WHERE TO NEXT?

Neovascular AMD has been changed from a hopeless ordeal into a largely treatable condition, as has diabetic retinopathy, at least in those patients who present early enough and possess the willpower to follow through with their treatment regimens.

Surgery can correct the structure of the retina, and intravitreal injections of anti-VEGF and steroids can improve its function. The respectable results across the board allow me to be in quite good spirits after a day in the vitreoretinal operating room. The same can be said for my colleagues in medical retina.

But at the end of every day in the hospital, I walk past the ophthalmic genetics clinic, where Bart Leroy MD, PhD, the chairman of our ophthalmology department, diagnoses genetic disorders such as Leber congenital amaurosis type 2 and retinitis pigmentosa. Within his field, his research and diagnostic work are world-renowned. But the therapeutic options he, or anyone else, can offer to patients suffering from inherited eye diseases leave much to be desired. They are in a similar position as ophthalmologists were with neovascular AMD years ago: make the diagnosis, provide counselling, and irrationally hope it doesn’t turn out as poorly as one knows it will.

So what is one of the next frontiers in retinal disease? Gene therapy. Although many remain sceptical, the trials that are now being reported show that the results are encouraging and that gene therapy has a strong and lasting effect in vivo. The Lancet will soon publish a paper, of which Prof Leroy is co-author, describing the results of gene therapy in the second eye of patients suffering from childhood-onset blindness due to RPE65 mutations. This is exciting.

MAKING A DIFFERENCE

Prof Leroy has an active involvement in the gene therapy studies at the Children’s Hospital of Philadelphia, USA. This collaboration will lead to the participation of our centre, Ghent University Hospital, Belgium, in future gene therapy trials.

Until then, we as retinal specialists involved in day-to-day clinical cases will concentrate our efforts on the problems which we regularly encounter: preventing the proliferative vitreoretinopathy that can destroy an otherwise successfully treated retinal detachment; figuring out why macular hole closure does not necessarily mean visual recovery; and deciphering the reason(s) why neovascular AMD, despite optimal anti-VEGF treatment, can sometimes end up atrophic.

In this edition of EuroTimes, I have also reported on my experience of treating a victim of the recent terrorist attacks in Brussels. Ophthalmologists are occasionally called on to make a difference in people’s lives outside of routine, scheduled surgery. This can make our work engrossing, and motivates us to stay sharp and expect the unexpected.

The same mindset applies to the cutting edge of retinal disease. If the gene therapy trials require surgical intervention, my vitreoretinal colleagues and I would be delighted and honoured to participate.