December 2018


EyeWorld/ASCRS reports from the 2018 OIS@AAO

EyeWorld/ASCRS reports from the 2018 OIS@AAO,
October 25, Chicago

View videos from the OIS@AAO:

Yari Mitchell discusses the IC-8 small aperture IOL.


The 2018 OIS@AAO meeting featured several company showcases and panels on a variety of topics across ophthalmology.

Masters of the Industry

The popular “Masters of the Industry” session was back at this year’s OIS@AAO. It was moderated by Jim Mazzo (Carl Zeiss Meditec, Jena, Germany) and featured panelists David Endicott (Alcon, Fort Worth, Texas), Tom Frinzi (Johnson & Johnson Vision, Santa Ana, California), William Meury (Allergan, Dublin, Ireland), Ludwin Monz, PhD (Carl Zeiss Meditec), David Parke II, MD (AAO, San Francisco), Calvin Roberts, MD (Bausch + Lomb, Bridgewater, New Jersey), and Steve Speares (ASCRS•ASOA, Fairfax, Virginia). 
Mr. Speares was asked to comment on the impact on practices of more patients who are self-informed prior to consulting with a doctor. He discussed surveying administrators around the country on the amount of time they schedule per patient. More time may need to be allotted per patient if it seems the patient will be asking a lot of questions. In fact, he said that 45% of those surveyed responded that they now build in almost twice the amount of time per patient.
In addition to asking more questions of their doctors and administrators, patients may find bad information on their own, so practices spend almost an equal amount of time correcting misinformation, Mr. Speares said. 
It’s interesting how practices are trying to build a chain of information for patients before they come through the door, he observed. Though self-education can be a disadvantage, it can also be a benefit when patients learn more about some of the new technologies available, Mr. Speares noted.
Mr. Meury commented on how ophthalmology differs from other medical specialties, noting the great partnership between industry and ophthalmology. Ophthalmologists have a greater appreciation for innovation, he said, and are often more receptive to innovative new products and know how to work with industry in ways that other specialties don’t. 
When asked what he would tell smaller companies, Dr. Roberts said that if you’re looking to the future, it’s not just what you’re doing, it’s the “who, where, and how much.”
“Who” starts with who is going to be delivering the product, he said. If it’s a diagnostic device, is it up to the doctor, care extender, or patient to deliver it? Anything a doctor has to do himself or herself becomes a much bigger burden, as opposed to something a patient can administer.
Similarly, you have to consider the “where,” Dr. Roberts said. Does it have to be done in a doctor’s office? If so, it could be taxing on a doctor and the practice staff. But if it could be done at another office or at home, it could be an opportunity to expand the product’s scope.
You also have to think about “how much,” Dr. Roberts said. Is it something that is going to cost the doctor money or increase the cost of medical care? If it increases the cost of medical care, it could be a harder value proposition, he said.
During the panel, Mr. Speares also commented on collaboration between industry and practitioners. He noted that there’s often foundational knowledge built along the way that can be leveraged when launching a new technology. But sometimes, there’s still a gap in institutional knowledge. 
Mr. Speares said that to address this, there needs to be a “more holistic type event” to help further understanding as commercial entities launch new technologies. 
In addition, he suggested collaboration among associations. Even in areas that may not seem related, you have to recognize that there cannot be enough education and information as technologies are launched, Mr. Speares said.

Blindness prevention research 

A session focused on Research to Prevent Blindness, with Brian Hofland, PhD, president of Research to Prevent Blindness (New York), speaking about some of its efforts to preserve and restore vision by supporting research to develop treatments, preventives, and cures for all sight-threatening conditions. Founded in 1960 by Jules Stein, the organization today focuses on early stage research and supports early career researchers.
Also during this showcase, several presenters shared their current research. Anthony Daniels, MD, Nashville, Tennessee, highlighted his research in curing retinoblastoma. Retinoblastoma is the most common eye cancer in children, he said, and when left untreated, it is universally fatal. However, when treated, survival rates in the U.S. are greater than 95%. Dr. Daniels noted that retinoblastoma affects both eyes about half the time.
Many eyes are saved with IV chemotherapy; however, IV chemo has poor rates of globe salvage success for more advanced disease. There are also side effects, including immunosuppression, transfusions, hair loss, and more. Intra-arterial chemo is an alternative option, Dr. Daniels said, which helps to avoid some of the side effects related to IV chemo. However, this method has its own problems, as melphalan, which is used in intra-arterial chemo, is toxic to the retina. So even though the eye can be saved, the patient could still lose vision. 
Dr. Daniels spoke about his research efforts to find drugs that are just as effective as melphalan but that can also save sight. This involves targeting specific tumor pathways. He mentioned research with a small animal model in rabbits of intra-arterial therapy. He said that research so far has been successful, with multiple classes of drugs that appear promising.
Utilizing eye-targeted therapies increases treatment success and reduces systemic complications, Dr. Daniels said. He noted the formation of the treatment model, the tumor model, and the assessment platforms to develop and test new drugs in vivo. He has also identified a new class of targeted therapeutics with high efficacy and low toxicity. 

Building a strong pipeline through acquisitions and innovation 

A panel moderated by William Link, PhD, San Francisco, focused on acquisitions and innovation and included panelists Naveed Shams (Santen, Osaka, Japan), Carl Romano (Regeneron, Tarrytown, New York), Robert Dempsey (Shire, Lexington, Massachusetts), Mr. Frinzi, Andrew Stewart (Allergan), and Jehan Tamboowalla (Novartis, Basel, Switzerland). 
The panel discussed innovation and how it is handled both internally and externally. Dr. Link asked panelists to think about the last decade and how many product launches their company did that were sourced internally and how many were sourced externally. 
Mr. Frinzi said that over the past 10 years, Johnson & Johnson Vision has had 58 product launches, 70% of those internal and 30% external.
Shire, Mr. Dempsey said, is in a bit of a different situation, and over the last 5 years has had one product launch, which was an external acquisition. They had to launch the franchise, he said. This goes back to the relationship industry has with ophthalmology and the receptivity ophthalmology has with industry, he said. 
Within Novartis, Mr. Tamboowalla said, it is a more complicated question. He mentioned that Lucentis (ranibizumab, Novartis) was launched from a partnership. But he said that the company does not benchmark what it does internally vs. externally. 
Mr. Shams noted that Santen does not have an internal discovery engine and is therefore dependent on its licensing and partnerships. This will hopefully change over the next 3–5 years, he added. 
Mr. Romano added that Regeneron has only one ophthalmology product (with many expanded indications). Of the company’s seven approved products, he said that all seven were approved in the last 10 years, and 100% of these were internal efforts.

Editors’ note: The speakers at OIS@AAO have financial interests with
the companies they represent.

EyeWorld/ASCRS reports from the 2018 OIS@AAO EyeWorld/ASCRS reports from the 2018 OIS@AAO
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