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RETINA CONVERSATIONS: A Conversation With Jeffrey S. Heier, MD

He found his niche in ophthalmic research.

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Jeff Heier has lived a life based on a strong work ethic and significant achievement. Growing up in Miami, he was a promising tournament tennis player. After receiving his undergraduate degree at Brandeis University, he made a military commitment as part of a health professional program that earned him a scholarship to medical school at Boston University. His stint in the military included participation in Operation Desert Shield/Desert Storm, where he was awarded a Bronze Star for his dedicated service at a forward Combat Support Hospital. He also prepared a much-praised paper that catalogued the types and number of eye patients he had treated during the war over a 6-month period. After joining Ophthalmic Consultants of Boston (OCB) in 1998, he transformed the practice from one that participated in few clinical trials to a leading center of investigational ophthalmic research. Today, Dr. Heier is one of a small group of prominent retina specialists who are much sought after to serve on scientific advisory boards and act as lead investigators in clinical trials.

Jeffrey S. Heier, MD
PHOTO COURTESY DR. HEIER

Q. What initially attracted you to ophthalmology as a career choice?

A. It started with a summer internship early in medical school where I got to go into the OR on a daily basis and observe operations, mainly cataract and cornea. I found it fascinating and could see the impact these procedures were having in improving people’s lives. Then I gravitated to the retina clinic and found that my interest was leaning toward retina.

Q. Between your internship and residency you served as a physician in Operation Desert Shield/Desert Storm.

A. Yes, I was the youngest of 18 physicians serving in a combat support hospital, which is somewhat comparable to a MASH unit. Fortunately, this was before improvised explosive devices became a huge problem, so most of the eye injuries I saw were related to the climate — foreign bodies getting into soldiers’ eyes. I had brought a slit lamp with me and was able to keep a record of the injuries I had treated, which later became a presentation that I made in the United States and at an international meeting in Geneva, Switzerland. That was something for me as a first-year resident and I made a decision that research and publication would be an important priority of my career.

Q. Can you talk about how you won the Bronze Star?

A. There are 2 ways to win a Bronze Star. You can do something heroic, like rescuing soldiers trapped behind enemy lines, or you can work long, hard hours on a daily basis. I did it the second way. I typically put in 16-hour days, 7 days a week, running the ER, running sick call, assisting the internists, and assisting in the OR. Between the ER and sick call, we usually saw 50 to 60 soldiers a day.

Q. You did your residency at a military hospital in Colorado?

A. Yes, Fitzsimons Army Medical Center, which supported 13 states. There were many Army retirees who moved to Colorado just to be near Fitzsimons. I got to see a lot of older patients with retinal disease. At that time, laser treatment was our main option, and we didn’t make a significant impact on preserving or improving vision.

Q. You joined OCB just in time for what you consider to be the start of a “golden age” of retina treatment advancement.

A. The advances in medical retina in recent years have been outstanding. At OCB, I was fortunate to have a great mentor in Dr. Trex Topping, who strongly encouraged and supported my interest in clinical research. And I was equally fortunate to join OCB, which was, and remains today, one of the most prestigious multispecialty ophthalmic practices in the country. The first clinical trial we did was for a laser treatment for drusen in dry AMD. The trial failed, but our strong recruitment efforts gave us opportunities to participate in more trials. We were the top enroller for an early phase Genentech study evaluating the precursor of Lucentis called RhuFabV2. Around that time, many retina practices were in the EyeTech trial for Macugen, so we got major participation in the first Lucentis multidose trial. I had the first 5 patients in that Lucentis study and I could see the dramatic response.

Q. You strongly believe that retina practices and individual retina specialists should make a major commitment to participating in clinical trials.

A. We had more than 100 patients in our practice who were receiving Lucentis 5 years before the drug was approved — same with Regeneron’s anti-VEGF Eylea. I could see what this meant for the patients and their families. And it demonstrated that our practice was on the cutting edge of providing new therapies to our patients. Even when the trials failed, we created excitement within the practice and our community that we were actively seeking better treatments for patients.

Q. A number of retina-related clinical trials are currently ongoing, some with very promising data. What new therapies for the most prevalent retinal diseases might be available over the next 5 years?

A. I think longer intervals between injections is a real possibility. We are already seeing in trials drugs that may be given every 12 weeks without losing efficacy. That would be helpful, as real-world results for anti-VEGF have never been as good as the phase 3 highly controlled clinical trials. We’ve had some failures with sustained-release delivery systems, but I do see potential. One such example is Genentech’s LADDER trial for the sustained-release delivery of Lucentis, which appears to be the furthest along. In addition, a number of combinations have been tried — and more are being studied. Combinations have a high bar to meet, because they must be clearly superior to monotherapy; anti-VEGF injections are outstanding and have proven to be remarkably effective in many retinal diseases. At some point, I expect to see some combinations that will clear that bar and be approved.

We are also involved with gene therapy for both wet and dry AMD, which is promising because gene therapy is well suited for the eye. The eye is small, immune-privileged, and easily accessible with diagnostic tests that are reliable.

Q. Many people have remarked on the collegial and collaborative nature of the retina community. Do you share that belief?

A. Absolutely. In the Boston area, in years past, there was little interaction between practices and academic institutions. Today, we work together to advance the interests of patients as well as the education of our trainees. I also see that at meetings and in retina organizations. We are deeply committed to mentoring our young colleagues. Our fellows are outstanding, and seem to keep getting better. They are the cream of the crop. I interact with our fellows on a daily basis. They push us and question us. That environment makes all of us better. RP