Bill Harvey: The Gene Genie
Author: Bill Harvey
Exciting news from Oxford Eye Hospital this week with news reports of the successful injection of DNA material into the retina of a patient with macular degeneration. As exciting as the introduction of anti-VEGF treatment for wet AMD was, the treatment of the much more common dry form of the illness remains one of the big Holy Grails of modern medicine. Hence the excitement over this new development.
AMD was unheard of a century ago. Life expectancy was such that the condition that rarely appears in the under 60s was just not seen. It is now the leading cause of visual impairment in the UK. Current management tends to focus on enhancing what vision remains (good old low vision practice) and minimising risk factors (smoking, poor diet, lack of short wavelength filtering in non-phakics and so on). Though the vision loss is not as dramatic as that of the wet form of the disease, people suffering the insidious progression of central distortion and loss are often so disturbed by the impact upon vision that they embrace wholeheartedly any intervention that seems to make a difference, even when measurable improvements are difficult to confirm.
The use of a viral vector to introduce DNA coding for a protein that has a protective effect in eyes undergoing degeneration is promising. As yet, details seem very sparse and it is unusual for such widespread publicity to surround what appears to be a potential therapy many years hence. I have already had prematurely excited patients asking about the treatment. That said, if the therapy was to prove effective at the first signs of disease, such as the first autofluorescence suggesting lipofuscin aggregation and inflammation, this might be a treatment in years to come where optometrists play a key role in initial patient identification. Alas, I will likely be long gone by then – typical.