October 2016

Somewhere, in some mythical PowerPoint presentation, there is a slide that shows just how many retina products failed to come to market. Drugs (and less often, devices) frequently fail to reach the necessary safety or efficacy requirements to go from bench to bedside. Indeed, even some of the most promising products fail between phases 2 and 3. These failed products sometimes enter a secondary market, where they are scrapped and sold for pennies on the dollar to a team who believes it can resurrect the product from the near-death of a missed primary endpoint. Others become footnotes in the long history of retina, relegated to obscurity as a new generation of doctors enters the fray.

NRMD readers aren’t hoping to divine the future of retina—they aren’t fortune tellers, and their fellowships did not involve reading tea leaves or turning tarot cards. We at NRMD aren’t so bold (or foolish) to presume that we have any more insight than anyone else on matters involving a products’ chances of approval or of postmarket influence. NRMD can, however, offer readers a glimpse at the future, and let them judge for themselves which products are most likely to succeed.

Inside our cover series, you’ll find five article dedicated to the future of retina. Starting on page 23, Thomas L. Edwards, PhD, FRANZCO, discusses the possibility of gene therapy for inherited retinal diseases. Dr. Edwards uses choroideremia as a backdrop to illustrate the unique challenges researchers face when designing gene replacement–based cures for blinding conditions.

This issue of NRMD takes a look down the drug pipeline. Baruch D. Kuppermann, MD, PhD, reviews the clinical trial data for ALG-1001 (Luminate, Allegro Ophthalmics), starting on page 35. As Dr. Kuppermann explains, if ALG-1001 can indeed target multiple integrin sites, then there is high potential for the drug to function as an effective treatment for multiple retinal diseases. Starting on page 32, Salman Yousuf, DO, and David Eichenbaum, MD, review lampalizumab (Genentech), a drug with the potential to offer patients with geographic atrophy a degree of relief never before available.

While ALG-1001 and lampalizumab undergo the strict scrutiny of federal drug regulators, the devices of tomorrow have already arrived. Starting on page 28, Yoshihiro Yonekawa, MD, offers pearls to surgeons making the jump to 3-D heads-up surgery. Dr. Yonekawa covers everything from spatial arrangements in the OR to adjustments to be made during surgery. S.K. Steven Houston III, MD, discusses the role of telemedicine in the management of retinal diseases, starting on page 25. Although some telemedicine uses already exist (such as the use of photography screening centers), the future Dr. Houston sketches invites telemedicine into the home—and for good reason, as Dr. Houston’s infographic on page 26 shows.

The future is coming—in some ways, the future is now—and NRMD is here to give you a head start.