The EURETINA 2017 Congress, held in Barcelona last September, presented the latest advances in ophthalmology. Dr Jordi Monés was the moderator of two sessions at the Eurotimes Satellite Education Programme and presented communications and ePosters. You can check out here the activities of the BMF and Institut de la Màcula teams.
Here we summarize the most prominent advances in the field of advanced therapies.
Stem Cells: A new approach
Stem cell therapy is a useful tool and offers a new approach in regenerative therapy for diseases for which there is still no cure.
There are currently several studies being conducted which use both embryonic stem cells (ESC) and induced pluripotent stem cells (iPSCs) in patients with Stargardt disease, and neovascular and atrophic age-related macular degeneration (AMD): hiPSC-derived RPE sheets in AMD (RIKEN), hESC derived RPE in acute wet AMD (Pfizer), hESC derived RPE cells in Stargardt macular dystrophy and AMD (Astellas).
Genome editing is much more feasible both in vitro and in vivo thanks to the CRISPR/CAS system. This avant-garde genome-editing technique allows for the precise study of the function and edition of genes.
Optogenetics and RP
Studies carried out on mice with a combination of optogenetic techniques and photoreceptor transplantations demonstrate that the genetic reactivation of cones restores visual response in retinitis pigmentosa (RP).
Genetic studies show that there are genes like ARMS2 or complement factor H (CFH) that are expressed in various eye diseases, such as central serous chorioretinopathy (CSC) and AMD. Even so, these diseases are still phenotypically and genetically different.
The genetic variants can be used to generate predictive models to detect and manage or treat diseases before they lead to blindness.
Monocytes and AMD
Differences in monocyte count between neovascular AMD and atrophic AMD have been proven. In neovascular AMD, a higher percentage of non-classical (CD14+/CD16++) monocytes and intermediate (CD14++/CD16+) monocytes cause a proangiogenic and pro-inflammatory effect. On the other hand, in atrophic AMD, the classical (CD14++/CD16-) monocyte or phagocytic population is greater.
Electronic implants and devices also played a leading role in EURETINA. There are currently three electronic retinal prosthesis systems in Europe: Alpha-AMS, Argus II, and PIXIUM. These devices are currently able to restore some vision in patients with retinitis pigmentosa. They also have many advantages: they don’t cause immunological reactions, their safety has been proven, synapses formation isn’t necessary as may be the case with cell transplants, and it also is not necessary for the retinal pigment epithelium to be intact.
However, the amount of times that an implant can be replaced is yet to be determined, due to the surgical risk involved and the cost of these devices.
Use of artificial intelligence
Artificial intelligence is becoming increasingly more important in all fields of study. Moorfields Eye Hospital in London and Google DeepMind are working together on a Machine Learning project to create an algorithm which detects the early signs of diseases such as neovascular AMD or diabetic retinopathy. This technology’s success could greatly increase the speed and accuracy of the diagnosis of these diseases and therefore, avoid loss of vision in thousands of patients.
IBM Watson, an artificial intelligence computer system capable of understanding, reasoning, learning and interacting, has been used of oncology to assist experts in this field and reduce patient evaluation times. IBM Watson is currently being used in the field of ophthalmology to detect and identify eye diseases, such as glaucoma.
These artificial intelligence tools open the debate on how they should be used. Some believe that medical specialists should use them, whereas others argue that the implementation of these tools would be more appropriate in primary care so that, from there, the patients can be referred to the medical specialist.
Eduardo Rodríguez, MSc., member of the BMF research team