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AMD: Your Questions Answered (February 2020)

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Headshot of Avnish Deobhakta, MD

Avnish A. Deobhakta, MD

Ophthalmologist and Assistant Professor

The guest speaker is Avnish A. Deobhakta, MD, who is an ophthalmologist and Assistant Professor at the Icahn School of Medicine at Mount Sinai in New York NY. 

  • BrightFocus Foundation
    AMD: Your Questions Answered
    February 26, 2020
    1:00 p.m. EST

    The information provided in this transcription is a public service of BrightFocus Foundation and is not intended to constitute medical advice. Please consult your physician for personalized medical, dietary, and/or exercise advice. Any medications or supplements should be taken only under medical supervision. BrightFocus Foundation does not endorse any medical products or therapies.

    Please note: This Chat has been edited for clarity and brevity.

    MICHAEL BUCKLEY: Hello, I’m Michael Buckley with the BrightFocus Foundation. Welcome to—or perhaps welcome back to—the BrightFocus Chat. Today’s topic is “AMD: Your Questions Answered.” Our guest is a first-time guest here at BrightFocus, Dr. Avnish Deobhakta. He’s an ophthalmologist and an Assistant Professor at the Icahn School of Medicine at Mount Sinai Hospital in New York City. I’m going to take a minute to tell you a little bit about what we’ll do today. Once a month, on the BrightFocus Chats, we have an opportunity to spend about 30–35 minutes with some of the leading experts in the nation on vision disease and eye health. Let’s turn to our first-time guest, Doctor and Professor Avnish Deobhakta. So, Dr. Deobhakta, let’s start by telling us about yourself. What do you do at the Mount Sinai Hospital?

    DR. AVNISH DEOBHAKTA: Sure. Thank you for having me. It’s a real privilege to be able to speak to people in this sort of a setting for a disease that affects quite a few people in this country. I’m a vitreoretinal surgeon at the Mount Sinai Hospital, which is also part of the New York Eye and Ear Infirmary of Mount Sinai, and I’m in the academic faculty practice. We see all sorts of different patients who have retinal diseases. We perform surgery on them, and we treat them in our clinics. I also am very, very connected to our academic teaching program. I’m helpful in running the fellowship for the young residents who want to become retinal surgeons, as well as the fellows who wish to become retinal surgeons in the future. We do a lot of research on things like macular degeneration. We certainly do a lot of imaging, and we’re very, very familiar with this disease. It’s certainly something that makes up probably around half of my clinic that I see privately, so it’s certainly something that I’m very, very interested in.

    MICHAEL BUCKLEY: Great. So, I guess the Career Day question: How did you come to do this?

    DR. AVNISH DEOBHAKTA: Oh, sure. When I started in medical school, one of the things that I thought of was that, of all the senses that we have, vision, I think, is incredibly fundamental to the human experience. You know, we kind of reflect that idea in our platitudes, like “Seeing is believing,” and certainly the ability to give back sight is so foundational that it’s actually found in our ancient religious sects, right? It almost is a proxy for the Divine.

    But in the real world, our ability to help people with vision-related problems was, up until recently, very limited. And I think that part of what excited me about the field was that—outside of the ability to interact with a variety of different patients and directly intervene surgically—to me, scientifically, I think it’s part of the next frontier of medicine. The ability to have really specialized medicines (like those that we all know are used to treat macular degeneration) or to have cutting-edge approaches to solving new problems (like the first-ever FDA-approved gene therapy, which was actually for something called retinitis pigmentosa), or even sort of a science fiction–style potential (like regenerative medicine of things like the retina, which is ongoing research that we have) are all part of vision science. So, to me, I think the field has incredible potential advancements that we haven’t discovered yet, and I think, from my perspective, it was wonderful to have the opportunity to contribute to that.

    MICHAEL BUCKLEY: Thanks. I just want to stay on the point you made about how important the sense of sight is. From my perspective, there’s sort of a paradox of: Losing vision is probably one of most people’s greatest fears, but yet it also seems like most people either don’t know enough or don’t do enough about their vision health. I recently saw a study in the news from the American Academy of Ophthalmology. It said four out of five Americans weren’t aware of the major diseases that cause blindness, such as macular degeneration and glaucoma. From your vantage point, how do you see that paradox of people worrying greatly about losing their vision, but yet at the same time maybe not knowing too much about how to preserve their sight?

    DR. AVNISH DEOBHAKTA: Yeah. I think that’s a major, major issue, and to be honest, I think that pretty much falls squarely on our shoulders—that is, eye professionals, eye doctors, eye health specialists—since we function as de facto purveyors of vision health education when push comes to shove.

    One of the biggest tragedies of a disease like macular degeneration is that people will often show up once something severe has occurred, such as a bleed underneath the retina or something like that, because that’s when they’re symptomatic and have vision issues. And so, the problem is that these issues are often difficult to reverse once they’ve occurred, and sometimes these patients are facing permanent vision loss. But if they were identified earlier in the course of the disease, it may have been possible not only to reduce the chance of some of these complications occurring, but also to catch potentially dangerous situations from occurring prior to them becoming impossible to manage, and then to intervene with things like surgery or injections more quickly.

    So in my opinion, that article really points to the fact that any activity that we do that increases the public’s knowledge of vision-threatening diseases and what they are and how to treat them—sort of like this very session we’re doing right now with BrightFocus or any other type of outreach program—are immensely helpful in potentially reducing the chance of some of these things from occurring. So, I think it’s a big, big issue.

    MICHAEL BUCKLEY: I appreciate your point. You know, one of the goals of the BrightFocus Chats is to educate people about the latest developments in vision health, and I understand there’s a new treatment for wet AMD that just recently came onto the market. I was wondering if you could mention what that is as a way of helping people know what some of the options are and maybe being familiar with a word or two when their doctor mentions it?

    DR. AVNISH DEOBHAKTA: Oh, certainly. The new medicine that really just came out a few months ago called Beovu®, and what it is … it’s something called a single-chain antibody fragment. Now, you don’t have to know what that exactly means, but all you have to know is that that’s a very new way of targeting the molecule that we think primarily causes the wet form of AMD, which is a very dangerous form of AMD. That molecule is called VEGF, for those who aren’t familiar. Because VEGF causes new, more fragile blood vessels to form underneath the retina, when it’s secreted in high amounts in the wet form of AMD, this molecule can damage the retina by increased bleeding and subsequent scarring. A lot of people lose their vision because of that; thus, blocking this molecule in particular is key in the treatment of this very dangerous form of AMD. Each medicine that you know of on the market—there’s something called Avastin®, something called Lucentis®, something called Eylea®, and now there’s something called Beovu—they each target and block this VEGF molecule somewhat differently. And in the specific case of Beovu, some of the studies have shown that, relative to some of those other medications, it might be able to treat the wet form of macular degeneration with fewer treatments: fewer injections, fewer administrations than some of these other medicines that are currently on the market. And that’s one of the biggest advantages when we’re treating AMD is to have something that can last maybe a little longer and maybe reduce that treatment burden but still be efficacious. And so, this is this new medicine that’s come out.

    MICHAEL BUCKLEY: Well, that’s great, and I appreciate the update. Just for people’s curiosity, how does a new drug go from the scientist’s lab into a clinician’s office? How does that process work?

    DR. AVNISH DEOBHAKTA: That’s a great question, and I think—speaking as somebody who does quite a bit of research, it’s very material to sort of the things that I do—but in the United States, in particular, any new drug that’s available for public use has to be basically approved by the Food and Drug Administration, which most people know by its acronym as the FDA. And this process for approval is very, very extensive.

    The individual or the group—or, in this case, the manufacturer or sponsor—has to initially conduct a series of scientific tests to determine that the drug itself is safe, that it does what it’s supposed to do, and that it shows some kind of health benefit. If they can show those three things, then it can get approved. But these tests are usually trials that are first done in a laboratory setting: We first do it where there’s no life involved, just in a laboratory setting; and then on animals; and then once these new drugs are shown to be safe there, then later on humans.

    So, if any of the people listening have heard of the phrase “clinical trials,” well, those are the trials that are done on humans, and they’re done after these laboratory settings and these animal tests have shown that this drug is safe and does what it claims to do. So then, they have to hurdle now with the human tests. Typically, a manufacturer will have to go through a number of phases of clinical trials. It’s not just one; usually, it goes through a bunch of them, including what’s called a Phase 3 trial. That trial tends to be the final one, where the new medicine is tested either against what’s called the “dummy medicine,” which is a medicine that really doesn’t do anything if there’s no other treatments out there for comparison, or a gold standard medicine already in use. In AMD, we have a lot of medicines that are in use—like Eylea, Avastin, Lucentis—so these drugs would be tested against those drugs.

    If the new medicine that’s coming out—in this case Beovu, or any other drug—shows safety, does what it claims to do, and shows some kind of health benefit after even the clinical trials, then the FDA will make a decision on whether to approve or not approve the medicine for public use.

    One thing I always like to point out whenever a resident, fellow, or a patient asks me about this process, I say that the whole process is quite extensive and expensive, and so as a result, the FDA really only approves something on the order of 30–50 new medicines per year. That’s not really a big number there, and it goes to show just how difficult it is to hurdle those processes. So, when a new drug does make it to market, it really has gone through a lot of these sort of hurdles.

    MICHAEL BUCKLEY: Thank you, Dr. Deobhakta. In terms of the new medicines that come on the market, maybe somebody could cynically say that medicines only work if you take them. My understanding of the wet AMD process is it can seem challenging—pretty time-demanding on caregivers and the patients—and I think you and I both recently saw a study from the University of Pennsylvania that says if you just miss one treatment over a couple-year period, that there can be some regression. So, how do you and your practice help patients and their families adhere to treatment regimens as best they can?

    DR. AVNISH DEOBHAKTA: I think you hit the nail on the head. I mean, I think one of the most difficult aspects of this disease that paper points out is that it’s this almost unrelenting pace of the necessary treatment. In this disease, some patients require monthly injections, and sometimes they require monthly injections in each eye in order to control their disease. So yes, and I’ve seen it: Even missing one visit can sometimes lead to devastating bleeds that, once they’ve occurred, they cannot be easily fixed. I have a few patients that will see me almost 24 times in 1 year because they need injections in each eye, and for whatever reason we can’t do both eyes on the same day, etc. This is a very, very, very challenging situation that we deal with. You know, our clinic tries our best to connect them … we happen to be connected to a social work apparatus that is extremely good, and so I often—if patients can’t get rides and that sort of thing—I’m able to connect them with various people and things that can help them to access  the various programs in the state of New York.

    But another way to mitigate some of this is that the new treatments that we have, which can potentially extend the durability of treatment and thus reduce that injection burden, like we discussed earlier, might be able to help ameliorate this problem. As an example, it doesn’t matter whether you’re a patient or just a person, it’s incredibly difficult to just find a ride if you need one 24 times in 1 year, let alone if you need it to go to your doctor’s appointment. But in a very real sense, given the variables required for each visit—you have to find a caregiver, you probably sometimes have to take off work, etc.—it’s almost exponentially easier to accomplish all of that if it’s only necessary four or five times a year. So, getting that burden down is one of the ways to kind of deal with the problem, and also then connecting them with different programs if you have access to them. We happen to have access to it because we’re part of an academic facility, and that’s helpful in this case.

    MICHAEL BUCKLEY: I appreciate that. Those are great tips, and I think you’re right, if everybody involved works to make it as manageable as possible. Let’s start with a couple of listener questions that have come in. I want to ask you about genetic testing. I think people hear more and more advertisements in the media about genetic testing. Is this something that has value in terms of macular degeneration?

    DR. AVNISH DEOBHAKTA: Well, you know, it’s a good question. I get the question almost every single day whenever I have clinic—probably multiple times—of whether people should be getting genetic testing or not. Definitely we know that AMD is what’s called a multifactorial disease: In this case, it’s affected both by genetics and by environment. I think the number is that people with an affected parent have something like twice the risk of getting the disease as compared to someone who does not have an affected parent. I never actually ask people to go and get genetic testing, despite the fact that we know that in the future it’s probably going to be helpful from an academic sense; at the moment, the information at present hasn’t really been shown to change any treatment strategy. So, what I often say is that if somebody has an affected family member or has a family history of AMD, then it’s best for them to see an ophthalmologist, which most people do; eat a diet rich in fruits and vegetables; avoid red meat; eat fish; and, above all else, avoid smoking. Control the environmental factors that you have, and then if at some point in the future we start seeing that genetic testing is leading to treatment changes, then for sure I think we would say for people to get it. But, at present, it hasn’t shown that; it’s more for sort of an academic perspective. Perhaps in the future it will be necessary, but not just yet.

    MICHAEL BUCKLEY: That’s interesting. I think it shows you both the importance of good communication between generations in the family, but also some of the lifestyle issues. I’m sure we’ll have other questions about that pretty soon. Another question someone asked: Is it possible to reverse vision loss that’s already occurred?

    DR. AVNISH DEOBHAKTA: This is a very good question, and I think a lot of patients come in with that sort of concern. What I always say is: It depends on the type of disease that you have. Macular degeneration, in particular—if that’s what you have—is split into two different forms. One is the dry form, which is what most of the people have, where you don’t have bleeding and swelling of the retina and fluid accumulation in the retina. And then you have the wet form, which is the thing that we discussed earlier, where you can have bleeding, you can have new blood vessels growing, and that’s stuff that we treat with medicine. If you are having some fluid that is potentially removable by some of these medications, which we deliver with injection, then yes, it is possible to actually have an increase in vision. That’s probably one of the biggest advancements in the last 20 years that we’ve had in our entire field, let alone just for macular degeneration: that these injections can actually reverse some of that damage, depending on what type of damage it is.

    If it’s fluid in the retina that is removable with these injections, then yes, a lot of times patients can see. However, if there is permanent damage—like scar tissue forming or something called atrophy, which is where the retina itself is damaged to the point where it cannot regrow back, or it’s kind of disappearing because it’s been damaged so much over time (and that can also happen with the dry, and it can happen with wet)—then in those cases, oftentimes we really can’t do anything at present.

    I’d always tell patients—and I always tell them this—that just like we didn’t have a treatment for macular degeneration in its wet form 10, 15, 20 years ago and now we do, we certainly are working on things to try to fix some of the unfixable things, some of the unfixable parts of vision loss that this disease puts on patients. So, I never tell them to lose hope, but it’s just sometimes we can reverse it and sometimes we can’t. And it all depends on what it looks like when you see your ophthalmologist, so I always encourage them to go see their ophthalmologist so they can figure out exactly what type of damage they do have.

    MICHAEL BUCKLEY: To the point you made a few minutes ago about the number of injections that people need, we have a listener who emailed us a question asking: Is the eyeball damaged from these repeated injections?

    DR. AVNISH DEOBHAKTA: That’s a really, really great question. You would think … initially, when I first learned how to do these injections in residency, you would think that in the eye—if you continuously inject somebody—there would be some major permanent damage that you have because you’re sticking a needle in someone’s eye. But in reality, we don’t really see that. It really matters what you’re injecting. A lot of times, you inject different types of medicines into the eye for different diseases. Some of the safest, actually, medicines out there are the medicines that we use for macular degeneration, the ones we’ve talked about: Beovu, Eylea, Lucentis, and Avastin. Those actually don’t really show really longstanding damage to the eye. The one thing I would say is that if somebody is getting so many injections—and we see this, people have been getting injections for 7, 8, 9, 10 years—sometimes you can have elevated risks of glaucoma or some other types of diseases, or cataracts, or something like that. But in reality, those are pretty rare. On an injection-to-injection basis, it’s a fairly safe procedure if you’re getting it long term. I’d actually say it’s safer than anyone could have imagined, to be honest.

    MICHAEL BUCKLEY: That’s good to know, and certainly compared to some of the alternatives. Another listener is wondering about saffron. Is that helpful? She has heard that saffron could be helpful for AMD. This is not something I’m familiar with. I was wondering if you were.

    DR. AVNISH DEOBHAKTA: That’s great. I mean, she’s been really looking into the studies there. There are some small studies out there that, initially, just the saffron in small doses can help what’s called … the way they put it is “stabilize the retina” for a small period of time. I believe one of the studies that was done actually only had a follow-up of about 6 months, and it was recently published.

    The issue with it is that—like all things, dietary or otherwise—the evidence is somewhat limited at present. So, you know, it’s not something that I would say should be a generalized indicated use for AMD treatment, but it’s certainly something that we need to consider for the future and definitely merits further study.

    To be honest with you, the whole reason why we have the vitamins that we do—the AREDS2 vitamins that people use for dry macular degeneration and prevention—is because someone made an observation decades ago that people who had certain diets actually seemed to be doing better and had a reduced progression risk with macular degeneration relative to other people who were not on that diet. That’s what spurred on everyone to look into what vitamins worked and what didn’t, what food items worked and what didn’t. So, who knows? Maybe in the future this could be true; at the present, the studies are just too small, but certainly future evidence would be great if we could get it.

    MICHAEL BUCKLEY: That’s great. Another question from our audience really builds on that point. You mentioned AREDS2 and vitamins and nutritional supplements, and this listener basically is wondering: Can you have too much of a good thing? Is there a risk for having too many of these vitamins and supplements and nutrients?

    DR. AVNISH DEOBHAKTA: This is a great question. The AREDS2 formulation … well, just to go back, you had some people that were very instrumental on BrightFocus ’s sessions in the past who were incredibly instrumental in running these studies when they first began, including Dr. Emily Chew, and she sort of figured out which ones to use in her team—which types of vitamins to use—that can reduce vision loss or certainly progression of vision loss from this disease. But initially, it was one formulation; now it’s a different formulation, and the reason why is because some of the stuff that we included, like beta-carotene, in the first formulation was shown to have some adverse effects. So, it was switched out, and we’ve added lutein and zeaxanthin to the current AREDS2 formulation. There were some components of that that can, when taken in excessive doses, be harmful—in particular, vitamin E and zinc. Now, the studies basically showed that the formulation that we have right now is fairly safe, so if you’re taking the AREDS2 formulation, you can continue taking it. But if you’re taking in addition to that a lot of vitamin E, that can cause some bleeding problems. And if you’re taking a lot more zinc, then that can cause some urinary problems, nausea, stomach pains, that sort of thing. So, I would be cautious if you’re taking large doses of some of those things, like vitamin E and zinc, because those have been shown to have issues. But if you’re not doing that and if you’re just taking a small multivitamin or something like that, that’s usually okay, or if you’re taking vitamin D or vitamin B, which a lot of people are, those are okay. But specifically those two, if you’re taking it in addition as a supplement, that’s something that you should speak to your doctor about to see if you’re taking too much of it. But it’s something to think about.

    MICHAEL BUCKLEY: Dr. Deobhakta, we’ve gotten a number of questions today about cataracts and their connection to AMD. In any particular order: Do cataracts cause AMD? Does AMD cause cataracts? If you have cataracts, does that affect your AMD treatment, or vice versa? So, it’s really just kind of any part of that cataract/AMD intersection that you want to talk about.

    DR. AVNISH DEOBHAKTA: AMD doesn’t necessarily cause cataracts or vice versa, but both are age-related, so that’s the first thing to remember. As we get older, we develop both diseases in tandem. We develop many diseases, but those two in particular are very age sensitive. In addition, smoking can cause both of them, as well, so if you’re a smoker and you’re getting older, both of those things may cause you to have AMD and cataracts. I did mention earlier that if you have a large number of injections—and I mean quite a few over years—you can certainly start developing a small cataract faster in the eye that’s being injected than the other—than the contralateral eye—so that’s a way to kind of link the two.

    One of the questions that we’re often asked is whether surgery for cataracts can cause progression or something like that? No. The data out there is very equivocal, so I would say at present, no, so you can go ahead and get your cataract surgery if you have AMD. However, the way I treat patients—just because when someone progresses from dry to wet, we need to be Johnny-on-the-spot and take care of them with injections, or at least make sure and monitor them—I like to monitor them much more closely. So, if somebody I’ve been following for years is about to get cataract surgery, I tend to make them come in to see me just a little bit earlier right around the time, or maybe after they get their cataract surgery, to make sure nothing has occurred.

    But in reality, there’s no huge dataset that shows us that, so it’s not really connected in terms … you should not be frightened of getting cataract surgery if you have AMD. But I think it’s always good to be vigilant and see your doctor a little earlier just to make sure that everything is squared away and that nothing untoward has happened, because we can intervene in this era more quickly with medicine, as we discussed earlier, than we could have in the past. And so, that’s where it is. But again, it doesn’t cause the two, but it’s a lot of what I said: If you smoke or if you’re getting older, your risk for getting either of those independently is higher.

    MICHAEL BUCKLEY: Well, thank you. That addresses a number of questions today. Dr. Deobhakta, I want to switch gears to the weather and the seasons and how that affects eyes. For example, here in Maryland, it’s been perpetually gray and foggy for weeks, and New Hampshire has blinding sun off of the snow that she has up there. Any tips for people to navigate when the sun seems to get really low in the sky in the winter? The house can get dark and shadowy. Any tips to help people navigate both inside and out of the house during the winter?

    DR. AVNISH DEOBHAKTA: Sure. One of the issues with snow, to be honest, is you can get snow blindness. This happens to skiers, so it’s not unusual for anybody—whether they have AMD or whether they have any type of underlying disease—for them to have this issue. It’s because the sun’s light is actually unpolarized when it comes out of the sun, but when it hits the snow, it actually becomes one sort of angle, and that can really blind you because it comes right at your eyes; the angle is sort of right in your visual axis. One of the things that’s easy to do is to just use either sunglasses, but if you’re going to be out in the snow—or maybe even out on a boat, because this same phenomenon happens on water—is to use polarized sunglasses. If your sunglasses are polarized the right way—and you can ask your optical shop about what this means—it can really remove that aspect of the sunlight from bouncing on it, because it’s very preferential to being blocked by those types of sunglasses. But, in general, wear hats, block your eyes. It’s always good to have some sunglasses around, especially if you’re having issues.

    Certainly, if you’re having a lot of glare at night and you’re looking up at a streetlight, you might want to go see your eye care professional because you might have cataracts or something like that; that may be causing more of an issue than you may have otherwise thought, and this new weather is sort of bringing it out.

    Inside, I always tell patients—especially if they have an underlying disease like macular degeneration—night blindness starts to happen. You’re not as good seeing in dark spots than you were before. Keep lights on. I mean, it sounds silly, but keep the bathroom light on when you’re going to sleep because it helps to not fall over and do those sorts of things that could really be a problem in the future, and it’s just very easy to do. Other things that I do is … try your best—because one of the things that people do when it’s dark is they turn on their phone, and then they start reading it, and that’s the next thing that they do—that can really strain your eyes, because the backlight of your phone tends to have a little bit more of a blue light, which keeps you awake longer and it makes your eyes strained. So, one of the other things that I tell patients to do is to change their background of their screen to be a little bit redder or go into nighttime mode a little more quickly, so that way they can go to sleep and wake up appropriately. And so, all of these things start happening because it’s getting darker and people are staying indoors and that sort of thing. So, keep a light on in your bathroom, try to not stay on your phone too much, and wear sunglasses outside—certainly polarized ones if you’re looking at the snow too often.

    MICHAEL BUCKLEY: Great. I appreciate that. I’m going to kind of shift gears again for a second. You say you see patients in the clinic at Mount Sinai on a very regular basis. From your perspective, what makes it all work in terms of the patient, the caregiver, the eye care professional? What’s the optimal way that the visit itself can go well … and future visits and adherence? How can the patient and physician and caregiver all work together best?

    DR. AVNISH DEOBHAKTA: I think it’s a great question. I think it’s probably as material to our profession as anyone’s because of how important it is to make it to these appointments. One of the things I try to do is I try to eliminate any sort of communication mishaps. We have actually, with our EMR—electronic medical record—something called MyChart, which allows a patient to basically drop an email, if you will, into their chart, and I can access it at a later point and send it back to them. And through this very HIPAA-compliant solution—basically a legally compliant solution—we can communicate with each other, even in off-hours, so if a patient has a question that they need to have answered, they can send it to me.

    The other thing that I often do is, instead of … whenever I schedule appointments, if I know that a patient’s going to have to see me multiple times, I try to get those appointments all scheduled at once. So, for instance, when someone starts off with an injection profile because they have macular degeneration that is wet, I try to schedule three appointments, because the loading doses of these injections typically are once a month for 3 months. So because of that, I like to just say, “Okay, well, we need to do 3 months in a row,” and that allows the patient, myself, and whoever their caregiver is to discuss amongst each other exactly whether there’s going to be a problem 2 months from now, which you may not have thought about if you’re just doing single visits. And that’s really important, because I think—as we heard with that other paper that we discussed earlier on in the conversation—if you miss one visit, especially early on, something devastating could happen. So, it’s good to get those out of the way and schedule them such that the patient can come.

    And then for me, one of the things that we often do is, if I see that a patient can’t get there or I see her in a wheelchair or something is required, I try to communicate with their primary care physician or connect them—if they don’t have a primary care physician or somebody that manages their other care—with a social worker or someone that can help from our department so that way we can connect them to these people, and they would be informed of their issues with seeing and that sort of thing. So, I think that, overall, the answer is communication as much as possible, but also to eliminate any of these other variables that routinely pop up with this sort of disease that we face with macular degeneration.

    MICHAEL BUCKLEY: Well, thanks. That’s great advice. Dr. Deobhakta, before we conclude, I wanted to definitely thank you for being a part of this. This is your first time in a BrightFocus Chat, and I really welcome you to the BrightFocus family, and we’d love to have you back in a future discussion. In conclusion, when you look back on your career as a clinician and also teaching future eye care professionals, I was wondering: Is there one big thing you’ve learned in your career, or is there one piece of advice that you’d like to say to all of your patients? I was just wondering if you had some final thoughts for us today.

    DR. AVNISH DEOBHAKTA: Sure. I mean, I think the one thing I’ve learned in my career is that there’s really nothing better than to do what I do, and that’s how I feel. There’s nothing better than to give someone back vision when they’ve potentially lost it. I mean, it’s one of the best feelings in the world, and the amount that it helps people is just immense. I don’t know how else to put that. This is a field that is super, super important from my perspective, and it can really, really change people’s lives if we advance it and if we can treat our patients well.

    The other thing is that we treat—and I tell the residents and fellows this—we treat a heterogeneous group of patients. We treat neonates all the way up to the oldest of patients. We treat all genders. We treat all different types of people, different diseases affecting the young and the old, women, men—anybody, we treat. It’s not like—especially as a retina specialist—it’s not as if there’s a specific one for older people and a specific one for middle-aged people. So, you get to have the opportunity to see all different types of patients, so actually one of the most kind of exhilarating parts of my career is that I get to do that.

    The piece of advice that I would love to give my patients is: Don’t give up hope. I mean, I think that that’s one of the things that is instructive if you look at our history, especially in retina. We are right now on the verge of helping people who have genetic illnesses that were unfixable as early as 2 years ago, and now we have an FDA-approved drug for gene therapy, which is the only one that exists out of any of the fields, and it’s for retina. We didn’t have these medications—Beovu or Eylea or Lucentis—for decades. We considered macular degeneration basically unfixable, and then all of a sudden now it’s something that we actually have—some tool in our armamentarium to do something about it. So, who knows what’s going to happen in 5 or 10 years? So, I always say, it may be today right now, but always control the environmental factors that you have, because maybe tomorrow we will have come up with something. So, that’s the advice I give them.

    MICHAEL BUCKLEY: Well, that’s great, and I think that’s a fantastic place to leave today’s discussion of don’t give up hope and the really tremendous progress in this field. And so again, Dr. Deobhakta, I just want to thank you for being a part of our discussion today, and I want to thank our audience for just a tremendous number of questions, many of which we weren’t able to get to today, but we’ll hang on to them for upcoming Chats. On behalf of BrightFocus Foundation, thank you for being with us today.

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