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Seeing the Bottom Line

SriniVas Sadda, MD

President & Chief Scientific Officer

I’m keenly aware that economics must be acknowledged as a very real part of the eye care we can develop and deliver.

Here’s just one current example of how the economics question comes up in our work and patient care. The much anticipated results of a trial of two drugs used to treat retinal vein occlusion were revealed at the annual Association for Research and Vision in Ophthalmology (ARVO) conference in May, and the news has important implications. My Doheny colleague, Dr. Michael Ip, who led the NIH-funded study, found that Avastin, a much less costly option than Eyelea, works well. After six monthly injections, treatment with either drug improved visual acuity on average from 20/100 to 20/40. These findings matter, because more than 16 million adults around the world are affected with this disease, which can lead to blindness.

Avastin, however, is approved by the FDA as a drug used to treat cancer, not eye disease. So while the SCORE 2 findings provide excellent evidence that it works well for retinal vein occlusion patients, with no significant side effects, it is not FDA approved for this purpose. This conundrum confronts doctors and asks us to weigh the rather small risk assumed by using Avastin vs. Eyelea. This challenge is real: the approved injectable eye injections are the biggest single expense for Medicare today. Avastin is much cheaper, because only a tiny amount is needed to treat the eye, compared to the large amount that would be necessary to treat cancer. The distributed burdens of this cost are real, too. In the U.S., pharmaceutical prices are set by the drug companies, and some of that profit funds critical research. Elsewhere in the world, the prices are negotiable so that healthcare providers, including government entities and insurers, can deliver excellent care at reasonable costs.

The important SCORE 2 trial results seem to point to a path forward that includes expanding the conversation about how we can get the medicines and treatments that work best to patients at prices that we can afford. I invite your thoughts on these questions, as we continue our work to deliver quality care at reasonable costs, without shortchanging vital research and development.

AI: Intelligence + Images
In the quest to treat eye disease and cure blindness, Doheny Eye Institute works with a range of iconic companies, including Google and Nikon. The Doheny Image Research Center (DIRC), our lab work here at DEI, and patient care in all of our Doheny Eye Center UCLA clinics aspire to develop tech solutions and artificial intelligence for improved treatment. Doctors are master diagnosticians. We also know that when fed thousands of images, computers can deploy algorithms to ably scan, sort and diagnose images with great accuracy. If you are interested in work on the cutting edge of artificial intelligence to automate and improve precision in treating eye disease, I invite you to listen to the Doheny Podcast Network in the coming months. DPN will feature conversations with leaders at the frontiers of this technology who are transforming approaches to eye care.

LOOK AHEAD: Stephen J. Ryan Initiative for Macular Research
This interdisciplinary group will next convene in April 2018. Doheny is pleased to offer pre-conference tutorials online that invited participants can view to get acquainted with the most recent and relevant research. This valuable resource is another way that technology accelerates our work together. Delivery of information ahead of our international gatherings makes the time spent together even more valuable, as the exchange of ideas begins before arrival.

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