New Era for the Eye

JASON S. SLAKTER, MD

It is difficult to believe that it has been only 1 year since ranibizumab (Lucentis, Genentech) was approved by the Food and Drug Administration for use in exudative age-related macular degeneration (AMD). Many of us had been using bevacizumab (Avastin, Genentech) for almost 1 year prior, so the concept and practice of intravitreal administration had become routine. I do not believe, however, that any of us could envision just how much our practices would be affected by the introduction of ranibizumab. Several retinal physicians provide insight into their own thoughts and concerns regarding this therapy in an article within this issue.

Of greater importance has been the impact on our patients. The approval of ranibizumab represented the first therapy that offered the potential for vision improvement in patients with exudative AMD. I am sure that everyone would agree that it has dramatically affected our patients', and our own, expectations. That is not to say, however, that there are not significant limitations with regard to the use of ranibizumab; many questions have arisen over the past year as experience with this drug has increased. For this column, I have compiled some examples of what we have learned over the past year and the questions that remain to be answered.

What we do know is that ranibizumab has the potential to offer significant improvement in vision in some patients with choroidal neovascularization due to AMD. Additionally, individual patients' responses vary greatly and some patients will require repeat ongoing intraocular injections to maintain the therapeutic benefit. Utilization of ranibizumab in a busy retina practice has had a profound impact on patient flow, diagnostic equipment, and technician needs. Last in my short list of things we do know about ranibizmuab is that reimbursement continues to be problematic for both practices and patients.

What we don't know are the distinct features that can definitively predict how patients will respond and how many treatments they will require to maintain the effect. We also don't know whether ranibizumab and bevacizumab perform in an equivalent fashion or when to stop treatment with either drug. The debate continues over the best treatment regimen for patients and the extent to which combination therapy offers significant benefit. Finally, how do we design and conduct clinical trials of new therapeutic approaches in the Lucentis era?

FAR-REACHING CHANGES

These are just a few of the issues that confront us in this new era of pharmacologic therapy for retinal disease. Only time will tell what the answers to these questions are, or whether they can even be answered in a conclusive fashion. The only thing we know for sure is that the world of retinal disease has changed and that we as retinal specialists will be utilizing pharmacologic therapy for a variety of the conditions that we treat for many years to come.

JASON

Retinal PHYSICIAN
Editorial Advisory and Review Board Jason S. Slakter, MD. Editor-in-Chief New York, NY. jslakter@aol.com (212) 861-9797 ■ Lloyd P. Aiello, MD, PhD, Boston, Mass Fareed Ali, MD, FRCS(C) Mississauga, Ontario, Canada Riva Lee Asbell, Philadelphia, Pa Abdhish R. Bhavsar, MD, Minneapolis, Minn Stanley Chang, MD, New York, NY Emily Y. Chew, MD, Bethesda, Md Kevin Corcoran, COE, CPC, FNAO San Bernardino, Calif Donald J. D'Amico, MD, Boston, Mass Dean Eliott, MD, Los Angeles, Calif Sharon Fekrat, MD, Durham, NC Frederick L. Ferris, MD, Bethesda, Md Donald C. Fletcher, MD, San Francisco, Calif Morton F. Goldberg, MD, FACS, Baltimore, Md Julia A. Haller, MD, Baltimore, Md Allen C. Ho, MD, Philadelphia, Pa Lee M. Jampol, MD, Chicago, Ill Mark W. Johnson, MD, Ann Arbor, Mich Eddie F. Kadrmas, MD, PhD, Plymouth, Mass Peter K. Kaiser, MD, Cleveland, Ohio Martin A. Mainster, PhD, MD, FRCOphth Kansas City, Kan William F. Mieler, MD, Chicago, Ill Joan W. Miller, MD, Boston, Mass Dennis A. Orlock, CRA, New York, NY Kirk H. Packo, MD, Chicago, Ill Carmen A. Puliafito, MD, MBA, Miami, Fla Carl D. Regillo, MD, FACS, Philadelphia, Pa Richard Rosen, MD, New York, NY Philip J. Rosenfeld, MD, PhD, Miami, Fla Reginald J. Sanders, MD, Washington, DC Steven D. Schwartz, MD, Los Angeles, Calif Ingrid U. Scott, MD, MPH, Hershey, Pa Johanna M. Seddon, MD, ScM, Boston, Mass Stephen C. Sheppard, Springfield, Mo Jerry A. Shields, M.D., Philadelphia, Pa Lawrence J. Singerman, MD, Cleveland, Ohio Richard F. Spaide, MD, New York, NY Paul Sternberg Jr., MD, Nashville, Tenn Michael T. Trese, MD, Royal Oak, Mich George A. Williams, MD, Royal Oak, Mich Lawrence A. Yannuzzi, MD, New York, NY

Retinal PHYSICIAN

Editorial Advisory and Review Board
Jason S. Slakter, MD. Editor-in-Chief
New York, NY. jslakter@aol.com
(212) 861-9797
■
Lloyd P. Aiello, MD, PhD, Boston, Mass
Fareed Ali, MD, FRCS(C)
Mississauga, Ontario, Canada
Riva Lee Asbell, Philadelphia, Pa
Abdhish R. Bhavsar, MD, Minneapolis, Minn
Stanley Chang, MD, New York, NY
Emily Y. Chew, MD, Bethesda, Md
Kevin Corcoran, COE, CPC, FNAO
San Bernardino, Calif
Donald J. D'Amico, MD, Boston, Mass
Dean Eliott, MD, Los Angeles, Calif
Sharon Fekrat, MD, Durham, NC
Frederick L. Ferris, MD, Bethesda, Md
Donald C. Fletcher, MD, San Francisco, Calif
Morton F. Goldberg, MD, FACS, Baltimore, Md
Julia A. Haller, MD, Baltimore, Md
Allen C. Ho, MD, Philadelphia, Pa
Lee M. Jampol, MD, Chicago, Ill
Mark W. Johnson, MD, Ann Arbor, Mich
Eddie F. Kadrmas, MD, PhD, Plymouth, Mass
Peter K. Kaiser, MD, Cleveland, Ohio
Martin A. Mainster, PhD, MD, FRCOphth
Kansas City, Kan
William F. Mieler, MD, Chicago, Ill
Joan W. Miller, MD, Boston, Mass
Dennis A. Orlock, CRA, New York, NY
Kirk H. Packo, MD, Chicago, Ill
Carmen A. Puliafito, MD, MBA, Miami, Fla
Carl D. Regillo, MD, FACS, Philadelphia, Pa
Richard Rosen, MD, New York, NY
Philip J. Rosenfeld, MD, PhD, Miami, Fla
Reginald J. Sanders, MD, Washington, DC
Steven D. Schwartz, MD, Los Angeles, Calif
Ingrid U. Scott, MD, MPH, Hershey, Pa
Johanna M. Seddon, MD, ScM, Boston, Mass
Stephen C. Sheppard, Springfield, Mo
Jerry A. Shields, M.D., Philadelphia, Pa
Lawrence J. Singerman, MD, Cleveland, Ohio
Richard F. Spaide, MD, New York, NY
Paul Sternberg Jr., MD, Nashville, Tenn
Michael T. Trese, MD, Royal Oak, Mich
George A. Williams, MD, Royal Oak, Mich
Lawrence A. Yannuzzi, MD, New York, NY

Retinal Physician, Issue: July 2007