Letting the Good Times Roll in Retina

American Academy of Ophthalmology 2013

Carl D. Regillo, MD; Allen C. Ho, MD; Sunir J. Garg, MD


December 04, 2013

Editorial Collaboration

Medscape &

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In This Article

Developments in Wet AMD

Carl D. Regillo, MD: Hello. I'm Dr. Carl Regillo, Chief of the Retina Service at Wills Eye Hospital in Philadelphia. Welcome to Medscape Ophthalmology Insights, coming from the Academy of Ophthalmology (AAO) meeting in New Orleans. This is part of a series of commentaries produced in cooperation between Medscape and Wills Eye Hospital.

Joining me today are Dr. Allen Ho and Dr. Sunir Garg of Wills Eye Hospital. Dr. Ho is the Director of the Retina Service at Wills Eye, and Dr. Garg is Associate Professor on the Retina Service at Wills Eye.

We will be discussing the latest developments in retina presented at this year's meeting, and there is a lot to talk about. It's been an exciting meeting with a lot of new developments. Let's start with wet age-related macular degeneration (AMD). What do you think are the biggest developments in wet AMD at this meeting?

Allen C. Ho, MD: The biggest developments in wet AMD were the results of some of the clinical trials, both positive and negative results. For example, in the LUCAS study,[1] we learned that a treat-and-extend approach comparing bevacizumab with ranibizumab yielded equivalent results with no new safety concerns. That was important because we previously didn't have a treat-and-extend study including that many patients.

Dr. Regillo: Sunir, what did you think was top news in wet AMD?

Sunir J. Garg, MD: One thing that we were hoping was going to pan out was an eye drop used to treat wet AMD. Unfortunately, those data didn't look very good, and I am not sure that this current molecule has much of a future.

Dr. Ho: I would agree, with the emphasis on the current molecule, because other eye drop molecules are in development right now that may be different, and therefore we can't cross off that category or that delivery system yet for our patients. We need something better for the treatment burden of wet AMD.

Dr. Regillo: You are speaking specifically about pazopanib,[2] the kinase inhibitor eye drop that was tested at phase 2 and didn't show a signal for efficacy. Is that how you took it?

Dr. Garg: Exactly. We were hoping for more.

Some Areas Still Need Work

Dr. Regillo: What about radiation therapy? Is that going to be part of what we are going to see in the future on the basis of what was presented at this meeting?

Dr. Garg: There has been a lot of interest in it over the past few years. The current studies suggest that there might be some benefit; however, I don't know whether it is going to change how we treat patients on a day-to-day basis.

Dr. Regillo: What are the benefits? Better vision? Fewer treatments?

Dr. Garg: Fewer treatments. Patients often have to come in monthly or every other month for treatment, which becomes a big burden on the patient and their families. If you can keep them out of the office, that would be great. That was the hope with radiation, but it wasn't as impressive as I was hoping it would be.

Dr. Regillo: How is designed ankyrin repeat protein (DARPin) looking? We have been hearing a lot about DARPin. It's now in phase 2 testing. Will that be an antivascular endothelial growth factor (VEGF) agent that will give us an extended durability of effect?

Dr. Ho: What is attractive about the Allergan DARPin program is that the molecule is a different kind of molecule to inhibit VEGF. They believe that binding affinity is increased, with potentially longer duration of action.

We know from the presentation by David Callanan[3] that we still need to do a little work on formulation. So the answers are still out there. We don't know the answers quite yet. But there is some promise there. We shall see.

Dr. Regillo: What is the issue with formulation?

Dr. Ho: The issue with formulation was inflammation that some of the patients experienced.

Dr. Regillo: Have we seen that decreasing as the formulation is evolving? Is it looking any better now in phase 2 than in phase 1?

Dr. Ho: There is a little bit of improvement, but they need to improve it more.

Dr. Regillo: The LUCAS study was much anticipated for quite some time because all we have had are smaller treat-and-extend-style therapies, and this was the first large prospective study that actually showed that treat-and-extend, whether with bevacizumab or ranibizumab, can have very good results. The mean number of treatments in year 1 was 8, and they achieved visual acuity results that looked good, on par with what you would expect with frequent fixed therapy -- for example, ranibizumab in MARINA and ANCHOR.