SUBSPECIALTY NEWS

"Women in Retina" Group Brings Colleagues Together

They Mentor, Communicate, and Inspire.

BY RENÉ LUTHE, SENIOR ASSOCIATE EDITOR

■ There are at least 2 reasons for a group called Women in Retina (WinR) to exist, according to cofounder Nancy Holekamp, MD, associate professor of clinical ophthalmology and visual sciences at the Washington University School of Medicine, St. Louis.

One is to provide leadership development for female physicians within a predominantly male profession. The other is to remind members, in the words of a Zen Buddhist monk who recently addressed the group, of "the humanity physicians have when they take care of patients." Small gatherings at large retina meetings that allow for less formal interaction and dialogue between WinR members help to fulfill both.

The pharmaceutical company Genentech can be credited with getting Women in Retina out of the starting blocks, says Dr. Holekamp. "There was talk from numerous women retina specialists about this for a couple of years," she explains. "It was actually the women professionals at Genentech who said, ‘You really ought to do this.’" And it happened in March 2007 with a founder's board meeting in Chicago. In addition to Dr. Holekamp, the other founding physicians are Julia Haller, MD, Jennifer Lim, MD, Alice Lyon, MD, and Pauline Merrill, MD.

While the Women in Retina mission statement crafted at that time is "to be of value to women in retina by offering networking and mentoring activities not already provided by other organizations in ophthalmology," Dr. Holekamp can offer a less formal rationale.

Left to right: Alice Lyon, MD, Nancy Holekamp, MD; Puanani Burgess, guest speaker at WinR meeting; Julia Haller, MD; and WinR administrator Cordie Miller.

"Only 11% of retina specialists are women. That means there are about 2000 retinal specialists and only 220 are women. If you go to very large meetings like the Academy or the American Society of Retinal Specialists, women won't come in contact with each other often enough to have networking or mentoring opportunities," explains Dr. Holekamp. "One of our purposes is to make very large meetings smaller — so we can bring women together. Some of the issues that women face professionally are different than the issues men face professionally. In addition, it can be nicer to have a small forum for discussion of interesting cases, common practice issues, or shared life choices."

To provide those smaller forums, WinR conducts functions (sponsored by industry) at the major retinal meetings. Dr. Holekamp says Women in Retina offers 2 events at the annual American Society of Retinal Specialists meeting and 1 event at both the American Academy of Ophthalmology and the Association for Research in Vision and Ophthalmology meetings. And the group is fine-tuning its plans for the future as it learns what topics most interest its members.

"For 2009, we've heard a request from our constituents that they would like a panel discussion of prominent women in retina, so that they can discuss how they ‘did it’ — how they were able to do research, publish, have a busy practice, raise a family, and volunteer in their communities," says Dr. Holekamp. "Hopefully, this panel format will lead to discussion between women who have found the right balance and the audience members who have a range of choices to make."

Holding its events at the major meetings is part of a strategy to make Women in Retina user-friendly for its members. "If you are a retinal specialist, there are a lot of meetings," explains Dr. Holekamp. "If you have kids and a practice, you don't want to head to another meeting that's called Women in Retina. We always want to have functions at meetings women are going to anyway."

Anyone who is a member of ASRS is automatically a member of WinR and so eligible to attend these events; the group is open to other women by invitation. For more information, e-mail Dr. Holekamp at nholekamp@gmail.com.

Considering Long-term Anti-VEGF Effects

Animal Study Encourages Vigilance in Humans.

RESEARCH FROM SCHEPENS EYE RESEARCH INSTITUTE

■ Scientists at Schepens Eye Research Institute have found that reducing the levels of VEGF in adult mice causes the death of photoreceptors and Muller glia — cells of the retina that are essential to visual function.

This finding was recently published in PLoS ONE, an interactive, peer-reviewed online journal sponsored by the Public Library of Science. The research, if confirmed in humans, could hold implications for the long-term use of anti-VEGF drugs, which act to eliminate abnormal and damaging blood vessel growth and leakage in the retina by neutralizing VEGF.

"The take-home message of this study is that physicians should be vigilant in monitoring patients undergoing anti-VEGF treatments for any possible signs of these side effects," says Principal Investigator Patricia D'Amore, PhD, senior scientist at Schepens Eye Research Institute. Anti-VEGF drugs "are very good at reducing the edema (fluids) and eliminating the abnormal blood vessels that characterize wet macular degeneration, but our results suggest that there could be unanticipated side effects."

Scientists have long known that VEGF is essential for normal development of the vascular system and for wound healing. Unfortunately, VEGF also stimulates the growth of abnormal blood vessels that leak and damage retinal tissue. However, Schepens researchers say that a growing body of evidence also indicates that, beyond its impact on blood vessel growth, VEGF may play other vital roles in the adult body and eye, so that eliminating the growth factor might lead to unexpected consequences.

Given the popularity and promise of the new anti-VEGF drugs for the treatment of macular degeneration, Dr. D'Amore and her team believed that investigating the broader role of this growth factor in the normal adult retina was critical. She and her laboratory mimicked the action of the anti-VEGF drugs by introducing into adult mice a soluble VEGF receptor, known as sFlt1, which binds and neutralizes the VEGF in much the same way that ranibizumab does in the eye.

After 2 weeks, the team found no effect on blood vessels of the inner retina but did find a significant increase in the number of dying cells of the inner and outer nuclear layers, which include amacrine cells that participate in transmitting the visual signal; Muller cells that also participate in the visual signal and support the photoreceptors; and photoreceptors, which are responsible for color and night vision. The team then used electroretinograms to measure visual function and found a significant loss in visual function. Consistent with these observations, they discovered that both photoreceptors and Muller cells express VEGFR2, the major VEGF signaling receptor, and they found that neighboring Muller cells express VEGF.

Parallel studies in tissue culture demonstrated that suppressing VEGF in Muller cells led to Muller cell death, indicating an autocrine role for VEGF in Muller cells (i.e., Muller cells both make VEGF and use it for survival). Further, they used cultures of freshly isolated photoreceptors to show that VEGF can act as a protectant for these cells.

"Insight into the complex role of VEGF in the eye and in other parts of the body indicates that increased care should be taken in the long-term use of these drugs and that this new information should be considered in the design of future clinical studies to ensure that these possible side effects are taken into account," says Dr. D'Amore.

"Mice eyes differ from human eyes in many ways, so we cannot directly extrapolate these results to humans, but this study is an important headsup that clinical application of anti-VEGF therapy in the eye needs to proceed with caution," she adds.