Following the launch of The Ophthalmologist’s Retina newsletter, we present a round-up of the latest thinking in the field. Here, Robyn Guymer – Deputy Director, Centre for Eye Research Australia, Professor of Surgery (Ophthalmology), University of Melbourne; and Senior Consultant, Royal Victorian Eye and Ear Hospital, Melbourne – gives her view on promising GA treatments and the importance of well-designed phase II trials.
What advances are you most excited about in the retina field right now?
I'm excited about the first treatments for geographic atrophy (GA) being approved in the US and Australia. It heralds a new era in the management of age-related macular degeneration (AMD). The current approved treatments are the first step, as we have never had anything to offer people with GA. Now there are two approved treatments in the USA and one of these, pegcetacoplan, in Australia. This is just the start as there are many more in late stage clinical trials so that more options may be not too far away.
What are the biggest challenges you face with current treatment regimens?
The biggest challenge is the amount of time trainees spend in injection clinics rather than seeing patients and learning disease management. With respect to treatment, it is the less than ideal biomarker of “black gaps” on an OCT that is interpreted as active fluid driven by VEGF. We need a better way to decide if VEGF is still driving fluid accumulation in the retina as we use individualized treatments that require the clinician to determine if the disease is active or not.
What recent clinical data or developments do you think will be most impactful in the next 6–12 months?
Data showing the improved functional testing strategies in GA, which allows better structure functional correlations which will help provide the data needed to get regulatory approval of drugs that reduce GA growth rates.
What advice would you give to companies or researchers developing new treatments for retinal diseases?
Retinal diseases like AMD are chronic, slowly progressive diseases. Interventions, early in the disease, must be the way to go. Undertaking trials early will, by necessity, be longer than companies want. But the payoff if successful will be worth the initial investment. Hence it is crucial to design phase II trials well and have appropriate endpoints, so that only those interventions with strong evidence go forward into phase III, appropriately designed and of adequate duration.
