Angiogenesis 2023: Dry AMD and ellipsoid zone integrity

Justis Ehlers, MD, discusses examining imaging biomarkers for progression risk in dry AMD from his presentation at the Angiogenesis, Exudation, and Degeneration 2023 conference with David Hutton, Executive Editor, Ophthalmology Times®.

Video transcript

Editor’s note: This transcript has been edited for clarity.

David Hutton:

Hello, I'm David Hutton of Ophthalmology Times. Dr. Justis Ehlers presented "Ellipsoid Zone Integrity in Dry AMD: An Imaging Biomarker for Progression Risk and Clinical Trial Endpoint" at the Angiogenesis, Exudation, and Degeneration 2023 conference. Thanks for joining us today. Tell us a little bit about your presentation.

Justis Ehlers, MD:

David, thanks so much for the invitation, and for the introduction. I'm excited to share with the viewers today some background around our presentation that we just presented at the Angiogenesis meeting. As you know, dry macular degeneration is really becoming a great area of interest within retina.

We have multiple potential therapeutics that are not that far away from potentially being used for our patients. And many other potential therapies in development and to try to understand how we can intervene earlier and earlier in this disease to prevent vision loss.

One of the big questions that we have as clinicians is really identifying those patients that may benefit most from therapy. But also as we get to earlier stages of the disease — identifying those patients that are at greatest risk for progression, to potentially enroll in clinical trials and to be able to complete those clinical trials in a faster way. And that really led to some of the basis of the work that we've been developing here at the Cleveland Clinic, which is focused on particularly quantitative assessment of the ellipsoid zone. Which is an outer retinal band, that's a surrogate for photoreceptor health, and when it's gone — photoreceptor loss.

What we've found in looking at this is it may be a very early leading indicator of progressive dry AMD, even at the intermediate stage before developing geographic atrophy. And using now advanced technologies, such as machine learning, we're able to potentially integrate this into essentially profiling patients for risk stratification, as well as understanding therapeutic intervention. So for example, we're seeing in some emerging therapies, that there's preservation of the ellipsoid zone in reduction of progression over time. Which means that you're saving photoreceptors.

So we think this is an exciting area to continue to look at both in terms of clinical trial use, but then as we start to use these therapies with clinicians, to be able to deploy these technologies and use them to better understand which patients might benefit most from treatment.

Hutton:

What's your next step in this research?

Ehlers:

Well, there's 2 things that we're really looking at. One is how to potentially optimize it for automatic use. Where you're not needing any sort of human intervention that could be deployed in a clinical decision assist tool or something along those lines that clinicians could use. But also continuing to refine it and better understanding the disease itself.

So we're looking at a large natural history study, to really understand the cadence of easy loss, or photoreceptor loss, to geographic atrophy progression. And then also working with many of our collaborators in the drug development teams, to understand as emerging therapeutics come along how this may play a role in understanding those therapies and how we might be able to use this as a biomarker tool.

Hutton:

And ultimately, what can this mean for patients?

Ehlers:

Well, I think that the biggest thing is understanding — the questions we always get is, "Am I going to go blind? Am I going to lose vision?" And with intermediate AMD in particular, we have studies that look at this long term. Some patients still progress faster than expected. And our hope is that this may be able to give us a much better tool to understand prognosis and to get those patients who need it, to therapy sooner.