International Age-Related Macular Degeneration (AMD) Awareness Week Congressional Briefing: Sustained NIH Funding Has Resulted in Successful AMD Diagnostics and Therapies
Featured speaker Amir H. Kashani, M.D., Ph.D. (USC Gayle and Edward Roski Eye Institute)
On September 14, in recognition of both Healthy Aging Month and International Age-related Macular Degeneration (AMD) Awareness Week, AEVRs Decade of Vision 2010-2020 Initiative and co-sponsors (see box below) held a Congressional Briefing entitled Advances in the Diagnosis and Treatment of AMD and Retinal Diseases.
Clinician-scientist speaker Amir H. Kashani, M.D., Ph.D., an Assistant Professor of Ophthalmology at the USC Gayle and Edward Roski Eye Institute within the Keck School of Medicine at the University of Southern California, spoke about his clinical practice and research activities as they relate to AMD and other retinal diseases. Dr. Kashani, who participated in AEVRs first-ever Emerging Vision Scientists (EVS) Day on Capitol Hill in October 2015, was invited to be the featured speaker at this years AMD Briefing, which began the Second Annual EVS Day. In the packed room were 22 early-stage investigators who have not yet received an R01 investigator-initiated grant from the National Institutes of Health (NIH) and who observed how their colleague described his emerging vision research to a public policy-oriented audience.
Dr. Kashani initially addressed eye disease/vision impairment generally—as well as its societal impact—by citing two recent publications in JAMA Ophthalmology:
- An August 2016 article, based on results from AEVRs 2014 study entitled The Publics Attitudes about the Health and Economic Impact of Vision Loss and Eye Disease which reported that Americans across all racial and ethnic lines perceive losing their eyesight as having the greatest impact on their daily life.
- A May 2016 article from USC which reported that, in 2015, 1 million American were blind and 3.2 million were visually impaired, which will grow to 2 million blind and6.4 million visually impaired by year 2050. A June 2014 Prevent Blindness report entitled The Future of Vision: Forecasting the Prevalence and Costs of Vision Problems has projected that the current estimated $145 billion annual cost of vision disorders in 2014 will grow to $717 billion in inflation-adjusted dollars by year 2050-driven significantly by the aging of the population.
AMD is the leading cause of blindness and low vision in the United States—especially in the age 60-plus population—and is increasingly prevalent due to the aging population, with greatest growth in the age 90-plus segment. The National Eye Institute (NEI) within the NIH estimates that 200,000 Americans each year go onto develop advanced AMD. Since AMD affects central vision-specifically the macula, which is the central part of the light-sensitive retina in the back of the eye-it impacts an individuals ability to read and drive, significantly affecting quality of life. One-third of AMD patients experience clinical depression.
Dr. Kashani discussed research activities to diagnose and treat AMD, both the wet or neovascular form of the disease—where new blood vessels disrupt the retina and which accounts for about 10 percent of AMD cases—as well as for dry or atrophic AMD, where the photoreceptors (the light-sensitive cells in the retina) gradually die away and which accounts for 90 percent of AMD cases.
He described the dramatic improvements in wet AMD treatment from anti-VEGF therapy. These therapies, which were developed in part through NIH-funded research, include Food and Drug Administration (FDA)-approved drugs that are injected into the eye, inhibiting abnormal blood vessel growth due to Vascular Endothelial Growth Factor (VEGF) and stabilizing vision loss—and, in many cases, improving lost vision. The diagnosis of wet AMD and the efficacy of drug treatments is determined in large part through the use of a non-invasive imaging technology called Optical Coherence Tomography (OCT) that can show microscopic changes in the eye caused by AMD. Since OCT was also developed through NIH-funded research, he emphasized that sustained funding has resulted in both the imaging technology to diagnose and monitor wet AMD disease progression as well as the drug therapies to treat it.
Dr. Kashani acknowledged that, although dry AMD is more prevalent, no current treatments exist. However, thanks to the NIH-funded Age-Related Eye Disease Study (AREDS) trials, an anti-oxidant regimen is available and can significantly decrease the rate of progression of dry AMD (see box below). Dr. Kashani reported that there are also several promising therapies on the horizon for dry AMD. He specifically described a novel stem cell-based experimental therapy that is being funded by the California Institute for Regenerative Medicine (CIRM) and for which he serves as Principal Investigator. He showed how a single layer of Retinal Pigment Epithelium (RPE) cells is grown on an artificial substrate which is then injected into the eye in sheets to patch degenerated RPE in dry AMD. He concluded by noting that this U.S.-based trial reflects the intersection of basic science, clinical research, and biomedical engineeringthe latter necessary for both the development of the substrate to support growth of the single cell RPE layer and for the technology to introduce those sheets of cells into the eye in the exact area of the retina that requires repair.
Numerous risk factors are associated with AMD. Non-modifiable factors include aging, genetics, gender, and race, while modifiable factors include smoking, diet, obesity, high blood pressure, high cholesterol, cardiovascular disease, and light exposure.
- NEI-funded research has identified more than 30 genes already associated with AMD, and genetics may account for 60 percent of the cause of the disease.
- AMD is more prevalent in White Americans and Hispanics, while glaucoma is more prevalent in African Americans.
- Smoking is a consistent risk factor, with greater risk in those with increasing number of cigarettes smoked.
- The NEI-funded Age Related Eye Disease Study (AREDS) demonstrated that daily high doses of vitamins C and E, beta-carotene, and minerals zinc and copper reduced the risk of progression to advanced AMD by 25 percent in five years. Data from follow-up study AREDS2 suggest that replacing beta-carotene with lutein and zeaxanthin may produce a safer, more-effective formula.
AEVR wishes to thank its co-sponsors for this event:
Research to Prevent Blindness
Alliance for Aging Research
Association for Research in Vision and Ophthalmology
European Vision Institute
Macular Degeneration Research Foundation
AEVR also thanks Regeneron for a grant to support event management.
Ruth Burns of Regeneron with Dr. Kashani
AEVR Executive Director James Jorkasky with Dawn Prall George, Executive Director of the Macula Vision Research Foundation—and event co-sponsor—and Michael Oscar, MVRF legislative counsel
Far right and second right: Dr. Kashani and ARVOs Matt Windsor, Ph.D. speak with a group of Emerging Vision Scientists among the 22 participating in AEVRs Second Annual EVS Day on Capitol Hill
Dr. Kashani speaks to the standing-room
Prior to the Briefing and under the auspices of NAEVR, Dr. Kashani met with Congresswoman Judy Chu (D-CA), with whom he had met in October 2015 during the first EVS Day