Now you see me, now you don’t: How can we change the trajectory for vision loss?

However, the retinal vessels of people living with retinal conditions can be unstable, leaky, inflamed and grow abnormally, leading to vision loss or even blindness. The impact on the person and their families is huge. It can be devastating physically, emotionally and economically, with everyday activities like dressing, shopping and taking part in hobbies becoming more challenging. In addition, the negative impact on their professional and social lives can lead to reduced income, social isolation, and depression and anxiety disorders. In short, people living with these conditions start experiencing life in a very different way.

With millions of people worldwide living with these retinal conditions and millions more playing an informal care role, ophthalmology scientists at Roche are determined to change the status quo. They are tackling the conditions from multiple angles, with the ultimate goal to hopefully prevent, and even reverse, vision loss. To do this, they must look beyond what we already know, beyond the standard of care eye medicines.

“We know that improving efficacy and durability are two of the most important elements for improving treatment. Anti-VEGF therapy is efficacious, and durability is improving, but we also need to tackle additional factors that can drive the progression of eye conditions, such as fibrosis, ischemia, and inflammation”, says Sascha. One of the tools to achieve this multi-target approach is bispecific antibodies, a type of engineered antibody that combines the unique ability of two separate antibodies into one combined molecule (formed of two antibody ‘arms’). A bispecific antibody can target and bind to two different types of proteins. This type of technology is called ‘CrossMab technology’, and was pioneered by Roche (find out more).

Additionally,  intravitreal injection treatments, the current standard of care for some of the leading causes of vision loss, such as neovascular or ‘wet’ age-related macular degeneration and diabetic macular edema, require people to visit their doctor once a month2,3,4. This can be difficult for patients, not only in terms of making time and having a caring support network available to get to their appointment, but also as the procedure can be quite daunting for many.

Altogether, this treatment burden associated with frequent eye injections and physician visits can lead to potential undertreatment, and potentially less than optimal vision outcomes2,3,4. Recognising this, Roche scientists are committed to finding and developing new therapeutic approaches for long-acting delivery that reduce the burden on patients. In this area, substantial progress continues to be made.

Sascha reflects on the treatment burden so many patients experience:

With the broadest retina pipeline in ophthalmology, Roche’s research and development is focusing on innovative treatments across many different modalities, such as antibodies and gene and cell therapies, targeting multiple vision-threatening conditions and autoimmune conditions. The next generation of bispecifics is already in clinical development: DutaFabs. DutaFabs are a type of bispecific antibody, with the ability to bind to two unique proteins within one molecule, but formed of just one antibody ‘arm’, meaning the molecules are smaller. The technology was developed by a small biotech (Dutalys), which was acquired by Roche in 2014, and paves the way for the potential discovery of multiple modes of action (MoAs) (find out more). 

Sascha emphasises that collaborations are absolutely essential to innovative progress.  An openness to finding new ways forward, to partner and collaborate with the best scientific minds, is enabling a continuous flow of ideas and new approaches.

Sascha describes Roche’s commitment in ophthalmology as truly unique: “What is so unique at Roche is both the access to amazing technology and hundreds of specialists, and our long-term research perspective. Not only are we developing therapeutic approaches that we hope will contribute to improving patients’ quality of life, but we really have that long perspective to bring about innovation in the ophthalmology space overall to make huge leaps forward in reversing damage from vision loss in the future.”