UPFRONT

A Pioneer Passes

JASON S. SLAKTER, MD

Just a few short weeks ago, we were all saddened to hear of the death of Judah Folkman, a true pioneer of science and father of the field of anti-angiogenesis. It is remarkable how quickly we, in the ophthalmic community, have all come to accept the use of antiangiogenic drugs. In fact, it took decades for the scientific community at large to accept the concept that angiogenesis inhibitors would control or reverse tumor growth and for clinical trials to be performed that would validate Dr. Folkman's viewpoint on this therapeutic approach. He actually faced resistance from other scientists and outright ridicule at times for his innovative concepts. Time, however, proved him right and the results of his endeavors, especially in the field of ophthalmology, have been the approval of drugs, such as pegaptanib sodium (Macugen, OSI/Pfizer) and ranibizumab (Lucentis, Genentech), and the off-label use of bevacizumab (Avastin, Genentech). These have revolutionized our treatment of age-related macular degeneration (AMD), diabetes, and other retinal conditions.

CARRYING THE TORCH

While Dr. Folkman led the charge for this new therapeutic paradigm, it now falls upon us to carry the torch as we move forward in finding new therapeutic approaches for retinal and macular diseases. This task, however, is not always so easy. Many physicians take a very shortsighted viewpoint — that as we now have ranibizumab and bevacizumab available, there is little more that needs to be done. In my opinion, these drugs represent just the beginning, the first steps in the long march toward a treatment paradigm that offers the possibility for true vision restoration.

In order to gain the knowledge necessary to move the field forward and to determine if new treatment approaches are beneficial for our patients, we must, as clinicians, support current and future clinical trials. It is all too easy, as we go through a busy day in the office, to simply see patients, recommend an existing therapy, and send them on their way. It takes a lot more time and effort to explain the potential risks and benefits of participation in investigational clinical trials, and even more of a sacrifice to carry these studies out. However, without such determined efforts, further advancements cannot be made.

It is therefore incumbent upon all of us to take an active role in the discussions that lead to the development of new clinical trial protocols, to become active as recruiting sites for these studies, and to encourage our patients to participate when clinically and ethically appropriate. With such a concerted effort within the retinal community, I certainly hope that 10 years from now we will look back on today's "breakthrough therapies" the way we regard thermal laser for AMD or pituitary ablation for proliferative diabetic retinopathy: the first building blocks upon which we have established more effective treatments that improve the quality of life for all of our patients.