Looking Beyond the Needle

When intravitreally injected anti-VEGF agents first became available for treating wet age-related macular degeneration (AMD), it was exciting to be able tell our patients that there was a medical treatment that could not only stop progression of their disease and prevent further vision loss, but that could also help them gain back some of their vision.

After giving patients this good news, however, we also have to tell them that data from the clinical trials show these drugs are effective for a limited amount of time and that multiple, sometimes monthly, injections are required to maintain improvement. For many patients, hearing that they will have to undergo frequent injections for an undetermined amount of time deflates any excitement, much like pricking a balloon with a pin.

Research efforts geared toward finding new ways to deliver drugs to the posterior segment are ongoing. Different routes, sustained delivery, and increased safety are among the many considerations in drug and vehicle development. This issue offers several articles focused on drug delivery. David S. Boyer, MD, provides an overview of several therapies in the pipeline; Raymond Iezzi Jr., MD, summarizes his recent paper on dendrimer nanotechnology; Ehab N. El Rayes, MD, PhD, describes microcatheter technology for suprachoroidal delivery of steroids; and Albert J. Augustin, MD, offers his perspective using Iluvien (fluocinolone acetonide 0.019 mg, Alimera Sciences) to treat diabetic macular edema since the device was approved for use in Germany.

Also included in the issue is a virtual roundtable discussion among 3 industry executives from Allergan, Alimera, and Genentech. The factors that guide a company through the process of drug and device development and the challenges of bringing new extendedrelease treatments through the pipeline to US Food and Drug Administration approval were among of the topics covered.

As always, we welcome your feedback on the content of this issue. If you have any suggestion for future coverage, don't hesitate to contact us.