Personalising glaucoma
Professor Keith Martin from Cambridge University presenting at Allergan's Beyond glaucoma meeting in Sydney

Personalising glaucoma

August 28, 2018 Lesley Springall

Personalised medicine, moving away from a one-size-fits-all approach, is a big thing in today’s British National Health Service and this can make a big difference for glaucoma patients, said Professor Keith Martin, head of ophthalmology at the University of Cambridge.

Speaking at Allergan’s Beyond glaucoma meeting in Sydney in July, Prof Martin, the meeting’s keynote speaker, said primary open-angle glaucoma (POAG) tends to be considered as one disease with one treatment path - lowering intraocular pressure (IOP) - despite patients being very different and having a range of other conditions.

“If you look at what’s happened in other areas of medicine in recent years, they have been revolutionised by their ability to diagnose specific variants of their disease more accurately.” This is particularly true for breast cancer, with every UK patient now molecularly phenotyped and their treatment plan designed to fit to their specific form of breast cancer.

Driving this personalisation are advancements in understanding our own genomes and technology innovations. Technologies like the Sensimed Triggerfish contact lens sensor which can detect IOP-related changes over a 24-hour period, may help provide a better understanding of a patient’s glaucoma: slow versus fast progression or stable ocular hypertension versus ocular hypertension converting to glaucoma, said Prof Martin. “Health systems and health providers are now looking at ways to integrate this knowledge into patient care… to help us predict risk for diseases like glaucoma; who’s going to do well and who’s going to do badly and so will need more resources devoted to them.”

Within glaucoma there’s been a plethora of innovations in recent years, such as minimally invasive glaucoma surgery (MIGS) and Allergan’s Xen Gel stent. But that makes it even more important to work out which treatment is the best for each, individual patient, he said. “Because none of these treatments are right for everyone.”

At Cambridge, Prof Martin and his team are conducting a number of different studies looking at new, more personalised treatments for glaucoma patients, including stem cell research and other cell therapies. These have been shown to work in animal models but, as yet, there’s been no real clinical evidence. More worrying, he said, are the complications shown by patients who have had unsanctioned stem cell treatments off-shore, such as severe retinal scarring.

Advancements in gene therapy are showing particular promise for eye diseases, said Prof Martin, highlighting a number of ongoing clinical studies. “The main problem is you’re limited in the amount of information you can send into cells by the virus (gene carrier). Instead of a long email, it’s more like a tweet. So, you can only deliver limited instructions into the cell.”

Prof Martin and his team have the go-ahead and the funding to sequence the whole genome of up to 60,000 patients a year with glaucoma, macular degeneration and diabetic retinopathy in the UK. “Whole genome sequencing on that number of patients is mind blowing in terms of the amount of data that will be generated, but also a huge opportunity.”

While we wait for the results of these studies and other gene therapy clinical trials to come to fruition (and the cost of gene therapies to come down) we can still improve care for our glaucoma patients today, by better individualising care to maximse the benefits of both the new and older glaucoma treatments currently available, said Prof Martin. “This is where we get to become doctors again, to actually understand what our patients’ needs are, what their fears are, and to help them weigh up the risks and the benefits of different treatments and make sensible decisions.”

Allergan’s Beyond glaucoma meeting ran concurrently with its sister meeting, Beyond the retina, focusing on diabetic macular oedema (DMO). The two events were designed to talk about current and future treatments for glaucoma and DMO and introduce Allergan’s Xen Gel stent, a surgical implant designed to lower eye pressure in open-angle glaucoma patients, and Ozurdex, a sustained-release dexamethasone intravitreal implant, designed to treat DMO, to the Australia market. Both products were introduced to New Zealand at the end of last year. For more on both, search “Xen” or “Ozurdex” on www.eyeonoptics.co.nz.