ASRS 2023 highlighting diversity in approach, research and practice across retinal conditions

With such a range of data, discussion topics and attendees at this year’s meeting, ASRS made me ruminate about diversity in three ways:

1. The diversity of scientific approach in the research presented

From using 3D printed models for practising retinal surgery, to investigating CRISPR gene editing techniques to prevent disease progression, the range of approaches being explored to address retinal conditions was really evident at ASRS 2023.

I find this innovation particularly exciting because retinal conditions are complex, with multiple signalling pathways involved, progressing differently in different people. So, there cannot be just one approach for everyone – doctors and those living with retinal conditions can be better served with a variety of options.

We have seen this first-hand in conditions like neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME). While anti-vascular endothelial growth factor (anti-VEGF) treatments have helped hundreds of thousands of people with these conditions, around a third of people with nAMD and a fifth of people with DME still experience vision loss despite receiving these treatments. Clearly, their conditions are influenced by pathways beyond VEGF.

As a result, at Roche we have focused on exploring these other pathways, including Angiopoietin-2 (Ang-2), which contributes to vascular instability, causes inflammation and facilitates and amplifies the actions of VEGF. At ASRS, we also presented data investigating the impact of treatment on the fibrotic processes that may cause negative changes to the anatomy of the eye and compromise vision. I hope our research into inflammation, macular leakage and fibrosis pathways expands knowledge of and approach to these areas so that more people with nAMD and DME, as well as other conditions, can receive treatments able to prevent vision loss.?

2. The evident desire to encourage and support gender diversity at the meeting and among retina specialists

For too long, medicine generally has been in the purview of men. While great progress has been made, it has resulted in health inequalities for women and individuals from diverse racial and ethnic backgrounds; women’s increased risk of death from heart attacks and the heightened risk of birth complications experienced by African American women are just two examples.

Sadly, in ophthalmology and the field of retinal conditions, we also see the impact of health inequalities, with women more likely to experience low vision in their lifetime and, in some countries, less likely to seek and receive diagnosis, treatment and care. Furthermore, the American Academy of Ophthalmology reported a significant gender disparity from 2016 to 2019, with three times as many practising male ophthalmologists as female ophthalmologists. Addressing this gap in representation matters to ensure the diversity in the people seeing care is represented by those delivering care.

It is fantastic to see initiatives by ASRS that aim to combat this imbalance via the Women in Retina sessions and social events that took place at the meeting. While these initiatives are positive steps, they are just the tip of the iceberg, and more can be done to create an inclusive and welcoming atmosphere. We need scientists with a diverse range of perspectives and ideas to continue to experiment to learn more about these complex conditions and find diverse solutions.?

3. Evidence of greater diversity in research

It isn’t surprising, but the lack of diversity that has existed in medicine for so long has also impacted the medicines created, who they were created for and, crucially, how they were tested.

Historically, clinical trials were conducted predominantly across the US and Europe, largely because it was the easiest option, as these are where many pharmaceutical companies and research centres are based. However, this has meant that some populations have been underrepresented in medical research for decades. Research has shown that approximately a fifth of new medicines approved between 2008 and 2014 resulted in varying exposure and response levels across different racial and ethnic groups.

Fortunately, processes have shifted, with the goal of increasing diversity in clinical trials. As a result, the profiles of newer treatments are better understood in people of different races and ethnicities.

At ASRS, we presented the design of an ongoing phase IV trial, investigating one of our treatments in underrepresented patients with DME. The inclusion criteria specify that participants must identify as Black or African American, Hispanic or Latino American, Native American or Alaska Native or Native Hawaiian or other Pacific Islander, all groups that are underrepresented in research.

I’d like to leave you with this quote from the wonderful Maya Angelou, which summarises so much of what I have tried to say in this article:

“In diversity, there is beauty, and there is strength” Maya Angelou?