Collaborations and Controversies: Updates in Retina Care and Research
In this episode of Better Edge, Northwestern Medicine's Lee Jampol, MD, the Louis Feinberg, MD, Professor of Ophthalmology, and Amani Fawzi, MD, the Cyrus Tang, and Lee Jampol Professor of Ophthalmology, both members of the DRCR Retina Network, discuss some of the exciting new developments in diagnosis and therapy for retinal diseases, including optical coherence tomography angiography (OCTA) for imaging, photobiomodulation for diabetic macular edema, and more.
Featured Speakers:
Learn more about Amani Fawzi, MD
Amani Fawzi, MD | Lee Jampol, MD
Amani Fawzi, MD's research involves translational approaches to age related macular degeneration and ischemic retinal diseases with a special focus on functional retinal imaging and image guided interventions.Learn more about Amani Fawzi, MD
Lee Jampol, MD focus of work includes Inflammatory and infectious diseases the the retina, hereditary diseases of the retina,macular degeneration, diabetic retinopathy.
Learn more about Lee Jampol, MD
Learn more about Lee Jampol, MD
Transcription:
Collaborations and Controversies: Updates in Retina Care and Research
Melanie: Welcome to Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole and today we're going to hear from two experts in ophthalmology with a special focus on what's new and exciting with retina care, imaging diagnostics and new treatment protocols.
Let's take a deeper look at retina care and research. Joining me is Dr. Lee Jampol, he's a Professor of Ophthalmology at Northwestern Medicine and Dr. Amani Fawzi, she's a Professor of Ophthalmology at Northwestern Medicine. Doctors, thank you so much for joining us today, as we're going to talk about some of the exciting things that have been discussed at recent conferences. You both have a focus on care and research of the retina. Dr. Fawzi, I'd like to start with you. Can you share a little bit about your background and your focus?
Dr. Fawzi: Yeah. Thank you, Melanie. So I am a clinician scientist, so I take care of patients, see them in clinic, and I also do surgery. But in addition, I take care of research. I do clinical research focused on imaging in the retina. And I also have a lab that looks at ischemic models and developing new therapies for retinal disease.
Melanie: Dr. Jampol, can you share your focus for us?
Dr. Jampol: Yeah, so I'm very much interested in retinal diseases and a large amount of my time is involved with diabetic retinopathy, which is a major cause of vision loss in patients in their middle ages and beyond. And I work for the Diabetic Retinopathy Clinical Research Network. We do research on diabetes and the findings in the eye. And recently, we've also expanded into doing research on other retinal diseases.
Melanie: We're going to get into a few of those with you, Dr. Jampol, in this episode today. But before we do, Dr. Fawzi, there are so many new, more accurate and effective imaging options for detecting retina diseases than we've ever seen before, such as the infrared camera technology. Can you tell us what this means for patient care, how you're using these things and what new research is happening in this area?
Dr. Fawzi: So I think you're talking about OCT angiography and that's basically an adaptation of a technology that we've already had, which is the OCT. And here, we're able to use software to be able to measure an image, the retinal vessels and the retinal blood flow in real time without using a dye and very quickly and noninvasively.
So that has really added a new perspective on patients. And we're able to take quick images to diagnose diseases like neovascular macular degeneration, new blood vessels growing under the retina or ischemia and lack of blood flow in areas of the retina without having to inject a dye. So it's really sped up our care, allowed patients a more streamlined experience in our clinics and gave us a new sort of understanding of how these blood vessels react and how they respond to treatment and allowed us to monitor patients even more frequently and with better imaging.
Melanie: Well then, Dr. Fawzi, what guidance can you provide physicians who want to optimize or update their use of this imaging modality?
Dr. Fawzi: So that's a great question. So once you get the machine, you have to really get used to the utility of it and how to remove artifacts. So, unfortunately, the imaging of these blood vessels comes with a lot of artifacts. And if you're not used to them, if you haven't read about them, if you don't know what they look like, you can mistake things that are innocuous for other more serious new blood vessels and growths in the retina.
So it's very important for clinicians to get used to it, learn about it, read about it, watch videos, webinars, and learn about this technology and its full power.
Melanie: That's a good point. And Dr. Jampol, what other new technologies, protocol standards or diagnostic tools for the prevention and treatment of retina diseases are worth talking about and how will those impact the practice of care as you see it?
Dr. Jampol: So diabetes is becoming more prevalent in the United States and in the rest of the world due in part to the increasing incidence of obesity. As you have the increasing number of diabetics, you have more diabetic retinopathy, which is a potentially blinding disease. And it can blind the eyes in two main ways. One is leakage into the retina, what we call diabetic macular edema. And the second are blood vessels growing in the retina, we call that proliferative diabetic retinopathy.
The DRCR Retina Network, which I work for has over 120 centers around the country, which are doing clinical trials to determine new ways to treat diabetic retinopathy. And the studies that we've done have changed rather drastically actually in the last few years, the best way to treat diabetic retinopathy, both in terms of the leakage, the diabetic macular edema, and the proliferative retinopathy called neovascularization. So our research has changed things throughout the world.
Melanie: And Dr. Jampol, you've been on with me before where we talked about diabetic retinopathy. It was such a fascinating episode. And you coauthored a study published in JAMA that looked at delaying treatment for diabetic macular edema, as you just mentioned, please update us into what's new in this area. Tell us about your research. Do you have any updates for us on that particular study?
Dr. Jampol: So that study was called Protocol V and it was investigating patients who had good vision so that they were often asymptomatic, but who had leakage into the retina from the diabetes. And we found that patients did not necessarily have to be treated immediately in this situation. In the past, many doctors were immediately beginning injections into the eye to treat the diabetic macular edema. We found that you can wait and observe and not treat the patients until later on when they begin to lose vision. And the outcomes two years later were virtually identical.
We're also looking for new ways to prevent diabetic macular edema. And we have a fascinating study that's almost done called photobiomodulation. And this is using a light shine into the eye for 90 seconds twice a day, which we think has a good chance to slow down or prevent the development of diabetic retinopathy and to prevent its progression. So rather than the injections, which we commonly use now, we may be able to just shine a light in the patient's eye and be able to slow things down or even stop it. And that study is really completed and we should have the results within the next couple of months.
Melanie: If you would, Dr. Jampol, you both are actually involved in the Diabetic Retinopathy Clinical Research Network, tell us how this network has contributed to the many advances in the clinical care of eye diseases and any new information that might be coming out. Dr. Jampol, do you have some things from this network that you would like to share with other providers?
Dr. Jampol: Well, you should know about this network since it's done over 25 clinical trials on many aspects of retinal disease, especially diabetic retinopathy. There's about 110 centers throughout the United States and Canada that participate. Some of those are in private practice and some of those are in academic medical centers. And we, the investigators both in private practice and in universities, work out what studies we want to do. We perform the studies, we analyze them, we present them and we publish them.
And we began using the alphabet to name our studies with Protocol A and we worked all the way through the alphabet and we're now actually up to Protocol AJ, which is the second time around the alphabet. So you can see we're doing many trials on many different aspects of diabetic retinopathy and also other retinal diseases like macular degeneration.
Melanie: Dr Fawzi, the COVID-19 global pandemic has forced medical evolution for so many areas of medicine. Tell us how you feel the pandemic has impacted ophthalmology patient care. Has it delayed or altered essential treatments? Tell us how it's impacted your clinical research. How have you evolved with this pandemic? And where do you see it going in the future?
Dr. Fawzi: Yeah, I think in the beginning we really suffered a lot and our patients suffered. We were limited to treating only emergent conditions. So patients on the outside really weren't sure if they could contact us or not. And there was a lot of patients who were just waiting at home, afraid to come in, afraid to leave their house. So there was a lot of missed care, if you will. But the majority of patients who came in were taken care of and went through the process very smoothly.
And I would say that over the past few months, we've really evolved and become a lot more efficient. It's taught us a lot about how we can take care of our patients while we're staying safe and being efficient and maximizing our access. So I think it's made us stronger in many ways, and I think we're able to sort of flexibly and efficiently deal with the situation on a day to day basis now as a group, as a team, as a hospital. And I think what came out of it much better.
Clinical research, I think we lost some ground by having to cancel non-essential care, but patients who had essential treatments as part of a clinical trial were able to still come in and get their treatments and maintain their access. And we have now come back to almost full capacity in clinical trials and clinical research, so that's a positive overall, I would say.
Dr. Jampol: Well, I would just add that we're very much concerned about this new surge that we're seeing in the number of cases, because we're about to initiate some new clinical trials that DRCR Retina Network and patients often can come in. They're afraid to come in. The clinic will restrict to only emergency care or essential care. And so the studies that fortunately we were just finishing up, we only lost a little bit of information. But these future studies, we may have to delay them until we have things on the better control.
Melanie: Dr. Jampol, as we wrap up, you are in such an exciting field and pandemic aside, it's a very exciting time to be in your field. What would you like other providers to know about the expertise at Northwestern Medicine? The fact that you're with the DRCR and have professorships named after you, tell us as the expert that you are, what you'd like other providers to know about your field, Northwestern Medicine, and when you feel it's important that they refer.
Dr. Jampol: So I've been at this for a very long time, and this is definitely the most exciting time that there's ever been for me and for others in terms of taking care of the eyes. When I first started out, macular degeneration and diabetic retinopathy were blinding diseases. Now, we have excellent treatments for not every but most cases, and we have many other things in the pipeline for improving eye care further.
So with the new imaging that we have, with the new knowledge we have about these diseases, with the new treatments we have, Northwestern Healthcare is right at the forefront. We have the most modern equipment. We have doctors that are right at the forefront in both clinical care and doing the research to improve outcomes.
Melanie: Well, you certainly do. And Dr. Fawzi, do you have any final thoughts you'd like to add?
Dr. Fawzi: Yeah, I would add to Dr. Jampol's idea, is that we are also participating in the most up-to-date clinical trials. So we have now things like stem cell therapy coming through the pipeline, gene therapy and other exciting drug delivery devices. So there's a lot going on in retina that is happening right now and Northwestern is definitely a part of all of it.
Melanie: Thank you, doctors, so much for joining us today and telling us what's new in retina. So thank you again. To refer your patient, you can visit our website at nm.org to get connected with one of our providers.
That concludes this episode of Better Edge, a Northwestern Medicine podcast for physicians. Please remember to subscribe, rate and review this podcast and all the other Northwestern Medicine podcasts.
I'm Melanie Cole.
Collaborations and Controversies: Updates in Retina Care and Research
Melanie: Welcome to Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole and today we're going to hear from two experts in ophthalmology with a special focus on what's new and exciting with retina care, imaging diagnostics and new treatment protocols.
Let's take a deeper look at retina care and research. Joining me is Dr. Lee Jampol, he's a Professor of Ophthalmology at Northwestern Medicine and Dr. Amani Fawzi, she's a Professor of Ophthalmology at Northwestern Medicine. Doctors, thank you so much for joining us today, as we're going to talk about some of the exciting things that have been discussed at recent conferences. You both have a focus on care and research of the retina. Dr. Fawzi, I'd like to start with you. Can you share a little bit about your background and your focus?
Dr. Fawzi: Yeah. Thank you, Melanie. So I am a clinician scientist, so I take care of patients, see them in clinic, and I also do surgery. But in addition, I take care of research. I do clinical research focused on imaging in the retina. And I also have a lab that looks at ischemic models and developing new therapies for retinal disease.
Melanie: Dr. Jampol, can you share your focus for us?
Dr. Jampol: Yeah, so I'm very much interested in retinal diseases and a large amount of my time is involved with diabetic retinopathy, which is a major cause of vision loss in patients in their middle ages and beyond. And I work for the Diabetic Retinopathy Clinical Research Network. We do research on diabetes and the findings in the eye. And recently, we've also expanded into doing research on other retinal diseases.
Melanie: We're going to get into a few of those with you, Dr. Jampol, in this episode today. But before we do, Dr. Fawzi, there are so many new, more accurate and effective imaging options for detecting retina diseases than we've ever seen before, such as the infrared camera technology. Can you tell us what this means for patient care, how you're using these things and what new research is happening in this area?
Dr. Fawzi: So I think you're talking about OCT angiography and that's basically an adaptation of a technology that we've already had, which is the OCT. And here, we're able to use software to be able to measure an image, the retinal vessels and the retinal blood flow in real time without using a dye and very quickly and noninvasively.
So that has really added a new perspective on patients. And we're able to take quick images to diagnose diseases like neovascular macular degeneration, new blood vessels growing under the retina or ischemia and lack of blood flow in areas of the retina without having to inject a dye. So it's really sped up our care, allowed patients a more streamlined experience in our clinics and gave us a new sort of understanding of how these blood vessels react and how they respond to treatment and allowed us to monitor patients even more frequently and with better imaging.
Melanie: Well then, Dr. Fawzi, what guidance can you provide physicians who want to optimize or update their use of this imaging modality?
Dr. Fawzi: So that's a great question. So once you get the machine, you have to really get used to the utility of it and how to remove artifacts. So, unfortunately, the imaging of these blood vessels comes with a lot of artifacts. And if you're not used to them, if you haven't read about them, if you don't know what they look like, you can mistake things that are innocuous for other more serious new blood vessels and growths in the retina.
So it's very important for clinicians to get used to it, learn about it, read about it, watch videos, webinars, and learn about this technology and its full power.
Melanie: That's a good point. And Dr. Jampol, what other new technologies, protocol standards or diagnostic tools for the prevention and treatment of retina diseases are worth talking about and how will those impact the practice of care as you see it?
Dr. Jampol: So diabetes is becoming more prevalent in the United States and in the rest of the world due in part to the increasing incidence of obesity. As you have the increasing number of diabetics, you have more diabetic retinopathy, which is a potentially blinding disease. And it can blind the eyes in two main ways. One is leakage into the retina, what we call diabetic macular edema. And the second are blood vessels growing in the retina, we call that proliferative diabetic retinopathy.
The DRCR Retina Network, which I work for has over 120 centers around the country, which are doing clinical trials to determine new ways to treat diabetic retinopathy. And the studies that we've done have changed rather drastically actually in the last few years, the best way to treat diabetic retinopathy, both in terms of the leakage, the diabetic macular edema, and the proliferative retinopathy called neovascularization. So our research has changed things throughout the world.
Melanie: And Dr. Jampol, you've been on with me before where we talked about diabetic retinopathy. It was such a fascinating episode. And you coauthored a study published in JAMA that looked at delaying treatment for diabetic macular edema, as you just mentioned, please update us into what's new in this area. Tell us about your research. Do you have any updates for us on that particular study?
Dr. Jampol: So that study was called Protocol V and it was investigating patients who had good vision so that they were often asymptomatic, but who had leakage into the retina from the diabetes. And we found that patients did not necessarily have to be treated immediately in this situation. In the past, many doctors were immediately beginning injections into the eye to treat the diabetic macular edema. We found that you can wait and observe and not treat the patients until later on when they begin to lose vision. And the outcomes two years later were virtually identical.
We're also looking for new ways to prevent diabetic macular edema. And we have a fascinating study that's almost done called photobiomodulation. And this is using a light shine into the eye for 90 seconds twice a day, which we think has a good chance to slow down or prevent the development of diabetic retinopathy and to prevent its progression. So rather than the injections, which we commonly use now, we may be able to just shine a light in the patient's eye and be able to slow things down or even stop it. And that study is really completed and we should have the results within the next couple of months.
Melanie: If you would, Dr. Jampol, you both are actually involved in the Diabetic Retinopathy Clinical Research Network, tell us how this network has contributed to the many advances in the clinical care of eye diseases and any new information that might be coming out. Dr. Jampol, do you have some things from this network that you would like to share with other providers?
Dr. Jampol: Well, you should know about this network since it's done over 25 clinical trials on many aspects of retinal disease, especially diabetic retinopathy. There's about 110 centers throughout the United States and Canada that participate. Some of those are in private practice and some of those are in academic medical centers. And we, the investigators both in private practice and in universities, work out what studies we want to do. We perform the studies, we analyze them, we present them and we publish them.
And we began using the alphabet to name our studies with Protocol A and we worked all the way through the alphabet and we're now actually up to Protocol AJ, which is the second time around the alphabet. So you can see we're doing many trials on many different aspects of diabetic retinopathy and also other retinal diseases like macular degeneration.
Melanie: Dr Fawzi, the COVID-19 global pandemic has forced medical evolution for so many areas of medicine. Tell us how you feel the pandemic has impacted ophthalmology patient care. Has it delayed or altered essential treatments? Tell us how it's impacted your clinical research. How have you evolved with this pandemic? And where do you see it going in the future?
Dr. Fawzi: Yeah, I think in the beginning we really suffered a lot and our patients suffered. We were limited to treating only emergent conditions. So patients on the outside really weren't sure if they could contact us or not. And there was a lot of patients who were just waiting at home, afraid to come in, afraid to leave their house. So there was a lot of missed care, if you will. But the majority of patients who came in were taken care of and went through the process very smoothly.
And I would say that over the past few months, we've really evolved and become a lot more efficient. It's taught us a lot about how we can take care of our patients while we're staying safe and being efficient and maximizing our access. So I think it's made us stronger in many ways, and I think we're able to sort of flexibly and efficiently deal with the situation on a day to day basis now as a group, as a team, as a hospital. And I think what came out of it much better.
Clinical research, I think we lost some ground by having to cancel non-essential care, but patients who had essential treatments as part of a clinical trial were able to still come in and get their treatments and maintain their access. And we have now come back to almost full capacity in clinical trials and clinical research, so that's a positive overall, I would say.
Dr. Jampol: Well, I would just add that we're very much concerned about this new surge that we're seeing in the number of cases, because we're about to initiate some new clinical trials that DRCR Retina Network and patients often can come in. They're afraid to come in. The clinic will restrict to only emergency care or essential care. And so the studies that fortunately we were just finishing up, we only lost a little bit of information. But these future studies, we may have to delay them until we have things on the better control.
Melanie: Dr. Jampol, as we wrap up, you are in such an exciting field and pandemic aside, it's a very exciting time to be in your field. What would you like other providers to know about the expertise at Northwestern Medicine? The fact that you're with the DRCR and have professorships named after you, tell us as the expert that you are, what you'd like other providers to know about your field, Northwestern Medicine, and when you feel it's important that they refer.
Dr. Jampol: So I've been at this for a very long time, and this is definitely the most exciting time that there's ever been for me and for others in terms of taking care of the eyes. When I first started out, macular degeneration and diabetic retinopathy were blinding diseases. Now, we have excellent treatments for not every but most cases, and we have many other things in the pipeline for improving eye care further.
So with the new imaging that we have, with the new knowledge we have about these diseases, with the new treatments we have, Northwestern Healthcare is right at the forefront. We have the most modern equipment. We have doctors that are right at the forefront in both clinical care and doing the research to improve outcomes.
Melanie: Well, you certainly do. And Dr. Fawzi, do you have any final thoughts you'd like to add?
Dr. Fawzi: Yeah, I would add to Dr. Jampol's idea, is that we are also participating in the most up-to-date clinical trials. So we have now things like stem cell therapy coming through the pipeline, gene therapy and other exciting drug delivery devices. So there's a lot going on in retina that is happening right now and Northwestern is definitely a part of all of it.
Melanie: Thank you, doctors, so much for joining us today and telling us what's new in retina. So thank you again. To refer your patient, you can visit our website at nm.org to get connected with one of our providers.
That concludes this episode of Better Edge, a Northwestern Medicine podcast for physicians. Please remember to subscribe, rate and review this podcast and all the other Northwestern Medicine podcasts.
I'm Melanie Cole.