OIS@ASRS Co-Chair Mark Humayan Says Attention to Retina “Long Overdue”

New ASRS President Mark S. Humayun, MD, PhD, shares the challenges of entrepreneurship in innovation. Co-Inventor of the world’s first FDA approved artificial retinal prosthesis developed by Second Sight, Humayan tells OIS-TV the device side “is under a lot of pressure … I really hope that trend doesn’t go too far to the right and that we begin to fund devices in ophthalmology and particularly the retina.” Humayan talks about the importance of devices as well as the emergence of combination therapies. Watch the interview to hear more from this recognized innovator.

Participant:

Transcript

Tom Salemi: This is Tom Salemi at OIS TV. I am at OIS@ASRS. I’m here with Dr. Mark Humayun. You are the Director, and you know this, of USC Institute of Biomedical Therapeutics.

Mark Humayun: Thank you. Thank you for having me.

TS: Thanks for helping us put together this event. What do you think? The day’s just about over. How did it go? Is OIS and ASRS a good fit?

MH: OIS is a great fit for ASRS. It’s fantastic. it’s well overdue to have OIS actually focus just on the back of the eye. In the big meetings, yes there are some retina talks, but it was really wonderful. Big attendance already, right out of the gate. And I think it’s going to be a big success.

TS: Do you back of the eye and front of the eye guys get along OK?

MH: Yeah, we do. We talk to each other once in a while.

TS: I’m sure there’s some turf wars going on there. You were honored earlier this year. You got a National Medical Technology and Innovation medal from President Obama. Sounds really great. What was it like? Was it an honor for you? Obviously to get an award from the president sounds wonderful. But what did it mean to you to be honored so publicly and by your country?

MH: Well, it was amazing. The National Medal is really a – obviously given to very few people. I was just blown away looking at the people who’ve gotten it before in non-ophthalmic fields, as you mentioned: Bill Gates, Steve Jobs. It was really amazing to have – to be on that stage and get that award. And especially for ophthalmology, it’s good to really emphasize our field. And in fact, on the opening comments, President Obama only highlighted two technologies, and one of them was really our technology to restore sight to the blind.

TS: Well, let’s talk about that. it’s a story I keep retelling because it just is sort of classic medtech, where you have that – and we call it – we did a podcast earlier this year, this sort of aha moment where you see something that might work and you stick to it, and 20 years later you’ve got a device that can help restore vision for people who have lost their sight, which is amazing. What was that process like, to go from the moment where you saw what could be possible to the moment to it actually became possible?

MH: Well, in this case it was a really long process. But it was enjoyable. I mean I enjoyed all aspects of it. Lots of ups and downs, a lot of scientific ups and downs. But fortunately, Al Mann, who founded Second Sight, was very true and heart fast to the concept, and provided the funding throughout those years. You know, often, it’s tough enough to struggle with the science, and then you have to struggle with the funding of it. It gets really, really complicated. So I can’t thank Al Mann enough for really being there through all those years.

TS: Do you feel that innovation in ophthalmology is still being supported as it was, or more so?

MH: I think innovation in ophthalmology is really being supported by the innovators. And I think the industry is there. But as we heard today, the device side is really under a lot of pressure. I think the money’s being moved more to the biologics and the drugs, the cell based therapies. And I’m just being a device guy, being a gadget guy, and I really hope that that trend doesn’t go too far to the right and we continue to fund devices in ophthalmology, in particular, retina.

TS: But we had a panel today talking about paying for the drugs as well. And it seems like it’s a different – the same story, sort of different chapter for drugs. They’re starting to get under the same pressure.

MH: Right. I think anything for the back of the eye, drug – or for the eye in general, or medicine also – everything is becoming under a lot of scrutiny in terms of cost and cost pressures. I mean we just heard back when Lucentis was proposed for $2000 an injection, we didn’t think much of it because we didn’t think how often we’d use it and for how many. But now that you sit back and look at the total dollar amount, it is staggering, and it is something that everyone’s focused on, how to improve that and how to make that better.

TS: We talk about costs as investors, and as the business side. But as a physician, how does the emphasis on cost impact your day to day life?

MH: Well, in terms of my decision making, it doesn’t. You have to give the best therapy you can for the patient. And I think that’s first and foremost. I mean that’s – what I would do for my eye is what I’d like to do for my patients. And if you stick by that motto, you’ll always fare well.

TS: That’s a good motto to have. You were on a panel about combination therapy. And what were some of the takeaways from that discussion?

MH: Well, combination therapies is now that we have this wonderful anti-VEGF drugs, which are doing very well for us, you know, how much better could another drug do? And what how would you use it in the clinic? Would you actually give 2 separate injections to a patient versus one if it’s truly better how much better would it have to be? Would it have to be just better a couple letters or does it have to be better a whole line or two lines? Does it have to be better in the sense that you don’t have to inject it every month or 2 months, but in fact it’s 3 or 4 months, you know, increase the duration? So we really talked about a lot of that. And then of course in the context of how is this all affordable.

TS: That comes up a lot this day was the cost of the drugs. But the delivery of the drugs also has been an issue. How are things looking on the drug delivery side?

MH: Well, I think the drug delivery side is very exciting. These injections, they work and when patients show up, when we give them the injections, they work. But patients are elderly and it’s difficult for them to sometimes come in. They’re often dependent on their family members to bring them in. So it’s very difficult and our clinics are now better suited to give 50 injections a day. But still it’s a big treatment burden. And I think drug delivery devices, if they can elute these drugs where you can implant something surgically or maybe inject something into the eye that can last a couple, two, three months would be very important.

TS: And one of the things we didn’t talk about in the Podcast because actually it just came out recently was we were talking about innovation and innovations, and we joked about whether to talk about this or not. But the study recently where it was demonstrated that you could regrow optic nerves in mice, and it was done through a really clever way. You’re following this field; you’re following innovation in the field. Is that another aha moment? Is this something you think that we’re going to look at 20 years from now, or maybe hopefully 10 or 5 years from now and say it sort of started right then?

MH: Well, it was a very interesting study. I mean don’t grow nerves either in the body, the eye, wherever. They’re difficult to grow and repair, and to have this treatment that actually in these animal models, the mice as you mentioned, they created a crush injury of the nerve and then were able to really improve the connection. What was really intriguing about that study was OK, you can sort of rev up these cells, the nerve cells to maybe sprout at connections. But what was really amazing is these connections knew where to go. And if you just sprouted connections and they went wherever and didn’t go to the right places, then it wouldn’t benefit you. But what was really interesting is not only the fact that these nerves actually sprouted, but they actually went to where they were supposed to for the most part.

TS: And it sort of demonstrates just how central they eye is to many different parts of the body. This study involving the optic nerves, I mean maybe it’s translated to other nerve growth elsewhere, as well. I mean the eye is really a place where so many different roads come together, isn’t it?

MH: Well, I think it’s a great test bed because we understand it very well as the retina is very structurally organized. We know the neural connections, and we could really study it. And the tests that we use are simple and they’re easy to follow, you know, different types of behavioral testing in animals and so forth. So the eye is a really wonderful test bed for treating neurological conditions.

TS: And looking at the business side of things, you’re the incoming President of the American Society of Retinal Specialists, right? You’ll be taking on –

MH: Correct, I’m going to be taking over after this meeting.

TS: So do you go into this with sort of an agenda in mind, things you’d like to accomplish? And if so can you share some of that with us?

MH: Well, the American Society of Retina Specialists is now the largest society and it really is growing every year by 10%, so it’s really a robust society. And it’s really – it sets preferred practice patterns. It also is a voice. When sometimes cuts are coming for certain procedures, it’s able to step in and clarify that. We’ve spent a lot of time in terms of having doctors have the choice to treat patients because you know, one of our drugs, Avastin, is very cheap, and so a lot of insurances in different parts really push back and say the patient should have failed Avastin before you used some of these other drugs, where some of these other drugs could be better for these patients in certain diseases. So we really push back to give retina specialists a voice and the ability to use the type of drugs they want to use. And really also help with patient education, to really, you know, what is retina, what is the macula, so to really make them understand. And diabetic retinopathy, that’s so important because their diabetic control and how well they treat their diabetes really helps with their retinopathy. So we get the word out there, and I’m looking forward to a busy 2 years of being a President of this society. And we’re going to have a lot of great initiatives including working with the OIS.

TS: And we’ll look forward to that. So looking ahead 2 years, when you’ll be handing over the – I don’t know if you use a scepter, or how do you rule the ASRS?

MH: A crown?

TS: A crown. What kind of successes and milestones do you think we’ll see happening over the next 2 or 3 years in terms of – in ophthalmology and retina? What would you like to see happen?

MH: Well, I would like to see the physicians be really able to use the drugs that they would like to use that they feel are best in the patients, and not be continuously under the pressure of having to use a particular drug because it’s less expensive. I think once Lucentis, there’s a biosimilar to Lucentis, things are going to change. How much they’re going to change, what that pricing is going to be is going to be interesting to see. So the world of biosimilars is going to come to retina, and we’re going to see how that affects our therapies. And then beyond that, as I mentioned earlier, I’m a gadget guy, so I’d like to see more instruments and devices in the operating room to improve our surgical procedures. Visualization is a big part of it. What we see through the microscope is at times limited. Digital enhancement in the microscopes. So there are lots of things in drug delivery devices we touched a little bit on. And gene therapy, very exciting area. I mean who could balk or say anything against being one and done? You know, having one injection, gene therapy, and then it’s able to treat disease. And lastly, cell based therapies. Stem cell approaches to treating these difficult conditions. So it’s very, very exciting. I see a lot of these things coming through from policy to science to therapeutic approaches.

TS: We’ll be talking about a lot of it in OIS@ASRS 2017 and 2018, I hope.

MH: Yeah, absolutely.

TS: Great. Thanks for joining us.

MH: Thank you for having me.