Nimesh Patel, MD, a retina specialist focusing in pediatric retina at the Mass Eye and Ear Infirmary in Boston Children’s Hospital and Assistant Professor of Ophthalmology at Harvard Medical School and the Director of Pediatric Retina, discussed the many advancements in both diagnostics and treatment in the retina realm.
Plus, hear Dr. Patel talk about the next frontier of treatment for retinal conditions.
Question:
What are the latest trends and advancements in retinal diseases as it relates to diagnostics, imaging, and treatment innovations?
Nimesh Patel, MD:
There are a lot advancing in retina, and that’s why it’s a really fun field to be a part of, both in diagnostics and treatment. I think mainly in diagnostics, what we’re trying to do is look at how can we image patients non-invasively, and that’s where optical coherence tomography angiographies has taken a big leap forward. No longer are we doing often fluorescein angiographies, which is a dye-based, injection-based technology, and we can usually get most of the information with a wide-field OCTA. Some of those are in research, but there are some clinical devices available, so that’s probably our latest advancement in imaging. In terms of therapeutics, there are a lot of different options for the treatment of diabetic disease and macular degeneration. There are a lot of innovations both looking at certain pathways. We’ve been using anti-VEGF, but there are other pathways that could potentially be available to us as an option. Then also looking at durability and seeing if there’s ways that we can increase the duration of treatments of some of the medications that we already have.
Question:
How is artificial intelligence being used to diagnose and treat retinal disorders?
Nimesh Patel, MD:
There is a lot of research in artificial intelligence. It’s a hot area, not just in ophthalmology. It surprisingly hasn’t really hit prime time yet, and even for pediatric retina and ROP, it seems like it should be able to. Ophthalmology is a very imaging specific specialty, and a lot of things can be fairly black and white in terms of decisions to treat or not treat. It’s surprising that artificial intelligence hasn’t really taken off. Currently, there is an FDA-approved treatment or imaging device called the IDX, but that really tells you whether you can refer or not, and it’s not really in the ophthalmology clinics. I think the best avenue for artificial intelligence is probably a screening device to tell us, if you go into CVS, could you get this image and let us know if you should see an ophthalmologist? It’s probably not ready for being in the ophthalmology clinics to assist clinicians and how to treat, and how often to treat.
Part of the limitations have been that these have to be trained on a certain data set of patients, and they’re not always generalizable to other patients. There are also some issues right now with data security. Who’s liable for this? Let’s say the artificial intelligence tells you something wrong, who’s liable for that? Also in reimbursement, so if these images are being overread by someone who’s being reimbursed for that, so there’s some challenges still to the implementation of artificial intelligence in ophthalmology.
Question:
How do you approach discussing prognosis and treatment plans with patients with progressive retinal diseases?
Nimesh Patel, MD:
The good news in retinas, we can cure a lot of diseases. Retinal detachments, membranes, a lot of the surgical, even diabetic retinopathy is often reversible if you catch it early. Some of the things that we do treat do progress, things like macular degeneration and geographic atrophy. We’ve had to have these conversations a lot in the past with geographic atrophy, which tends to be something that progresses and eventually takes out the vision. We do have now some treatments available that can slow down the progression in theory, and that’s yet to be seen necessarily in the real world just yet. But we’ve been discussing that with these patients that although they have a progressive retinal condition, there’s a lot of research being done, and we try to provide them some hope, and I usually make sure I’m still seeing those patients every year or so to update them on what’s available.
For example, a couple years ago when there was nothing available for geographic atrophy, now I can see that patient back and say, “Here’s what we have right now. It’s in the early stages; here’s the risks and benefits,” and then see where they stand. Then even next year, maybe there will be hundreds of thousands of patients treated. I can now have a more informed discussion with them if this is a correct medication. In summary, for these patients with progressive retinal conditions that we may or may not have treatments for, I still like to see them back and try to give them hope, discussing what’s out there in the research pipeline.
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