A Year in Vision

Here is a collection of great things that happened, things we learned, and things to look forward to… and this is only a snapshot of the hive of activity occurring in this wonderful field.

Great stuff!

• December 19, 2017 saw the approval of the first gene therapy for retinal disease – Luxturna (voretigene neparvovec; Spark Therapeutics). Indicated for the retinal diseases Leber's congenital amaurosis and retinitis pigmentosa resulting from mutations in the RPE65 gene, this AAV2-based therapy delivers functional copies of the RPE65 gene to retinal pigment epithelium (RPE) cells, restoring functional vision. It might come with a high price tag for now, but it is an exciting step in curing a previously untreatable form of retinal disease. Currently available in the USA, the pharmaceutical company Novartis have purchased commercialization rights for outside the US and are looking to bring the treatment to Europe.
• Two separate teams have reported successful stem cell treatments for both wet and dry age-related macular degeneration (AMD). In a landmark study at Moorfields Eye Hospital, London, UK, four patients with severe wet AMD who received a patch of RPE cells (derived from human embryonic stem cells [hESCs]) gained vision. Across 'the pond', a team of Californian researchers reported phase I study results showing functionality and safety of their CPCB-RPE1 (full name, California Project to Cure Blindness-RPE1) implant. In four patients with severe dry AMD, the implant was reported to be safe. As AMD is the most common cause of age-related blindness in the developed world, the results show promise that patients might have a future alternative to monthly eye injections, especially for patients with dry AMD, for which there is currently no available treatment.
• In a landmark study, a collaborative team of researchers based in the UK and USA identified over 100 genetic variants that are associated with primary open-angle glaucoma (POAG) – the most common type of glaucoma. The team hope that their findings will aid in future screening programs for people at risk of developing glaucoma, as well as further understanding on how the disease develops and how best to treat it.

Things we learned

• Drinking hot caffeinated tea is associated with a reduced risk of glaucoma! Brew anyone?
• The eye – widely considered free of resident flora and fauna – has a commensal bacteria that lives on the cornea. But don’t worry, Corynebacterium mastiditis has been shown to protect the surface of the eye from pathogens.
• A 67 year-old woman presenting for cataract surgery was found to have 27 contact lenses behind her eye!

Things to look forward to

• Ophthalmology and vision science is a ‘tech-loving’ field, and many more technological advances can be expected. With technology such as robotic eye surgery, artificial intelligence (AI) and deep learning, virtual reality, and advanced imaging techniques under intense research, there is a lot on the horizon to look forward to. In March 2018, Action Against AMD (an organisation formed of three sight loss charities including Fight for Sight) formed a partnership with the AI company, Benevolent AI, to further understanding of AMD. As part of this, Benevolent AI will use an AI platform to study millions of sets of data and clinical papers in a quest to identify new features of the disease and its treatment.
• Keratoconus is a disease where the eye takes on a cone shape due to progressive weakening of the cornea. Currently, keratoconus is treated through a procedure called corneal crosslinking (CXL), which stiffens and flattens the cornea. Now, there may be an easier solution on the horizon – eye drops. A team of researchers from iVeena Delivery Solutions are currently working on IVMED80, a topical medication for the treatment of keratoconus. The magic ingredient? Copper! Results from pre-clinical studies are promising, so keep watching for the soon-expected clinical trial data.
• Disease biomarkers are a hot topic, with many vision researchers pursuing ways to detect eye diseases faster and more accurately, so that patients can be diagnosed and treated earlier. One such example is DARC, a new technology that can detect cells dying in the retina – and it might one day be in the clinic and helping to detect diseases such as glaucoma earlier.
• Right now, retinal prosthesis technology is available for some people who have lost vision to retinal disease. Whilst revolutionary technology, several groups are continuing this work to improve the quality of vision that is restored to patients who receive them.
• As mentioned above, the dry form of AMD is currently untreatable. With a research group in California showing feasibility of a RPE implant in patients with AMD, and many researchers focusing on the condition as well as how best to assess potential treatments, there could be a solution on the horizon!
• Cataracts are the most common cause of treatable blindness worldwide, but as many developing countries are underserved in terms of eye care, millions of people worldwide are blind – and waiting to be treated. With many dedicated teams across the world working tirelessly to disseminate surgical education and equipment – as well as develop low cost technologies for cataract extraction – an end to global cataract blindness could one day be in sight.

Ruth Steer is Managing Editor of The Ophthalmologist