So it is a lot less invasive. Do they still need to lay flat like they do with surgery?
Dr. Haller: No. That is one of the huge advantages particularly for macular hole patients because those patients normally not only are having an operation, but their eye is filled with a temporary gas bubble and they have to actually keep their head down so that the bubble pushes up against the edges of the hole and that means that they have got to have face-down positioning. Of course they have the normal postoperative medications and they have up to a month or so where they cannot fly in an airplane. They have severe motility restrictions as well as the standard risks of any operation, such as bleeding, infection, retinal detachment, and virtually everybody gets cataract progression as well as a cataract operation.
How does that compare then with the new medicine?
Dr. Haller: It is like night and day. Within a few days, your symptoms are gone. You have got recovery of vision. You have none of the risks of surgery, none of the postoperative positioning requirements or medications, far less expense, far less inconvenience, and far less down time. It is really miraculous.
So you don’t have to worry about cataracts and you don’t have to worry about being facedown?
Dr. Haller: Exactly. That inconvenience and side effect is a deal breaker for some people. They decide they are just going to live with really no functional central vision in one eye rather than have surgery. It is paradigm shifting for us. It is something that the ophthalmology community and particularly retina specialists are very excited about.
It does not prevent cataract?
Dr. Haller: It prevents the type of cataract that develops after retinal surgery, because you don't have to have retinal surgery. You don’t have the cataract surgery that you inevitably would need following the macular hole operation.
So, the majority of people would be interested in this if they are aging or near sighted?
Dr. Haller: Yes. The population that this would apply to is people who are developing this aging process in the vitreous. It tends to be people who are in their 50s, 60s, 70s, and older. Women, more than men, get macular holes. It is more common in people who are near sighted than in people who do not need to wear glasses for distance vision. It is potentially applicable to a host of other even more common diseases, but we have to test them. So, there is some thought that it may be valuable even in diseases as common as macular degeneration and diabetic retinopathy, but, that remains to be seen. There is a lot more work to be done. It is a very exciting new drug and we think it may be applicable to a lot more diseases.. For example, in diabetics, the most severe blinding complication of diabetes is when you have abnormal blood vessels that grow up out of the retina and they grow onto the back of the vitreous gel. The vitreous gel serves as a scaffold for them to grow. So, if you could remove that scaffold, there would be nothing for them to grow on. Potentially, you could save that most complicating and blinding form of diabetic disease from happening. Now, that has not been proven yet. It’s just a potential application, but that is one we are very excited about.
With this drug you can catch it early, instead of having to wait until they are nearly blind like they would do with the surgery?
Dr. Haller: Exactly. We know that if you operate at an earlier stage patients do better, but they also incur the risk at an earlier stage. So potentially as soon as people start to become symptomatic and have problems, we can offer them this as an alternative to surgery, a pharmacologic surgery and then they do not need to go onto an actual operation.
* For More Information, Contact:
Wills Eye Institute