The therapeutic options of many eye diseases have developed quickly in the past decades. Because of the advancement of surgical techniques, cataract can easily be treated in such welfare states as Finland, and the intravitreal injections of VEGF inhibitors for wet age-related macular degeneration (AMD) has revolutionised not only the outcomes but also filled eye clinics with patients. Gene and stem cell therapies are currently being intensively developed.
“The increasing number of therapeutic options has also given rise to the question to whom these options are best suited and the most efficacious. It is evident that we have to have proper biomarkers and adopt personalised medicine to these next steps,” says Professor Hannu Uusitalo from the University of Tampere.
Age-related eye diseases, such as AMD and glaucoma, are becoming more common as people live longer and the proportion of the aged population grows. Diabetes is increasingly common and its onset happens earlier, which means that there is an increase in the incidence of such complications as diabetic retinopathy among people in their active working years. The younger population can also be afflicted by hereditary retinal diseases.
“Globally, cataract is the most common disease causing visual impairment. In welfare states, we have learned to treat the disease using cost-effective microsurgery. But to be fair, we need to remember that a large part of the world’s population does not have this opportunity at all,” Uusitalo says.
A new form of laser treatment is being developed in Tampere
“In the past ten years, efficient treatments have been developed for the wet form of AMD. We now treat the disease by intravitreal injections of VEGF inhibitors, which blocks the growth of blood vessels under the retina,” Uusitalo says.
“These injections are currently the most common reason to visit eye clinics in Finland.”
Uusitalo and Researcher Antti Härkönen from Tampere University of Technology recently received one of the three Tampere3 Innovation Awards comprising a total value of one million euro. The City of Tampere awarded the prize for the development of a laser-based method for treating the dry form of ADM.
“Laser technology is commonly used for the treatment of eye diseases, for example the treatment of diabetic retinopathy and glaucoma and in refractive surgery.”
“Because of its transparent optical structures, the eye is an ideal target for this technology making it easy to deliver and focus laser treatments. We can often even see in real time how the laser takes effect in the eye during treatment.”
Gene therapy is first and foremost expected to provide remedies for those eye diseases that are caused by a single gene, such as many hereditary retinal diseases.
“The use of stem cells in the treatment of eye diseases is another hot topic which we also investigate in Tampere in co-operation with Associate Professor Heli Skottman and her research group,” Uusitalo says.
Human embryonal stem cells or induced pluripotential stem cells can be used for the replacement of damaged cells in, for example, the retina and the cornea. Stem cells may also be used as individualised disease models in the development of new therapies for eye diseases.
Genes and proteins help to develop individualised treatments
In recent years, Uusitalo has focused on researching the possibilities of personalised medicine in eye diseases. Personalised medicine has also become a central trend in medicine more generally.
The idea is to find out which treatment is the best for each individual in terms of efficacy, safety and cost-effectiveness.
“All medicines or other interventions are not suited for all patients even in the case of very finely defined illnesses. We commonly see patients who react differently to the treatments and sometimes even have unexpected serious reactions. Finding the right patient for the right treatment is very important and helps both the patient and the doctor. Moreover, this would also help managing health care costs. In most cases, we should be able to find the best suited and most efficient treatments as early as possible.”
The central tools in personalised medicine include genomics and proteomics, which investigate the production and function of gene-regulated proteins in individuals. Imaging is also a powerful tool in personalised medicine.
“We have participated in the development of new medical treatments for glaucoma and researched which medicine option suits the patient the best,” Uusitalo says.
“We have used proteomics for this purpose by taking a small sample of tears in order to discover the patient’s specific protein profile. Surprisingly, we are able to detect about one thousand different proteins, and the proteins seem to tell us many clinically relevant things, such as which glaucoma medication should be given to which patient.”
Personalised treatments are becoming more common
According to Uusitalo, personalised treatment methods are quickly spreading.
“Classifying patients on the basis of biomarkers is already used in the treatment of cancer. It will quickly become more frequent also in the treatment of eye diseases and rightly so because new treatment options are fast being developed.”
“Clinical studies of gene therapy and replacement therapies that use stem-cell technology are already on their way. At this stage, the focus of our research is on the safety of the methods we are using. If all goes well, the methods might become available in clinical use relatively quickly – although in the first phase in very select cases and with a limited number of patients.”
“However, it is very important to remember that the early diagnosis and early interventions are of great importance because many of the new treatments also work best at the early stages of the disease.”
“This is why it is vital to raise awareness about eye diseases, their therapeutic options and the significance of vision for people’s quality of life and functional ability in work and at home,” Uusitalo stresses.
Professor Hannu Uusitalo is the recipient of the first Junnola prize awarded by the foundation of Tampereen seudun näkövammaiset ry. – the association of the visually impaired in the Tampere region. With the prize established to be awarded from the Kaisu and Kalevi Junnola fund, the association wants to highlight the important work undertaken to diminish and even prevent the disabilities caused by visual impairment and to increase public awareness on visual impairment. The prize is EUR 10,000.
For more information, please contact:
Professor Hannu Uusitalo, tel. +358 40 190 1214