News

Recent positive results in clinical trials on retinal disease provide new hope for patients with retinal disorders. Here we review some data and plans for additional work to cure blinding disorders of the posterior segment.

Fenretinide for AMD
Wet AMD is the main cause of severe vision loss in AMD patients but is largely treatable now with a combination of anti-VEGF inhibitors (Lucentis, Avastin) and other agents (PDT, steroid injections). The geographic atrophy form of AMD can lead to similar degrees of vision loss but has no proven treatment. Recently the synthetic vitamin A derivative, fenretinide, has been found in phase 2 studies to reduce the progression of geographic atrophy and to reduce the incidence of developing wet.

Fenretinide is taken as a pill (no injection!) and works on three key AMD disease mechanisms: it has strong anti-inflammatory properties, inhibits abnormal blood vessel growth (angiogenesis) and reduces vitamin-A derived toxins such as A2E and lipofuscin. These toxins accumulate in the RPE and interfere with its ability to nourish the photoreceptors. Some patients note some reduced night vision since the agent actually blocks pathways for vitamin A metabolism.

AREDS II
The AREDS II study is underway but new formulation for vitamins based on the study protocol are now available. These formulations are free of vitamin A and typically have 10mg of Lutein and 2mg of Zeaxanthin as well as omega III fatty acids with a ratio of 400 DHA to 600 EPA. Additional studies assessing bilberry and grape seed extract suggest benefits for these antioxidants as well.

Ozurdex for Uveitis
Ozurdex, approved one year ago for retinal vein occlusion, is now approved for the treatment of uveitis. This drug implant provides sustained release of dexamethasone for several months and can be administered in the office setting, though the large needle bore makes it a greater challenge to administer than standard injections of other drugs.

Standard and High-dose Lucentis
Lucentis is now approved for the treatment retinal vein occlusions as well as wet AMD. Many reserve this drug for those patients that have failed other treatment options, such as Avastin, since it must be administered at 4 months intervals for best results and is also more costly. Recently, a high dose (2.0 versus 0.5 mg) Lucentis formulation has been developed and tested for wet AMD and the results are pending with early data suggesting improved outcomes with less frequent injections.

Stem Cell Update
Recent studies here and abroad suggest greater hope for stem cells for retinal disorders. Patients with Leber’s Congenital Amaurosis, a severe form of Retinitis Pigmentosa, have been treated with stem cell therapy using a proprietary method patented by StemCell Pharma, Inc. (SCPI) to deliver stem cells and growth factors to the retina. The University of London College team in transfecting cells with the CRx gene that allows differentiation into photoreceptors cells - a new approach which carries great promise. They have cured a few mice and are moving on to humans this coming year.
Retina research is making great strides for curing blindness. At RMI, we have a number of clinical trials in varying stages addressing dry and wet AMD, diabetic retinopathy, uveitis, and retinal vein occlusions and are developing novel treatment approaches for other disorders. Your patients should never lose hope.

Call us for more information:
Ron P. Gallemore, M.D, Ph.D.
Founder and Director
Retina Macula Institute and the
Retina Macula Research Center
Retina2000@yahoo.com
www.Retinamaculainstitute.com
South Bay 310-944-9393
Los Angeles 310-466-9393