National Eye Health Week - Progress in treatments and research

With eye health in the spotlight during National Eye Health Week, Christiana Dinah, an ophthalmologist at Central Middlesex Hospital has talked about the progress being made in research and treatment for macular disease. 

"The introduction of anti-VEGF injections in 2006, with Lucentis approved by NICE in 2008, has changed the outlook for hundreds of thousands of patients suffering with wet age-related macular degeneration (AMD). The number of intravitreal injections delivered worldwide has risen exponentially, with 388,000 intravitreal injections delivered in 2015 in the United Kingdom alone. Whilst the two currently available licenced drugs, Lucentis and Eylea have proven effective in improving visual acuity in some patients with wet AMD and stabilising vision in the vast majority, there continues the search for effective and longer-acting treatments to reduce the burden of treatment on patients

"To this end, treat and extend regimes are now used in most eye clinics, to pro-actively treat the disease whilst lengthening the interval of treatment on an individual basis. In addition, on the horizon, are longer acting agents that may be more efficacious in keeping the macula dry for longer. One such drug Brolucizumab, has been found to work for up to 12 weeks in approximately 50% of patients. It is soon to be assessed by NICE. Something else on the horizon is a surgical implant, known as a port delivery system, which slowly releases Lucentis into the eye, with refills required from anything between eight to 15 months. This implant is now in phase three trials and is currently being refined to reduce any complications which could happen during surgery.

"Sadly, it is still a fact that there is no treatment for geographic atrophy, the advanced form of dry AMD. However, our knowledge of this disease and the contributory causes has grown exponentially in the past two decades. Whilst the causes are multifactorial, we now know that the complement system, which is meant to assist our immune system to attack germs, plays a major role in driving the chronic inflammation that leads to death of cells in the disease. 

"Excitingly, phase three trials are now underway looking at the effects of APL-2, a complement C3 inhibitor, which has demonstrated the ability to slow the progression of dry AMD. The APL-2 phase three trial, called DERBY, will be taking place in 15-16 sites across the United Kingdom.

"Lastly, in Oxford, the first patient treated with gene therapy for dry AMD was announced in February this year. In this particular therapy the cell starts making a protein that we think can modify the disease, correcting the imbalance of the inflammation caused by the complement system. Up to 10 patients will be treated with this technique and we should hear more about early results sometime next year.

"These are indeed exciting times in macular disease research and I am hopeful our patients will see the fruit of this work in the clinics within the next few years."

Christiana Dinah