Ten years ago, the introduction of new drug therapies revolutionized the treatment of retinal disease. Today, Nashville-based physicians are working hard to improve outcomes, lessen the burden of care, and deliver new breakthroughs. Carl Awh, MD, of Tennessee Retina and Amish Purohit, MD, of the Toyos Clinic are two such vitreoretinal specialists.
Since being introduced in 2005, anti-vascular endothelial growth factor medications (anti-VEGF drugs) have proven highly effective at slowing or halting the progress of a variety of disorders, including macular degeneration, central serous retinopathy, diabetic retinopathy and diabetic retinal edema. Prior to the introduction of anti-VEGF medications, there was little retina specialists could do for some patients. Now they can often prevent those patients from going blind, and many patients actually experience improvements in vision when they undergo drug therapy.
“You really can call anti-VEGFs miracle drugs,” Awh said. “Drug therapy remains the gold standard of care for macular degeneration and diabetic retinopathy and diabetic edema. But every tool in our toolbox is important, and we use them as needed to provide the best outcome for each patient. Of course, we’re always looking for new ways to improve care.”
Anti-VEGF drugs are injected directly into the eye, and monthly injections are often required. Awh and Purohit acknowledge that easing the burden on patients would be ideal. Purohit added, “Any injection carries some risk of infection.”
He detailed the financial burdens, as well. “Anti-VEGFs are not inexpensive,” he said. “A cost of $2000 per injection is not untypical. The trend toward higher insurance deductibles means that more of that expense is borne by patients.”
Purohit is enthusiastic about the results he is achieving with laser treatment. While lasers have been in widespread use for decades, Purohit said ongoing advances in laser technology and techniques have created outcomes that rival those achieved with anti-VEGF medications.
At the Toyos Clinic, the Iridex® IQ577™ Laser System is one of the tools Purohit uses to treat retinal disorders. The manufacturer’s materials describe the IQ577 as “a true yellow wavelength laser that incorporates proprietary MicroPulse™ technology” to deliver “tissue-sparing therapy.” Purohit said that the IQ577 has proven effective in the treatment of central serous retinal disorder, diabetic retinopathy and diabetic edema.
However, care plans are individualized. Toyos Clinic physicians might treat a patient with injections, the IQ577 Laser System, or a combination of both. Purohit said laser treatment regimens also vary. In mild cases, a single treatment might provide lasting results. In more advanced cases, three, four or more treatments a year could be necessary.
“Patients are treated at the clinic, and each treatment usually takes less than five minutes,” Purohit noted. “The current cost is $1000 per laser treatment, and that treatment carries lower risks of infection and retinal detachment than injections. The IQ577 can provide outstanding results while significantly reducing the patient’s burden of care.”
Purohit mentioned one case involving a patient with central serous retinopathy who came to him for a second opinion. She had been told her treatment options were exhausted. “I was able to treat her with the laser, and she has experienced significant improvement in her condition,” Purohit said.
Currently, the Toyos Clinic is the only practice in the Nashville area using the Iridex IQ577 Laser System. “I am surprised this model and the techniques we use are not in far more widespread use,” Purohit remarked. Though the Iridex IQ577 is not currently used to treat macular degeneration, Purohit said he has begun “looking into developing a clinical trial for macular degeneration applications.”
At Tennessee Retina, Awh is well aware of the advances in laser treatment devices and techniques. However, he believes refinements and advances in drug therapies offer the most promising opportunities in the fight against retinal diseases. “I’m a surgeon, and I love what I do,” Awh explained, “but at this particular moment, I feel the most compelling, immediate breakthroughs will involve pharmaceuticals.”
This summer, Tennessee Retina will be one of the few practices in the country involved in sponsored Phase II clinical trials for new retina drug therapies. Awh is understandably excited about the practice’s participation.
He touched on three different approaches that will be put to the test. The first involves the placing of an implant in the cell wall of the eye. The implant is actually a tiny reservoir designed to store and dispense a special formulation of LUCENTIS® (ranibizumab), an anti-VEGF drug with a history of success. The implant offers tremendous potential to reduce or even eliminate the need for monthly injections. Two other trials focus on the use of topical and oral medications, again with the goal of reducing or eliminating the need for monthly injections.
The efforts of Awh and Purohit could not be timelier. America’s type 2 diabetes epidemic has brought significant increases in co-morbid retina disorders. Retina specialists now find themselves on the front lines of a healthcare crises. The use of new devices, techniques and medications that improve outcomes while reducing the burden of care will become increasingly important in the coming years.
###
TAGS: ; ; ; ; ; ; ; ; ; ; ; ; Iridex IQ 577 Laser System; LUCENTIS; Ranibizumab
PHOTOS: Headshots of Dr. Carl Awh and Dr. Amish Purohit. Plus manufacturing pics of the Iridex® IQ™ 577 Laser System and LUCENTIS®.
RELATED LINKS:
Iridex® Lasers: www.iridex.com
LUCENTIS®: www.lucentis.com
Tennessee Retina clinical trials: www.tnretina.com/Clinical_Trials/