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Developing Therapies for Age-related Macular Degeneration: The Art and Science of Problem-solving: The 2018 Charles
1Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
Purpose:
To review the roles of analytic and innovative thought in advancing knowledge, using past examples in ophthalmology, and to explore potential strategies to improve our understanding of age-related macular degeneration (AMD) and develop new therapies.
Design:
Presented as the 2018 Charles L. Schepens, MD, Lecture at the American Academy of Ophthalmology Retina Subspecialty Day, Chicago, Illinois, on October 26, 2018.
Participants:
None.
Methods:
Review of published literature and sources on creativity and innovation.
Main Outcome Measures:
Recommendations for future AMD research.
Results:
Innovative solutions to problems often seem intuitively obvious in hindsight. Yet, some problems seem impossible to solve. In the 1990s, AMD was a significant unmet need, with only destructive therapies for neovascular disease. This changed with the development of 2 therapies: (1) verteporfin photodynamic therapy (PDT) and (2) anti-vascular endothelial growth factor (VEGF) therapies, which are now administered to millions of people annually around the world. Now, we are frustrated by the lack of therapies for early and intermediate AMD and geographic atrophy. Photodynamic therapy and anti-VEGF drug development occurred through a combination of analytic thought and creative disruption through innovation. To get past our current impasse in understanding and treating AMD, we need to harness both analysis and innovation. We have many important building blocks in place-information on genetics, clinical findings, imaging, and histology-and have identified key pathways and potential therapeutic targets. Perhaps we need additional investigation, analysis, and integration to improve our understanding through work on structure/function and genotype/phenotype correlations and development of imaging and systemic biomarkers. We likely also need an innovative disruption. This innovation might be the concept that there are subtypes of early and intermediate AMD characterized by specific clinical phenotypes, genotype, functional characteristics, and biomarkers that are dependent on particular pathways and treatable with a specific agent. We need to encourage innovation in each of us within our research and clinical community.
Conclusions:
Although we have accumulated extensive knowledge about AMD, we are currently at an impasse in the development of new treatments. We need to continue the analytic process, but at the same time encourage innovative disruption to develop successful AMD therapies.
