Veeral Sheth, MD: Promising Developments from the Past Year in Retina

Veeral Sheth, MD

Another year has brought promising developments within ophthalmology and specifically within retina, from the approval of new treatments for age-related macular degeneration (AMD) and diabetic macular edema (DME) to the potential of first-time agents to slow growth in geographic atrophy (GA).

In a new interview, Veeral Sheth, MD, Director of Clinical Trials, University Retina and HCPLive Advisory Board member, joined to discuss what the past year has really meant for the clinicans in the larger eye care arena and how these game changing advancements may transform patient care.

Looking at the past year, what has really defined the year in retina, whether it's a new drug approval, big data from a landmark trial, etc. How will it be remembered in the near future?

I think there's going to be a couple of things that people look back on this year. Anytime we have a drug approval, I think that's always a big deal. For those of us involved in research and development we know it can take years and years for a product to come to market, not to mention that there are a number of treatments that don't end up making it. So when one does make it to market, it's pretty remarkable.

This year, we had faricimab-svoa (Vabysmo) approved in February of 2022. We’ve seen the usage really pick up especially over the last few months, because I think people are seeing good efficacy and good safety. That's always a good thing for us, because ultimately that will allow us to provide better care for our patients.

And if you look at where all the research and development is kind of pointing to, it's to two different things right now. We are looking at new mechanisms of action and more durable treatment options. This treatment option in particular is a great step in that direction. It's really good to see these wins.

That aside, I think there's a lot of excitement on future developments. This year was a big year for gene therapy. There are also new mechanisms of action being looked at by different pharma companies such as Unity, Opthea, Ashvattha and others. I think this robust pipeline is something to really be excited about.

One of the other big areas for the year have been the advancements in geographic atrophy and promising agents that are potentially near FDA approval. What are your feelings on being this close to an agent for GA and what it means for this patient population? Are they meeting that unmet need?

I think you hit it on the head, this is really the next area of excitement in our field. We have been treating things like diabetic macular edema (DME) and neovascular macular degeneration for over a decade. Having multiple potential treatment options for an unmet need like geographic atrophy is an exciting place to be. The real discussion now is going to be how we end up using these treatments, who we end up treating, and really the value that physicians, patients, and the community perceive with these newer treatments.

For me personally, I'm very excited about the two potential new agents with Iveric Bio's treatment [avacincaptad pegol] and Apellis' treatment [pegcetacoplan]. Patients are finally going to have some hope that we can really slow their disease down. These are some of the most difficult patients in our clinic.We have to have tough conversations with patients day in and day out and many times we’re delivering bad news. Today, these patients come in each visit seeing worse and worse and noticing the effect on their lives.

To be able to finally do something for these patients and have a positive impact is why we do what we do, whether it's in clinic or with the clinical trials that we're involved in.

What are you excited about going into next year? What area in retina deserves more focus or emphasis in 2023?

As far as what needs more focus, that's tricky because we have so many things that we're working on, and each of these things need a lot of focus. We've seen a lot of progress with gene therapy, but there's still a way to go to get to the finish line. I think that a lot of focus is being put on that and for good reason given how much of a game changer gene therapy could be for our patients and reducing treatment burden.

One thing that we are starting to see some early work on is regenerative therapy. Specifically we are seeing work on being able to bring back cell tissue, photoreceptors, retinal pigment epithelium (RPE) cells, which will hopefully translate to potentially bringing back vision. The big issue with certain diseases, geographic atrophy being a good example, is once that vision is gone, we don't have any treatments today that are approved or close to being approved that can bring that vision back.

I think these upcoming or pending approvals for geographic atrophy are a giant first step, because we're going to be able to do something we haven't been able to do thus far, which is slow down that disease state. The next phase then is going to be to then restore vision, improve patient's vision that has been lost previously.

Are there any other topics from the year that you think would be important to include here?

I think that you're seeing a lot of activity in retina. And I think it's because people realize the impact it can have on patients’ lives. That is promising to me, and it gives me hope. I think you're seeing a lot of collaboration and partnership between retina specialists and those in clinical development, which to me is really important because we as providers see what's happening on the front lines. The fact that we have input in this process is reassuring to me that we're going to come up with great treatment options for our patients as we move forward.