Retina 2007


Take a look at what happened in the Retina field in 2007 and what exciting developments are round the corner in 2008.

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2007 has been a year of transition in the field of retina therapeutics, surgery and diagnosis. In particular, this year has marked the introduction of the new vascular endothelial growth factor (VEGF) inhibitor class of therapies into most clinics treating age-related macular degeneration (AMD) patients, thus provoking a significant paradigm shift, not only in the way this debilitating disease is treated, but also in patient outcomes and practice management approaches. Innovations in imaging devices have also allowed specialists to improve the way they treat, diagnose and monitor patients, whilst vitreoretinal surgical procedures have continued to benefit from the reduced size of instruments for minimally invasive surgery.

OTE spoke with experts in the field to gauge what they felt made an impact in 2007.

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The money debate: many denied treatmentCombining therapies, combining benefitsWill anti-VEGF monotherapy become redundantBlue blocking benefits?Surgery: minimal invasion equals minimal destruction20G, 23G or 25G? That is the questionWas the imaging & diagnostics sector stagnant in 2007?Diabetics still needlessly going blind2008: the year for combining approaches

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2007: the year of anti-VEGF
Who could ignore the arrival of the anti-VEGF class of therapeutics this year? Although the first drug of this class [Macugen (pegaptanib); Pfizer] was approved in Europe early in 2006, and the anti-cancer agent Avastin (bevacizumab) was also being administered off-label in some clinics, it was 2007 that witnessed the full impact that this new therapy class had on retina clinics and AMD patients across Europe. This explosion in uptake of anti-VEGF therapeutics was largely attributed to the January 2007 approval of Novartis' highly anticipated agent, Lucentis (ranibizumab). Taking centre stage in most retina clinics, the European approval of Lucentis marked a huge turning point in specialists' fight against AMD.

"I began using the anti-VEGF agent Avastin in 2006 and introduced Lucentis into our clinic this year. Although we had been administering Macugen for a period of time, we have since abandoned its use in our AMD patients,- said Einar Stefansson MD, PhD. "These agents definitely mark the most important development in vitreoretinal therapeutics that this decade has witnessed. Their use has come into full force in our clinic this year," he added.

Martine Mauget-Faysse, MD introduced Lucentis into her practice following its approval for use in France earlier this year. "So far, the success we have had with this product has been staggering," she enthused. "No one could have imagined some years ago that these treatments, and their route of administration, would develop so rapidly and be so easily accepted by patients. The consequence of these new treatments is the near total replacement of photodynamic therapy (PDT)," she added.

Professor Albert Augustin and Professor Stanislao Rizzo have been administering anti-VEGF therapy since 2005. "I can now assure my AMD patients that we can improve their visual capacity and quality of life, instead of simply slowing the disease progression or stabilising it, as before," said Professor Rizzo.

It was never going to be easy
It is an acknowledged fact that, because of the regular dosing schedule and follow-up regimen required with anti-VEGF therapy, and because almost all subtypes of AMD are now treatable with this new class of agent, specialists face the unenviable task of reorganising their clinics to accommodate them. In addition, the number of AMD sufferers is expected to rise as the population ages. Taking these factors together, specialists opting to administer anti-VEGF therapy have had to significantly alter their practice management techniques and clinic organisation in order to provide a good standard of care.

"At present, we administer 20 to 25 injections per day, however, this has required a huge organisational and financial effort on our part. In order to administer this treatment, it has been necessary for us to plan a flexible, customized approach for each patient," confirmed Professor Rizzo.

Dr Stefansson agreed that the new therapies are associated with a vast increase in clinic workload. "We perform intravitreal injections in the operating room, which places a huge burden on the staff as well as on operating room schedules," he admitted. "Notwithstanding this, our experience with the therapies is excellent and we are in the process of creating a public health framework around this treatment," he explained.

"We have completely changed our practice to accommodate the new drugs; we now require a reliable team of nurses, orthoptists, secretaries and even a psychiatrist, trained to explain, examine and take care of each patient, so that we can achieve the best possible result," conceded Dr Mauget-Faysse. "Although the burden of this treatment is heavier than with other treatments that we are used to, the majority of our patients are now able to retain their vision and are very satisfied, so I feel the advantages far outweigh the disadvantages," she added.

Dr Mauget-Faysse explained that she tries to provide follow-up monitoring and treatment during the same consultation whenever possible in order to ease the burden placed on the patient and to avoid non-compliance. She also emphasized the importance of patient education and self-monitoring in securing sustainable success of treatment.

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