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In Focus: Age-related Eye Diseases and Latest Innovations in Ophthalmology

During the Ophthalmology Innovation Summit at the American Society of Cataract and Refractive Surgery congress 2019 (OIS@ASCRS), held in San Diego, California, a panel of leading experts in research and development in ophthalmology, led by Dr. Richard Lindstrom, founder and attending surgeon at Minnesota Eye Consultants and adjunct clinical professor emeritus at the University of Minnesota, discussed recent global trends and their impact on innovation in ophthalmology.

Experts’ take on innovations in eye care 

Undoubtedly, the aging population is one of the biggest concerns in eye care. “Above the age of 65, cataract, glaucoma, retinal diseases and dry eye-related problems become more significant,” said Dr. Lindstrom. “In addition, the millennial population is huge, and innovations in ophthalmology are needed to address growing problems related to refractive errors utilizing pharmacology, corneal surgeries and lens surgeries.”

A member of the panel, Dr. Jag Dosanjh, senior vice president, US Eye Care at Allergan, noted: “Costs associated with age-related eye diseases are rising significantly across the globe. Therefore, it will be increasingly important to think of how we generate data to support payment and continued innovation in the long term.” Furthermore, Dr. Andy Corley, principal consultant at Yelroc Consulting, shared his thoughts on opportunities and risks associated with innovation. 

“Every time you watch the news, you hear that the U.S. healthcare budget is 20% of the domestic gross national product (GNP), and there’s a good reason for that,” he shared. “That’s what seems important to the people of this country. We seem to be extremely privileged in the eye world because vision is so valued that people will pay for it.” 

As to risks to innovation, he noted: “The larger the market, the better the chances of recovery, so innovation has less risks in large markets.”

On the other hand, Dr. Ali Satvat of the private equity firm KKR shared: “What we have seen outside traditional U.S. markets, largely in the emerging globally, is a growing demand for good quality eye care. Historically, devices and pharmaceutical products are where the opportunities have been.” 

Meanwhile, Tom Frinzi, worldwide president, Surgical, Johnson & Johnson Vision, affirmed that  people are living longer, healthier lives and the demand on ophthalmologists is increasing. “The result of this will be that doctors of medicine (MDs) will be more occupied performing eye surgeries and less available for standard medical care, which will drive a symbiosis between MDs and optometrists,” he shared.

Innovation: What drives it?

The recent years have witnessed numerous mergers and acquisitions across small and large companies. Dr. Lindstrom and panelists discussed whether mergers can dampen innovation. 

“Both big and small acquisitions have been instrumental in driving innovation,” noted Dr. Finzi. “Either it’s a big or small acquisition, it is healthy and helps foster the innovation ecosystem.”  

Dr. Corley also shared his opinion on this subject. “A key consideration on risks is the strength of the technology,” he said. “Is the technology an improvement or a breakthrough? The answer to this will guide the amount of investment needed.” Furthermore, he stressed that innovation is risky, and there are pitfalls in every part of the innovation cycle. “When you get to the point of commercialization, ensure that you’ve actually got something that can live in the market.”

Meanwhile, Dr. Ali Satvat described some peculiar factors associated with the innovation cycle in ophthalmology. “I think what’s interesting about innovation in ophthalmology is the presence of a really strong ecosystem where you have the clinician involved and the more you can get that feedback of how a new product is going to work not just in a theoretical boardroom, but when it’s actually out there in the hands of a practitioner.”

More discussions among the panelists focused on areas of unmet needs. Dr. Lindstrom noted: “One area that is expanding globally, and which demands increased human and financial resource investments, is in the management of refractive errors. When I entered ophthalmology, 25% of the US population was myopic. Now its 42%.” 

Finally, panelists suggested that with a potential increase in age-related conditions, there’s need for more technology-driven innovation in eye care.

Shining light on glaucoma

In glaucoma, vision loss is caused by death of retinal ganglion cells. Today, there are several ways of measuring retinal ganglion loss, including optical coherence tomography (OCT) based measurement of retinal cell bodies and adaptic optics, which facilitate direct counting of ganglion cells in the retina. 

Dr. Vivek Srinivasan and colleagues from the UCSD presented data on their latest work on the early ganglion cell changes in glaucoma. Their work was supported by the Glaucoma Research Foundation, a non-profit nationwide research foundation at the forefront of funding research aimed at improving the treatment of glaucoma.

“Early glaucomatous changes in retinal dendrites precede changes in retinal cell bodies,” said Dr. Srinivasan. “Notably, ganglion cells that connect in the plexiform layer have been shown to demonstrate the earliest changes.”

But how do we apply this knowledge into early detection and treatment of glaucoma?

Dr. Srinivasan and colleagues tried to determine early time points when cells are degenerating before they die. This discovery could revolutionize patient diagnosis, facilitating treatment in earlier stage, and perhaps the triaging of cases to treat more aggressively to prevent vision loss. 

OCT imaging can be a useful biomarker. “With OCT, we know we can improve resolution by increasing the bandwidth,” shared Dr. Srinivasan. “However, we took the approach of reducing the wavelength. Instead of using infrared light as done on commercial OCTs, we switched to visible light wavelength to enable us to get micron level resolution, and potentially, sub-micron resolution in the future. We designed and built a visible light OCT system and optimized it over several years, working with several collaborators.” This system was deployed in the Stanford University Eye Clinic.

Dr. Srinivasan and colleagues arrived at astounding results. “We found that the bands that were not visible in the outer human retina have become visible,” he noted. “Particularly at the outer edge of the retina, we can see thin bands corresponding to Bruck’s membrane, which is particularly valuable in evaluating age-related macular diseases.” 

He added that using their platform, the sub-laminations of the inner plexiform layer of the retina also becomes visible and measurable with more averaging, and reflective changes can be measured as well. “These additional measurements provide better calibration of patient monitoring in glaucoma,” he shared.

In conclusion, Dr. Srinivasan said: “These measurements are currently being used in clinical studies in patients with varying degrees of glaucoma, as well as in patients undergoing novel neuroprotective regenerative therapies.”

Editor’s Note: OIS@ASCRS was held in San Diego, California, USA, on May 2, 2019. Media MICE Pte. Ltd. and CAKE Magazine are official media partners of all OIS events. Reporting for this story also took place at OIS@ASCRS 2019.

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