OIS@ASRS Co-Chair Tarek Hassan on the Rise of the Retina

Tarek S. Hassan, M.D., Professor of Ophthalmology at Oakland University William Beaumont School of Medicine and Fellowship Director at Associated Retinal Consultants in Royal Oak, Michigan, speaks to the lure of the retina.

Participant:

Tarek S. Hassan, MD

Transcript

Tarek S. Hassan, M.D., Professor of Ophthalmology at Oakland University William Beaumont School of Medicine and Fellowship Director at Associated Retinal Consultants in Royal Oak, Michigan, speaks to the lure of the retina. “What took me to retina was the ability to fix eyes that nobody else could. But in recent years, with the changeover from I think the very intense surgical innovation track that most industry was on to now the medical innovation track that most industry comes at us with, we sort of have a rebirth in accelerating ability to treat people that we weren’t able to treat before. So it’s exciting to be able to do something with diseases that we couldn’t deal with before. And we were always sort of on the fringe of eye care, but we’ve become a lot more mainstream because we can actually do something for end stage eyes.”

Tom Salemi: Hi, this is Tom Salemi at OIS TV. We’re here at OIS@ASRS, and I’m here with one of our co-chairs, Tarek Hassan, Professor of Ophthalmology at Oakland University William Beaumont School of Medicine. Thanks for joining us.

Tarek Hassan: Thank you, Tom. Happy to be here.

TS: Great, great event. Thank you for helping us put this together. What has been your experience so far of the day?
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TH: Oh, it’s been terrific. Actually we’re very happy to have OIS having their meeting adjacent to ours for the first time. I’ve been a longtime fan of OIS. I think it’s a terrific venue to bring together clinicians, scientists and certainly the money side of things, venture capital and those interested in the business side of things together in one place to talk about all these new ideas. And retina is such a fertile ground for –

TS: It really is.

TH: – basically the tremendous majority now of new research dollars and all different types of endeavors from imaging to basic science imaging, surgical, medical treatments that it’s really the perfect thing to have OIS within our meeting.

TS: Do you feel, as a retina specialist, you have more eyeballs on you? Has it been sort of a sleepy field in the past? I know the glaucoma fields always joke that they have the boring specialty until lately. How does it look from retina?

TH: Well, I think we were not necessarily the boring field, but we were certainly the small, niche field that was kind of way off at the end of the spectrum, that we sort of did our thing. So we had a lot of diseases that were not treatable for many, many years. And if I think of our specialty 20 years ago, it was a completely different thing than what it is now. And I think that we went roughly 10 years ago with the anti-VEGF era from being what I used to call sort of careful watchers to temporizers to now we’re healers. Now we actually can restore sight in eyes that were previously largely dead to us. And I think that with all of that, and the introduction of the pharmaceutical industry as part of what we do, and all of the new drugs and the greater understanding of the pathophysiology of our diseases that we’ve become a very exciting area, not only to ourselves and our patients, but to industry and sort of the venture side of things as well.

TS: It must be a lot more enjoyable to practicing nowadays. You’ve become a physician, you want to heal people and help people. What is it that brings you to the retina where, as you said earlier, you had very limited options for people? You’re still obviously doing some good, but what drove you to focus on the retina?

TH: I think a lot of people, particularly those my age, were driven to retina because of the surgical interventions because they were some of the more dramatic presentations, where people would lose vision. But they were things that we could fix. We had surgical tools that allowed us to fix the majority of eyes, and we did well. And in the early part of my career, surgical innovation was really at breakneck speeds. And people did increasingly better and better at repairing those eyes. So I think that’s what took me to retina was the ability to fix eyes that nobody else could. But in recent years, with the changeover from I think the very intense surgical innovation track that most industry was on to now the medical innovation track that most industry comes at us with, we sort of have a rebirth in accelerating ability to treat people that we weren’t able to treat before. So it’s exciting to be able to do something with diseases that we couldn’t deal with before. And we were always sort of on the fringe of eye care, but we’ve become a lot more mainstream because we can actually do something for end stage eyes.

TS: and as you sort of move into having more therapeutics to offer, that kind of gets into the topic you were talking about today, the sort of paying for the breakthrough eye therapies. I know you were on that panel and helped lead – led that discussion. As a physician, how does cost sort of factor into what you do? And what were some of your takeaways from the discussion today?

TH: Well, cost is playing an increasing role in our decision making process. And I think that’s largely unfortunate. I think for the most part we want to deliver the best care to our patients, and I think the efficacy of any treatment is really the primary driver that we all have when we try to decide what to do for our patients. But I think because of mandated plans from payers, whether they be private payers or the government or otherwise in international communities, we have to stop and consider other things other than just simply efficacy in how we treat our patients, particularly with macular degeneration and diabetic macular edema treatments, which uses the injectable agents, whether they’re anti-VEGF or steroids. And so one of the takeaways from our panel today was really it is a very quickly evolving landscape, which makes it more difficult, I think, each and every year to decide in what way we’re going to marry payment with technology and innovation and efficacy, particularly of pharmaceutically branded drugs that go through the typical manner of FDA approval and such. So we’re in a situation now where we have payers that demand that we use the lowest cost alternative to treat patients, even though it may not actually even be approved, for many of the indications that we’re asked to treat patients with. And then we have to work our way through tiered therapy plans, for example, with macular degeneration to get up to using the FDA approved drugs to treat wet macular degeneration. That’s just one issue on a daily basis that we face. There are issues with alternative payment models being created through the government, and as we try to sort of get a handle on the spiraling healthcare costs, which is certainly a worthy and needed goal to be achieved, and yet it puts pressure on us to be able to use what we think might be best for our patients if we can’t afford them as physicians to even supply this medicine to the patients, or if the patients can’t afford to pay for them.

TS: So how do you advise a company that’s moving in this space to sort of – to manage those risks? I mean you can come up with a wonderful drug that does what it’s supposed to do. When cost comes into play – and this is something we’re seeing on the medtech side more – but do you have concerns that it might slow the pace of innovation or funding of these companies?

TH: Yeah, I think many of us are concerned of exactly that fact. I think that unless a breakthrough therapy is truly breakthrough, changes the game in some manner, it’ll be hard for any company going forward, I think, to demand what one might consider to be a premium price for their new drug in particular. The existing marketplace is already under great pressure for the prices that we pay now for drugs that are truly miraculous in their ability to cure blinding disease. But I don’t think anything will be easily added to this milieu at those prices. And I think that with the advent of newer things coming down the road, like biosimilars and other pressure that are driving prices actually down, I think a new company is really going to have to sort of go through these waters sort of carefully, and I think with a bit of an eye to the future because again, it is a changing landscape. And I think that this may have the negative impact of sort of stifling or slowing down innovation.

TS: And you’re right because you can’t just fund a blockbuster or giant leap forward. You can’t – many, I think, iterative steps have to be taken before you find that really big successful drug. So if you’re not taking those smaller, iterative steps, you might miss out on the giant leap forward that you need. Where do you think we are in sort of innovation within retina, and kind of the moon shot of finding the therapies we need? Are we still in the very early stages? Are we in the mid stages?

TH: Well, it’s interesting. On the surgical side of things, I think we’re in the at least the mid stages. Because I think a lot of the surgical instrument companies and device companies have gotten us to an outstanding level. Our ability to treat diseases has improved so much in the last 15 to 20 years through the instrumentation that is now safer, more efficient, and really ultimately better for doctors and patients and hospitals and operating rooms a like. I think on the surgical side, we’re almost at a point where we need better – we need something new in science. We need more breakthroughs and ways of keeping detached retinas alive longer. We need something else to be additive to our surgical side. One area for that would be imaging and visualization, and our ability to see things. Certainly, the better we see, the better we operate. But I think that we’re certainly in a bit of a plateau on the surgical side. And that’s great news for our patients. They do particularly well with most surgical procedures. On the pharma side, we’re really I think still in the infancy. I think the anti-VEGF breakthrough in the treatment of macular degeneration and diabetic retinopathy was dramatic, monumental. And yet, those were the first salvos in this market. And now all of these companies that we hear today presenting at OIS and that we’ll read about have pharmaceutical agents that may be delivered as once a year, twice a year simple injections in the office, or potentially things like gene therapy or other methods of vector treatments that could deliver maybe once in a lifetime treatments. I mean I think there are greater understanding of the pathophysiology of these diseases and getting improvements in long term drug delivery systems, and the marrying of technologies outside of retina with those now within retina are really, really exciting for the future. So we’re clearly at our infancy on the medical side of treating these devastating diseases. But we worry about how to pay for them.

TS: It is, I guess, a good problem to have, to have that technology coming, but unfortunately there are financial limits on everything. You’ve spent the past year as President of ASRS.

TH: Yeah, actually 2 years.

TS: Two years, two years. What was that experience like?

TH: Oh, it’s been tremendous. I mean it’s been a great honor to be president of the largest organization of retina specialists in the world. It’s a very dynamic, inventive, wonderful group of people who I think really, truly love their patients, love what they do, are under pressure from a lot of different sources, as are many physicians in many specialties. But it is a terrifically motivated group to do the best they can with their craft and I’ve been really thrilled to work with the other people in the ASRS leadership, those that work from the membership with the leadership on projects. It is a very interactive association between the ASRS leadership and its membership, which has really been terrific for me to enjoy for the last couple of years.

TS: And has it been an organization that is committed to innovation, to finding – I mean every –

TH: Yeah.

TS: – clinical group is, but as you explained, there’s a lot of new ideas coming down the pike, a lot of new technologies. It must be a great time to be leading a group like that with so many new options coming.

TH: It really is. We have a huge emphasis at the ASRS on education. It’s really at the core of our mission is educating physicians to give the best care to their patients. And it certainly starts with our cornerstone, which is the ASRS annual meeting, which we’re speaking to you from. And it goes all the way to the many other educational offerings we offer to our membership on the website, through courses, through ancillary meetings, through even new journals that are going to be coming out from the ASRS. So our biggest focus truly is education and innovation is really very much in our sights. And we have outreaches with various committees and industry partners. We have a very strong industry partner program where we’re very much in touch with the new and advancing things in all aspects of research in retina.

TS: And looking forward to the next two years, I know you won’t be the president any longer, but what types of successes or milestones do you think we might be looking at a couple years from now?

TH: Well, I’m hoping we get further along in our understanding of and access to more therapies for the things that we still don’t have anything good for, like dry macular degeneration, for example. Wouldn’t that be terrific if we could stop those patients from losing sight with medications that we think are efficacious and actually have been proven to do that. So we’ll see some clinical trials that will give us data in the near term as to whether or not there are things in the offing. And we’ve heard today in our presentations of other companies that have similar exciting products in the pipeline. And in the next couple of years, we’re certainly hoping to do better with what we have. On the wet AMD side, there are new drugs that maybe get reaching FDA approval within the next 6 months to a year that may add to our armamentarium in ways that we can manage wet AMD and stop scar tissue formation; for example, the anti-PDGF drugs. So we have ways to improve what we’re doing. We have ways to find, hopefully, new drugs that are going to allow us to work on things that we haven’t yet been able to do. And I think some of the exciting things with imaging that are coming will help us to better understand these diseases so that’ll push us forward.

TS: Great. Well, look forward to we hope having OIS@ASRS two years from now, and reporting on many great advances then.

TH: I will look forward to it.

TS: Thank you for coming.

TH: Thank you, Tom. Appreciate it.