Joslin Lays Foundation for Improved Eye Treatment
Dr. Lloyd Paul Aiello
Tuesday, April 27, 2010
If left untreated, about a quarter of people with diabetes eventually lose some of their vision from diabetic macular edema—a condition in which leaking blood vessels cause swelling in the center of the retina. While laser treatments based on work pioneered at Joslin in the 1960s have helped to minimize this damage, injecting a drug called ranibizumab can be more effective, according to results from a major clinical study by the Diabetes Retinopathy Clinical Research Network (DRCR.net) announced today. Joslin scientists were leaders both in the basic research that led to the study and in the establishment of DRCR.net.
“The study shows that this medication therapy is substantially better than our current standard laser treatment alone for this condition, which affects hundreds of thousands of people worldwide,” says Lloyd Paul Aiello, M.D., Ph.D., director of Joslin’s Beetham Eye Institute. “Treatment with the medication as performed in the study results in more vision improvement and less vision loss than current laser therapy alone, and it doesn’t increase eye pressure or cataracts.”
“This will be a major benefit for patients with diabetic eye disease,” adds Dr. Aiello, who is also Associate Professor of Ophthalmology at Harvard Medical School. “Laser for diabetic macular edema has been the gold standard treatment for the past 25 years. Now, we have an even better therapy for these patients.”
The drug, marketed as Lucentis, targets a molecule called vascular endothelial growth factor (VEGF), a key player in the growth of blood vessels.
Working with George L. King, M.D., Joslin’s Chief Scientific Officer and Professor of Medicine at Harvard Medical School, Dr. Aiello made a string of major discoveries about the role of VEGF in the eye. These Joslin scientists were the lead authors in a New England Journal of Medicine paper that showed that expression of VEGF is heightened in patients with diabetic eye disease, and in other reports demonstrated that this molecule can be blocked with subsequent reduction of retinopathy in animals and that an anti-VEGF drug can reverse visual loss in a patient.
Dr. Aiello also was the inaugural chair of the DRCR.net, the premier network for doing clinical trials for diabetic eye disease in this country. About one-third of all retinal specialists in this country participate in DRCR.net, which is funded by the National Eye Institute, the National Institute of Diabetes and Digestive and Kidney Diseases and other groups.
In the other major form of diabetic eye disease, proliferative diabetic retinopathy, blood vessels grow in wrong places on the retina. Laser therapy provides excellent results for this condition, preventing severe visual loss in more than 95% of patients. This new clinical study wasn’t designed to examine the effectiveness of ranibizumab for these patients, but other data suggest that it might be helpful in their treatment as well. Further studies are underway to assess the benefit of this therapy for patients with diabetic eye conditions other than those evaluated in this study, says Dr. Aiello.