeneration that we really never had any true treatments for. There's also eye wear that's now approved for migraine sufferers. We even talked a little bit about practice management and outsourcing practice management things, billing and coding, not necessarily requiring that to be on site. But also this whole topic or this whole concept of virtual assistants, which is really exploding within eye care and providing some level of assistance without actually having people physically in the office.

So it was truly a unique discussion, and it surrounded itself around the innovations in eye care. Not only the technical aspects, where we now get to treat patients differently, but in addition to that, also some of the ways that the business processes are being performed.
Yeah, absolutely. I mean, innovation is not just technology. It's, you know, ideas and how we're moving the industry forward. So that's absolutely wonderful.

Kaiser Maharjan:
So you are a prolific speaker. You've been to quite a few conferences, to say the very least. What makes EyeCon stand out to you?

Brujic:
You know, I think the one thing like if you were to ask me, "Mile, sum it up in one sentence." This was a hyper-focused track around innovation. There was very little that I walked out of the conference with saying, "Oh, yeah, I kind of knew about that." I mean, these were all new topics, all relatively relevant with things that were topics and discussion points that I could actually take back to clinical practice and say, "Oh, yeah, I'm gonna be able to use that and implement that change based on the knowledge that I received with patient care when I get back into the office on Monday."

The other thing too, is I think the faculty was just so approachable. So it's in an environment that really allows a lot of discussion amongst faculty and the attendees. I think for those 2 reasons, it is just a unique dynamic that really fosters a lot of conversation. It's not dumping data to attendees. It's very interactive. And again, it's one of these intimate experiences where you can really kind of pick the brains of the experts in the field on these various topics.

Kaiser Maharjan:
Oh fantastic. Is there anything else that you'd like to add?

Brujic:
I just think, you know, for 2024 I'm just really excited to see what Optometry Times and the PER group have in place for this conference. I know that the last few years have been phenomenal. And I can already see this year compared to last year, it's even building. So it'll be interesting to see what happens in the next year or the coming year.

Kaiser Maharjan:
Well, we're very excited to keep moving forward as well. So Dr Brujic, thank you so much for taking the time to chat today. It was a pleasure as always.

Brujic:
Thank you.