Episode Transcript
[00:00:00] Speaker A: You.
[00:00:00] Speaker B: Hello and welcome back to the Bench to Boardroom podcast. I am your host, Cynthia Steele, and today's format is going to be a little different from usual, because over the weekend I had the tremendous pleasure of attending the glaucoma 360 meeting. And what we have for you today is a panel discussion recapping Friday's New Horizons forum, which is a meeting where companies and startups present some of their newest and latest and greatest data, preclinical data, all the way up to their newest clinical work, all in the field of ophthalmology. So today's guests are returning guests Barbara Roscoe, Dr. Cheryl Rowe Rendelman, and new guest, Dr. Julie Whitcomb. And we talk about what we're excited about, what we notice in the meeting, and the goal really is to excite all of you about new endeavors in the field of ophthalmology and what we see as the gaps in the research. So enjoy.
[00:01:25] Speaker C: A bonus episode of the.
[00:01:26] Speaker B: Bench the program podcast.
[00:01:28] Speaker C: As always, I am your host, Cynthia Steele, and I am joined today by some of my phenomenal colleagues who went with me to the we all just attended the Glaucoma Research Foundation New Horizons Forum meeting, where we got to hear all about the newest innovations in glaucoma research at the corporate level, anything that's in the pipeline, and things that we can look forward to in terms of future innovations. And so I've invited them here so we can talk to you about some of the things that excited us the most about today.
So let's quick go around the room and do some introductions. We do have two returning bench to boardroom guests and one future bench to boardroom guest here.
[00:02:12] Speaker A: Cheryl, introduction yeah, I'm Dr. Cheryl Rowe Rendelman. I'm the CEO and managing consultant at Omar Consulting Group.
[00:02:22] Speaker D: Hi, my name is Julie Whitcomb and I am head of medical affairs at Inovia. We're a small but mighty startup that has actually our first FDA approved product for dilation, which takes basically the device that creates eyedrops into an opalmic spray. So I'm happy to be here and talk about more about medical affairs and what I saw today.
[00:02:43] Speaker A: Excellent.
[00:02:44] Speaker E: Thanks, Cynthia. So, Barbara Roscoe, I am an adjunct professor at the University of Utah, both in ophthalmology and biomedical engineering, and then a serial entrepreneur with startups course.
[00:02:57] Speaker C: So really, it seemed like the morning began with discussions about the conglomerate of glaucoma treatments between surgical devices and drops, and does seem like we are starting to move away from pharmaceuticals in terms of drops.
And Julie you could probably speak more to that, but it does seem like the emphasis is becoming now people want more personalized treatments. Right. As you and I were talking about, Barb, actually, we can start with you. What excites you about this idea of personalized medicine in terms of ophthalmology, anyway?
[00:03:35] Speaker E: I always tell my patients that we basically classify them as having glaucoma, and it's a bit of a waste basket.
[00:03:41] Speaker C: Sure.
[00:03:41] Speaker E: And they'll ask what type, and I try to describe the different types. But then even as we were talking about the genetics behind it, and I think where the innovation is going to come, even with sustained release and home interventions, diagnostics, it really is that personalized perspective, because not every glaucoma patient is the same, and they're so variable, and their therapies should be different as well.
[00:04:10] Speaker C: Agreed. We treat cancer that way. We find the genetic basis for that particular tumor, or look for some particular weakness, so to speak, genetic weakness in that particular tumor. So that way we can target that. But we don't yet do that with glaucoma.
[00:04:28] Speaker E: Not even close, and even with our clinical studies. And Cheryl can talk more to this, too. We group patients as POAG. Yes, but there are so many different types of primary open angle glaucoma. So a colleague of ours actually said that we should get the p out of poag and just call it open angle glaucoma, which I thought was interesting.
[00:04:49] Speaker C: What do you think, Shell?
[00:04:51] Speaker A: I had an interesting interaction earlier in the meeting. Just before the meeting, I was able to have breakfast with two patients who had attended the meeting. They were normal tensive glaucoma patients, and they each had had a different kind of treatment paradigm. And I began talking to them about what was their journey in glaucoma. One had been in a clinical trial. She had received an implant for CNTF, a growth factor. Another one had received surgery. And they were both now on Rothatin.
And I asked about their satisfaction with the trajectory they'd taken, and neither were satisfied. Neither were satisfied. They wanted, first of all, more to be done. They wanted access to more clinical trials.
They wanted more personalized medicine for each of them. I was personally gratified to be able to have had the interaction in the first place, because typically at the meeting, there are folks like me who are in the regulatory and scientific space, like you, Barb, and we just don't get the interaction with patients who are not the ones that are depending on us for care, but who are actually there as advocates for themselves.
I thought that was incredibly powerful to hear them speaking. And one of them even asked a question, and he was very passionate.
[00:06:38] Speaker E: He really was.
[00:06:41] Speaker D: That was very moving when he came up to the podium.
[00:06:43] Speaker A: Yes.
[00:06:44] Speaker D: One thing that I was frustrated from the answers from the panel is that didn't get a clear answer, and they just went around the question and without just being honest and saying, we don't know, because that's, I think one of the things about glaucoma is we really don't know. All we do is treat iop. And this is a question I've always asked, how do we measure neuroprotection? I hear it and everything we talk about, even last night, we were talking about raising funds to understand it, but there's no really good way to measure it clinically. And so again, they're in the dark, I mean, no pun intended.
[00:07:24] Speaker A: And today we had it parsed even further. There's neuroprotection and there's neuroen.
[00:07:32] Speaker C: Even more subdividing.
[00:07:35] Speaker A: If that's going to lead us to a better way of describing what we're trying to do. It's very difficult to claim, as wallet chamber said, one or the other. So you don't get an indication for neuroprotection or an indication for neuroenhancement if you can't measure neuroprotection nor neuroenhancement.
[00:07:58] Speaker C: And it seems incredibly difficult if you're talking about neuroprotection, what you're talking about is cessation of loss.
So your vision goes down to a certain extent, and then it just stops going down. There's not a point that we can start getting it back. Those cells don't regenerate. So when former FDA head of ophthalmology Wiley Chambers said to us, you have to show improvement. There is no way to show improvement. All you can show is that it stops getting bad.
[00:08:33] Speaker A: I think there was a giant shrug in the audience when he said that, because currently we don't have the tools. So if there was anything someone listening to this podcast would want to work on, would be the tools.
[00:08:47] Speaker D: Yeah, I agree. No, that's just something that actually, I had a very similar conversation with Murray Johnstone, who, he's the famous in the world of ophthalmology, and he was saying, that's one thing, is that we're going back to the beginning when we should work near, closer to that near end, and then we can chip away at it. It's like I think about it, you're talking about, you're an engineer, you are an engineering department like I'm a trained engineer. And I think about reverse engineering, you see under the friend and you work backwards to understand it. And that's what we need to do is approach this is not start from the beginning and work our way up, but is to reverse engineer. Yeah, and I don't think that we've grasped that. And I think that's one thing that I think a lot of the researchers and the scientists that are starting their career, that's maybe how to approach it, is not want to go so big into this endeavor, but start small, and any level of improvement is better than none.
[00:09:46] Speaker E: And I think one of the things you said, too, is getting back to how do you assess and measure neuroprotection or neuro enhancement or neuro restoration? Is you can look at structure, but if you improve structure, you don't necessarily improve function. So they don't always correlate.
At the end of the day, it has to be a functional improvement.
[00:10:08] Speaker A: How do you measure that and how do you measure.
[00:10:10] Speaker E: Know, the FDA has accepted, obviously, visual fields. They've also accepted contrast sensitivity. So we have the tools and I think we can learn so much. Cynthia and I talked about this with luxtura.
[00:10:25] Speaker C: Yes.
[00:10:25] Speaker E: So it's really activities, visual activities or visual function under low illumination.
[00:10:34] Speaker D: Right.
[00:10:34] Speaker E: And that is another potential endpoint. So I think we're moving in that direction.
[00:10:40] Speaker A: I think that if we were going to move in a direction of getting an indication of neuroprotection or neuroenhancement, we would have to create a new agreed way. We had to do best corrected visual acuity was too blunt of an instrument to determine whether or not that drug was working.
So there needs to be a new assessment, a tool that will allow us to say that this is actually happening, as you said, doesn't follow anatomy, it doesn't follow structure.
[00:11:17] Speaker C: No. And for those who don't know, this gene therapy was created for an inherited, blinding disease. But the tools that we typically use to measure visual function really weren't sensitive enough to detect changes as a result of this really groundbreaking gene therapy. And so structurally, as I understand it, structurally, they did see some changes, but functionally they didn't. So what this company did was they actually created, and I learned this at the AOPT meeting last year. They created a maze for these children, and the children had to do the maze at different levels of light. And those levels of light were very, very well controlled. And that is how they were able to show that the children, after a certain amount of time, who had had the gene therapy could navigate the maze at lower levels of light, meaning that they had some preserved or some enhanced visual function. And so I think I love this idea because it shows us that the boundaries that we are working in right now need to expand, because all we have right now is lowering IOP and maybe using rat models, animal models, and measuring, quantifying the number of cells in the retina. But we can do better, or we should innovate more functional tests right now.
[00:12:44] Speaker A: When that mobility test was created, it wasn't just created de novo. There were meetings with patients to ask them, what kinds of changes in your life would you consider relevant? Useful.
Navigating in low light was one of them. And there was no tool at that time to demonstrate the capacity to navigate in dim light.
That became the beginning of this tool. So there were several iterations until they realized that in order to definitely demonstrate that something is happening, we'd have to put in a tunable luminance.
And then you could see and parse how well these patients were doing at one luminance. It wasn't enough, and this is what the patients wanted. So GRF is in a position to ask those kinds of questions of patients with normal tensive and open angle glaucoma. They're in that position to ask, what would you consider as a critically relevant outcome for you from a new drug?
[00:14:12] Speaker E: You know what's interesting, Charles? One of the things that I'll always hear from my patients, too, is their visual acuity may not change, but so often it's contrast, and you lose contrast with glaucoma. So, again, if we could ever get to a place, sure, we've know various measures and diagnostics to assess contrast, but they're not.
I guess they're validated, but they're not consistently used, and they're not the same, and they're not just a good endpoint yet. So if we can develop something like that. And back to you. What you said, julie, is, where do people start? What do we need? We need a tool that measures something that impacts the patient, that you can assess and say, okay, this change is clinically relevant.
[00:14:59] Speaker D: And inherently, we're in the dark. We don't have that tool because we're shooting for a goal that we can't see.
And I think what's one thing know, the FDA, they have these clear. They're very black and white in their approaches to getting things approved. I mean, I think. What was the panel they're talking about? Timal. No one uses Timalol as the first line of therapy, but yet it's the first thing that all companies or any product that wants to get approved is put against. But again, it's the lowest bar to know to get it to the market. Because at the end of the day, real world evidence is different than a controlled clinical trial. You can somewhat manipulate the data in your favor by choosing your patient mean it's a tricky slope. And at the same time, I think we need a lot of scientists and people that are studying this to go and flux into the FDA and understand this. Because I think sometimes that the people that does the review, they may know this is all new to them, too. So they're learning with us.
These meetings are great because we can partner with the industry, with the FDA, with doctors of patients.
[00:16:05] Speaker C: Totally.
[00:16:06] Speaker D: That's the only way to move the.
[00:16:07] Speaker C: Needle in a really. I did not know that. That the patients were asked what would be the most meaningful.
I mean, I think that's something at least as researchers, I would forget to do all the time.
Granted, I didn't know any patients. I didn't know any glaucoma patients as I was researching glaucoma. But I would read papers and think, that's really cool. I want to look into that. But at the end of the day, I think this came up when we were looking at those IoP detecting contact lenses. You have to think about whether a patient is actually going to use it.
I don't know if you guys saw that one.
It was the drug eluding contact lens that had a white rim around it. And so any patient who wore it would have a white rim around their iris, and they would look like a cyborg.
[00:17:01] Speaker D: Not even that. If you're 80 years old, putting a contact lens in could be hard.
[00:17:05] Speaker C: You have a hard time with the eyebrows.
[00:17:07] Speaker A: I don't think the 80 year old market is their demographic. I think their demographic is more like the young person who is still gainfully employed, who is losing their vision rapidly and needs to have very vigilant dosing. And that contact lens does that, and it tunes the dosing. Now, the heuristics, what it looks like.
That can be worked on. Sure.
[00:17:39] Speaker C: Agreed. Definitely.
So let's actually talk about eyedrops, because we did learn a little bit today about some new drops that might be on the market or new combinations that might be coming together. And so I'm going to start with you, Julie, because let's talk about. We can all talk about it, but I'll start with you. What are the limitations of eyedrops and where does Inovia come in?
[00:18:03] Speaker D: Yeah, well, Inovia, I think one of the kind of main goals is to eliminate some of those issues which are, in matter of fact, the eyedrop is more volume that you actually need from overfills and spills. There's a lot of side effects, specifically with pgas, they cause preoral fat loss. You get lengthening of eyelashes, although I know some patients do like that side effect. There's darkening of the skin around the eye. So the optageet is a device that basically uses pzoelectric technology, and it administers an opalmic spray. It's a micro volume, eight microliters, roughly, so it coats the cornea evenly. It beats your blink response, which is another added bonus. And you also can be vertical. You don't have to tilt your head back. So for patients that have, say, issues handling the device, I mean, handling eyedrops with a squeeze force, you can just easily administer it with a push of a button.
[00:19:05] Speaker C: So it is a push button. Yeah. So it's just one press.
[00:19:07] Speaker D: So if you have any disparity issues, that's also an added bonus.
[00:19:11] Speaker C: Every time I see the video, it reminds me of my asthma inhalers somewhat is like that.
[00:19:15] Speaker D: It kind of aerosolize it.
It creates these micro droplets that coat the cornea surface.
[00:19:22] Speaker A: I was so impressed with that. And this is in the trajectory of moving us towards a dropless society. Yes, and I love the idea that it beats the blink. It's faster than the blink reflex.
Can you use any kind of formulation with it? There has to be a formulation that adheres to specific specifications in order for it to be aerospaced in that way.
[00:19:56] Speaker D: Well, that's kind of a two part question. So it's a drug device. In order to get approved, the FDA, you have to go through both the.
[00:20:04] Speaker E: Pharmaceutical and then device arm.
[00:20:06] Speaker D: And so you have to prove that it works because it is a micro volume, so you have to have a comparator.
And then the second is that there is some limitations due to the viscosity of the formulation. So if it's very thick, that probably wouldn't necessarily work in the current device. But those are things you can easily modify and test. And I think the biggest issue is that you have to go through clinical trials, phase three, on a product or a compound that already works. We did that for our first approval product, mid combi, which is a dilation drop. So the first to market of a fixed dose combination. But say, if we want to go with just a PGA, we'd have to go through a phase three clinical trial that just adds more time. And eventually, it would be ideal for us to file for, like, a 510K as a device.
But at the end of the day, too, you have to think about profit. We're a company, and the cost of goods is a definitely added expense versus just an eyedrop bottle. These are all things that also, I think, are somewhat limiting, is that you have to always think about how much you're going to make at the end of the day versus the patient. And I would ideally like to see where we use SLT and then we go to the optage.
[00:21:28] Speaker C: All right.
[00:21:29] Speaker A: Yeah.
[00:21:30] Speaker C: Because now I gomed came and talked to us about interventional glaucoma, and I like this concept because it is a way of saying, we're not going to wait for your glaucoma to be so bad that we're actually going to do something about it, or we're not going to give you an eyedrop that we know you're probably going to take. What do you think, 30%, 50% of the time?
[00:21:58] Speaker E: I think it really depends upon the patient.
[00:22:00] Speaker C: Sure.
[00:22:00] Speaker E: I mean, I've got. Maybe I see the worst of the worst, but I have patients that are so religious with their eye drops. I do love using SLT, and we are using SLT more and more light study that came out.
But Cynthia kind of knows my bias. I think a lot of it is relating to IOP fluctuation that's occurring outside the.
Yeah, I think a lot of our patients are progressing because we're not controlling their IOP adequately.
[00:22:28] Speaker C: And so one of the first graphs that we saw today was about how, basically, glaucoma surgeries have really taken off big time.
And particularly the more micro invasive, the minimally invasive surgeries, like the stents and the shunts, that can be done in context of cataract surgery. It can be largely done by any ophthalmologist. They don't have to be glaucoma specific ophthalmologists. And the one downside. So the upside of surgery is that the patient most likely will not need drops or will be able to decrease the number of drops that they need for at least the immediate few months, six months, twelve months, something like that. Inevitably, it does seem like eventually another intervention is needed, and SLT is another means to lower that pressure and decrease that drop load or that drop burden for at least a little while. I guess what's been interesting to me is to see how we really have started to pivot away from these new molecules and these exciting new. It was always, what's the new mechanism of action?
That's what MSO, like us, lived on. Let's talk mechanism of action. But when I was at BNL, when we first launched our new drug, I thought we had the best mechanism of action out there, nitric oxide. But the drop was $150. It's almost impossible to compare. I would go to cities and talk to doctors, and they would say, well, my patients, they can barely afford their $5 timalol. And I would say, you know what?
Then obviously, this is not for you. So I understand the appeal of why we're pivoting more to, like, a laser therapy or surgical therapy or sustained delivery. Yes.
[00:24:18] Speaker D: Do you think, in your opinion, that is like treating the patient population that you are seeing? So say you lived in a more impoverished, or you treat more of an impoverished population who, they have a fixed budget monthly, and $5 is a stretch, or $8, $10. And then they all of a sudden, like, oh, you should try this new drug, but it's not covered. They have a fixed budget, and glaucoma is not their only disease that they're treating.
How do you treat a patient in that situation?
[00:24:52] Speaker E: It's doing, again like a laser procedure. But a lot of times, laser is not. I mean, we can always start with laser. All the studies show that laser works best in the new treatment. Naive patient that probably has mild to moderate damage. If at best, I think about laser as being equal to the efficacy of, like, a beta blocker. So you're getting 20% to 25% iop lowering. But now what we've been doing, which is fascinating, too, is if a patient has hydros and or an eye stent and is perhaps on a prostaglandin, and we want to get additional IOP lowering, we will go back and do an SLT, even with angle based surgery, and we're getting really good responses. So it really is that personalized medicine package. We try to give the patient sort of a little bit of this and that, depending upon the patient, their economic situation, the type of glaucoma they have, how advanced they are, and then there's other patients that are so advanced, we're like, they need a travel in a way, too.
[00:26:01] Speaker D: It's like the order of operations dependent.
[00:26:04] Speaker E: There is something to that point I think we're getting, at least for me, the way I teach my residents and fellows and Ike brought this up, is do not drug stack.
[00:26:14] Speaker C: Okay.
[00:26:14] Speaker E: So many of us have been taught 2030 years ago, just keep adding medications on, and you're receiving very little benefit for that. Each additional drug. And I've had patients where they come in on their own four different medications, and I'll take them back down to one. And their IOP is about the same.
[00:26:37] Speaker C: Wow.
[00:26:38] Speaker E: And their ocular surface are actually better.
[00:26:40] Speaker A: Now because not so much bak horrible medications.
[00:26:46] Speaker E: And then you can kind of reevaluate and say, okay, what are we going to do? Are we going to do a mixed procedure? Are we going to try SLT?
[00:26:54] Speaker A: Are we going to go.
[00:26:57] Speaker E: Every patient is different.
[00:26:58] Speaker C: Yeah, no, let's go back to the whole concept of personalized medicine and the need for other diagnostics and some way to figure out what's underlying a patient's glaucoma. But, Cheryl, I wanted to ask you because a very provocative question was asked during one of the sessions, which is, are we completely heading away from drops?
In ten years, is no one going to be using drops anymore? What did you think?
[00:27:22] Speaker A: I thought that the answers felt as if there was no forward looking thinking on that panel.
[00:27:30] Speaker C: Okay.
[00:27:31] Speaker A: Because I guess there were five men on the panel, and four out of five said, yeah, we're still going to have drops in 1520 years. And then only one said, no, I don't think so.
I kind of side with that one because there are many franchises out there that are drop heavy, drop specific, who haven't thought of reengineering or weren't at the space yet where they could reengineer their drugs so it could be delivered in a different way.
We're going to use drops, but drops are not very well tolerated. And I think there was something along the lines of 63% of people, although they use their drops, were not using them in the appropriate way.
So that, in turn, becomes less medicine in the right place, more of an on the cheek, more medicine, or more eye drop tips that can be contaminated. And as you know, the FDA recalled a bunch of drops last summer.
[00:28:48] Speaker C: Yes, they did.
[00:28:49] Speaker A: And so there is a feeling among public who read those FDA recalls, among the folks who are doing research, said, if I can deliver a drug without drops, I'm better off. How can I do that?
And we are moving in the direction now of taking some of our drugs and putting them into implants or some kind of intracameral delivery system such that small amounts of the effective drug is delivered on an hour by hour basis to the tissues that need it. And I think this is where we should begin to look. I'm not saying implants is the only.
[00:29:47] Speaker C: Thing we can look at.
[00:29:48] Speaker A: But right now, that's kind of where we are. There are so much new research that's going on out there for different ways of getting these drugs into the eye.
[00:30:04] Speaker E: And what's interesting, too, is even cataract surgery alone will lower IOP.
[00:30:09] Speaker D: Absolutely.
[00:30:09] Speaker E: And you have the opportunity to do a makes procedure at the same time. So a lot of my patients, I'll do an SLT first line or I'll start the monoprostaglandin, and then I'll always say, look, you've got a cataract. Instead of just adding additional medications on, we could even consider taking your cataract out and then doing a stent at the same time, or an angle based surgery, which will at worst keep you on one drop, perhaps get you off medications, control the IoP. So you're right. And again, personalize. Yeah, every patient is different.
[00:30:43] Speaker C: I'm actually going to make my father do that. He's been waiting to get, his cataract isn't bad, yet.
He has glaucoma in one eye. And I think I talked to you when he first started his drops. He's on a PGA and he was getting very powerful headaches on just that one side. I think particularly if he sneezed or if he left anything that kind of like raised the pressure on that side a little bit. And he would, being my dad, he would say, no, it's fine, it's fine. I'm fine. But I told him, when you decide to get your cataract surgery, want you to call me. I'm going to drive down, I'm going to talk to your doctor.
We're going to get you an ice and inject or something. At the time.
[00:31:22] Speaker E: I had a patient the other day who has cataracts and glaucoma, actually had cataract surgery. And her doctor had talked about doing the cataract makes at that time and for some reason did not do the MiGs. And I feel terrible saying this, but I almost think it's malpractice. It's such a shame because that was the one opportunity, because that's when insurance will cover that.
And if you did not have that.
[00:31:57] Speaker D: Procedure, make that off, you're out of luck.
[00:32:01] Speaker C: And it's funny that you say that because I heard that exact word malpractice used when Medicare was talking about the MiGs devices about this time last year. They had a panel of experts on that call and someone said, I think that if you don't offer migs at the time of cataract surgery for a patient that's glaucoma suspect or on glaucoma medications, early stage glaucoma, because so much of our medications seem to target that more moderate to severe patient, and we're trying again to step it back in a more interventional, more interventional mindset, to say, no, let's take that very mild patient who still has high iop and maybe is only on one drop, give them the stent, preserve their ocular surface for a little while, spare them the side effects of the drops and just that burden of having to remember. And if you don't, that word was used that might be considered. They said, I would consider that malpractice. So that's the second time I've heard you say that.
[00:33:02] Speaker D: One thing that I think that doesn't get brought up enough is the quality of life for the patient.
[00:33:06] Speaker C: Yes.
[00:33:06] Speaker D: And so many glaucoma says, scotch physicians say that they give cornea doctors a job because they ruin the surface due to all of the preservatives. That's one thing that I suffer from, dry eye. And I think about, if you have glaucoma managing this, and then on top of it, your eyes are irritated, it just sounds like a horrible position to be in. And you have to remember to take these every day. And so that's one thing, too, that the optoget, what we are working towards, it has the ability to monitor, monitor, and that's something that's so important for glaucoma, because glaucoma patients, they forget, and then these will automatically go to their phone. And we're entering the age where in 20 years, everyone will be a cell phone adequate, and they'll be able to do all these technology things. And I think that is something we track ourselves with our watches and all these other devices. Why not track our progress of glaucoma? People love metrics.
[00:34:07] Speaker C: They do.
[00:34:08] Speaker D: My dad has glaucoma and barely takes his medication. And I really don't understand, but he will monitor his Fitbit. If you had the same thing where you could monitor your drops and your medication, you would be on top of it.
[00:34:23] Speaker C: If this thing can remind me to stand up 10 minutes before the end of every hour, it should be able to remind me.
[00:34:29] Speaker D: Yeah, exactly.
So these are all the things that I sometimes think we forget to monitor, is that quality of life portion. And so many glaucopin patients, they are suffering the pain of dry eye and all these other things that they have to deal with on top of everything. So I think that's one important thing that we need to be aware of. And mean patient is the most important, not this whole equation.
[00:34:57] Speaker C: So let's continue on that in terms of monitoring, because you, Barb, headed up a nice panel discussion about home monitoring and ways that people can monitor their glaucoma progression at home. And so we saw, obviously, with my eyes, you offer eye care, home at home tonometers, so patients can measure their IOP just from the comfort of their own home.
And then we heard a few presentations on visual field assessments at home. And one of the things that I actually thought was very interesting is there's a couple of companies that are looking to using, essentially, VR goggles as a way to measure, have a patient do a visual field test at home, but one presented a visual field test that could just be done from your computer. And personally, I think that's a fantastic idea because the comparison that he made was, a lot of these people can't even. They don't really know how to even work their cell phone.
Going back to my dad, he just got a brick cell phone because my mom got tired of him going off for walks into the beach and everything without any form of communication, and I had to show him, okay, dad, you open the phone. If you press one, that'll call. Mom. If you press two, that will call. My know, my dad's an intelligent man, but he was not born in America. And if you talked to him, it would sound like he came over from Croatia yesterday, even though he's lived in America for 50 years. I think he likes his life. He likes how he likes things. And so for him to ask him to put on VR goggles, this would just blow his mind. But my mom does have an iPad, and she knows how to use.
She knows how to use it to call the kids, call the grandkids and talk to them. And I love that he said, you do this the same way that you would do a FaceTime with your grandchildren. So what did you think about your panel and some of the responses that you got with regards to echo monsters?
[00:37:02] Speaker E: I think it was really cool. I think we're definitely moving in the direction where patients can monitor themselves. Again, I keep equating it to diabetes, blood pressure, oncology. They can manage, they can follow, they can see, especially for IOP. So many of these patients are, in fact, fluctuating to very high numbers, and they would never have known it if they weren't able to check their IOP outside the office.
In terms of the visual field, there's so many different devices, and the clearance is not straightforward. So people, and Cheryl, get what you know.
These companies will state that they are FDA exempt, FDA listed, but they're technically not FDA cleared. Or if they are, they're class ones. They haven't done clinical studies. So I think there's a lot of the jury's out as.
And it's. Or Jason actually said, buyer beware. I think time will tell because there's so many things that you need to control for. One of the key things we need to control for is lighting, and you can't do that unless you have some sort of contained system.
[00:38:20] Speaker C: Right.
[00:38:23] Speaker D: I think a lot of those technologies also go hand in hand with clinical trials.
[00:38:27] Speaker E: Right, exactly.
[00:38:28] Speaker D: And then you get kind of a two for one.
[00:38:30] Speaker A: I think no one's going to risk their clinical trial assessment money on something that hasn't yet been approved. You can put it in as an exploratory endpoint.
If, for instance, the company says, yeah, we'll let you have these for free. But clinical trials are expensive, and the more assessments you put in, the higher your price, your charge per assessment, per patient in a clinical trial. And those assessments require measurements, and then there's extra piece on top of that. So unless there is a really clear cut and dry packet on how to do the assessment and then do the measurement and then do the interpretation, so it can become part of your clinical trial data, it's not going to be taken up very readily. It will be used by office providers, people who have offices with lots of patients in them who are interested in technology.
And that technology is actually being launched, soft launched today, as I said, and that means that they are going to be. And I spoke to the folks in the company, that means that they're going to knock on the doors of 60 different offices who said, yeah, we'd like to know a little bit more and we'll try it if we like it. That's the soft launch. And next year, they're hoping to come back to this meeting with some data, hard data from use by these clinics. There may be a clinical protocol for them to use it so that the data can actually be comparable. That's true, but they're working on that right now.
I don't see it being used in an independent clinical.
[00:40:42] Speaker D: I think another area, too, that I think that hasn't fully been touched upon in the area is like diagnostic equipment like OCT, and using a past historic data and finding trends so that you can maybe predict and understand the disease state earlier. I know there's a lot of companies that are doing that. But I think it's a little bit harder for diagnostic equipment to get to the market. It's a lot more expensive. There's a lot of things that do. And you have to utilize historic data which interpret that information. But I think there's room for that, too. That maybe not just with the treatment, but the prevention would be early on.
[00:41:21] Speaker C: Absolutely.
[00:41:22] Speaker D: Understanding if you're high risk before you have any visual field loss.
[00:41:27] Speaker C: Yeah.
So last question for you ladies before I let everybody go, and thank you so much for your time.
We, I think, all noticed that the foundation tried to do a very good job putting up diverse panelists with regards to the people who are moderating the know. Plenty of women up there, plenty of people of color. But the companies still sent, and I'll say exactly what I said to you, Cheryl. They send their oldest, whitest man to sit on the panels. And I just couldn't help but notice that every panel. I know. I texted you about it, too. Are you noticing this? So you did point it out to me. I did.
[00:42:10] Speaker E: That's Falana.
[00:42:12] Speaker D: But the thing is, I didn't think about it until you told me because that's the standard norm.
[00:42:17] Speaker C: That is the norm.
[00:42:17] Speaker D: Isn't that funny?
[00:42:19] Speaker A: No, it's not funny. It's sad.
[00:42:20] Speaker C: Okay, sad funny. Yeah, we left.
[00:42:24] Speaker A: Otherwise you cry lip service to Dei. And companies do even more. They make big statements and they make sure that their investors know that they are dedicated to it. However, there still needs to be a little bit more of this trickled down into the fabric of the company. And that would mean making sure not just putting out a woman or putting out a person of color, but making sure that there are people like that.
[00:43:00] Speaker D: Who are trained, they're merit based.
[00:43:03] Speaker A: Exactly. And who are in that position so they can go out and represent.
I think that's terribly important. I don't want to go just because I'm a black person. I want to go because I am probably the most qualified and I'm credible. Absolutely. And are those people playing in that space?
And sometimes the answer is no. Correct?
[00:43:35] Speaker D: Yeah, that's kind of ironic. I was just having this conversation before you grabbed me about that. And how do you distinguish checking the box of diversity, inclusion, and merit based? Because I think sometimes what happens is that just check that box of they're diverse, they're inclusive to our company standards, but then you lose that. But they deserve to be there. And then people get that, oh, they're only there because they're this box. This box. This box. And it's like, that's just not where I want to be. I don't think any of us have.
[00:44:09] Speaker A: The world we want.
[00:44:10] Speaker D: No.
[00:44:12] Speaker C: What I think I try almost on every episode, is to encourage the listeners that, first of all, you should consider a career in industry if you believe that it's right for you, regardless of what a mentor or somebody might be discouraging you or different directions that they're encouraging you to go in. But I think we may get more of this merit based if we can get more young women and more people of color who venture into industry, if we can get more applicants.
And I think it was someone at one of your previous companies who said, I want a medical science liaison that reflects where I want. For example, in south Florida. I mean, if you don't have an MSL that speaks Spanish, and it also goes down to Puerto Rico. I was the MSL in south Florida and in Puerto Rico, and I took German. I was completely lost. I took the most useless language, at least in south Florida and Puerto Rico.
Ultimately, if I move to Europe, then I'll be okay.
But I like this idea, though, that the more people we get and the more diverse group of applicants, then I think it has to become merit based. Or am I being too Pollyanna ish about that? I don't think so, no.
[00:45:42] Speaker D: You're creating a pool of more diverse fish versus just. It's all salmon, farm raised salmon.
You want something that is.
[00:45:56] Speaker A: Well, each one of those gentlemen on those panels, especially the panels that were very egregious in the way you said, had mentored or particularly made a point of bringing someone who was not like them to the panel, I think we would have seen.
[00:46:16] Speaker C: I completely agree.
So in our last 2 minutes, if we're talking to our audience of young residents, doctors, postdocs, junior faculty, just go around the table.
What message would you want to leave them with besides apply?
[00:46:39] Speaker D: Think outside the box.
[00:46:41] Speaker C: Think outside the box.
[00:46:42] Speaker E: Keep an open mind and don't give up. Persevere.
[00:46:49] Speaker D: There's never a bad idea. Be curious and be passionate, no matter if people tell you no. Because sometimes someone will tell you yes, and they eventually will.
[00:46:59] Speaker C: All right.
[00:46:59] Speaker A: I would say, remember the patient voice in the research that you're doing. I know that they may all be experts in a particular mouse model, but why and for what does that reflect in the patient's experience?
That's going to color the way you do your research and color the questions you ask, and that will lead to more effective therapies, in my view.
[00:47:28] Speaker C: I think that's perfect.
Sunday is International Women and girls in science Day. So happy international women and girls in science Day. As we're all watching Taylor Swift's boyfriend play in the Super bowl, we can also celebrate that day. I didn't know that. Thank you. Yes, thank you. Thank you all for your time. This was wonderful. And, yeah, I won't keep you any longer. I know we're all very busy, but thank you so much for being part of this.
[00:47:56] Speaker A: Thank you.
[00:47:57] Speaker C: Let's do it again next time.
All right.
[00:48:00] Speaker B: I want to thank so many people, actually. I want to thank Dr. Barbara Orosco, Dr. Cheryl Rovendelman, Dr. Julie Whitcomb for.
[00:48:09] Speaker C: Taking the time to join in on this panel discussion.
[00:48:12] Speaker B: It was phenomenal. I want to thank the Glaucoma Research Foundation, Tom Bruner, Nancy Grayden, everyone on their staff, of course, Dr. Andrew Ewa and Dr. Adrian Graves, who I want to be when I grow up for another fantastic meeting.
[00:48:28] Speaker C: It was absolutely wonderful.
[00:48:30] Speaker B: And two other things. One, I want to wish everybody a happy international women and girls in Science Day while everyone is watching the Super bowl today, which is February 11. It is also international women and girls in Science Day. So happy that day to all of you. And on a personal note, I found out this weekend that a pillar in glaucoma research has left us way too soon. So in honor of international women and girls in science Day, I do want to dedicate this episode and send lots of love out to Griffin samples. We will miss you tremendously. Thank you for listening and see you next time.
