In this interview, Dr. Chin Yee, a retina specialist at Georgia Retina, discusses how his recent clinical experiences with XIPERE (an FDA-approved corticosteroid used to treat macular edema associated with uveitis), and the microneedle technology developed by Georgia Tech that allows the medication to be delivered directly into the suprachoroidal space, have helped him provide the best possible outcomes for his uveitis patients.
 

Your interest in ophthalmology began with a very personal experience during your adolescence in Jamaica. Can you tell us about it?

I was about 13 years old and I had a teacher who was trying to help the Jamaica Society for the Blind. I was helping people to read, helping them with their finances, and this experience made me realize the dependence and the trust that these visually impaired individuals have on people who, quite frankly, can be complete strangers to them. For me, this really conveyed the importance of helping these people maintain their independence.

Around the same time, my father was diagnosed with glaucoma. I already understood what the implications would mean. Now I am in a situation where I am devoting my time to preventing people like my father from becoming visually impaired.

So, from a very early age, I knew I wanted to become an ophthalmologist and these experiences shaped my mission. I realize that we still haven't reached the Holy Grail, which, in my opinion, is stopping vision loss completely, or being able to reverse the damage of someone who is visually impaired. Right now, our goal is to catch or identify disease processes early and work towards preserving vision. Until we meet that need, my job isn’t complete. That's why it's important to continue developing research, and working with pharmaceutical companies to provide the latest, best options available for our patients.

What are some of the most significant challenges patients with uveitis face in their daily lives?

Uveitis is an autoimmune disease, and for many of these patients the main thing is the fear of the unknown when they may have a flare up. They could be doing quite well and then all of a sudden have a trigger – whether it be environmental or stress-related – and then they’ll develop significant pain, discomfort, and light sensitivity to the point it debilitates them.

The most significant challenge is that constant unknown – is this going to flare up while I'm on vacation? Is this going to flare up while I'm doing something important with my family? You have no clue when it may be reactivated and turn your life completely upside down.

How does XIPERE work, and what makes the suprachoroidal space such an important target for treatment?

The big thing with XIPERE is the delivery mechanism. Historically, we would treat uveitis with sub-Tenon's, where we'd access that part of the eye and inject steroids. But as a retina specialist, if you're not seeing any other systemic issues then you want to directly treat the core cause.

Sometimes you need to use a significantly higher dose or use drops, and unfortunately patients aren't always compliant and the drops can be irritating, and so your other options are sub-Tenon's or intravitreal steroids.

With XIPERE you can use a microneedle and get to the suprachoroidal space, which is an area that’s a little bit untapped in ophthalmology. What’s nice about the suprachoroidal space is that, a lot of times, it allows us to get access all the way back to the macula, which is where patients with uveitis may also have inflammation.

It's nice to have the medication get so close to the source of inflammation. The microneedle is tagged with XIPERE, which is what allows us to access that suprachoroidal space using a safe and precise mechanism.

The microneedle was developed at Georgia Tech. The hope is to use this same suprachoroidal device to allow access for gene therapy. Sura-vec – a one-time gene therapy that’s currently being investigated – which will potentially allow us to turn the eye into its own biofactory capable of creating anti-VEGF, specifically aflibercept, and so, in theory, a patient could have just one injection.

What outcomes have you seen in patients treated with XIPERE?

We're getting even more long-term durability than existing treatments. XIPERE can last from six months to one year, and so that fear of the unknown I mentioned is removed for patients, because any flare ups are already under control.

Safety is also important. We know steroids have significant side-effects, whether it be elevated IOP or development of cataracts. Because the molecule is within the suprachoroidal space, it does not have as much exposure to the anterior segment, and so you're not going to see as much IOP response with this treatment.

What does this collaboration between engineering and medicine tell us about the future of ophthalmic innovation?

We're in an arena right now where getting funding for research can be very challenging. For someone who is geared towards actually taking care of patients, I don't have as much time to commit to that aspect. I think it's imperative to have communication between engineers, scientists, and clinicians so that we can convey some of the difficulties or challenges that we see our patients face on a daily basis. This type of discussion enables us to develop solutions and see how we can make real-life impacts for these patients.

As awareness of uveitis grows, what would you like patients and primary care providers to better understand about the condition?

I’d like them to know that we are gradually seeing better improvements through the impact of this new technology. There is a bit of a learning curve with this device because it's now entering the suprachoroidal space, which is something we didn't do before, and any time you learn a new skillset there can sometimes be hesitation towards adaptation.

But we have good studies, clinical trials, and real-world experience to show that the device or mechanism of delivery is safe, effective, and is really working. We need to continue to push this collaboration – in terms of innovation and having patients who are open to clinical trials – to be able to reach the goal that we all have, which is to one day prevent individuals from becoming blind.

What excites you most about where ophthalmology is heading?

Specifically within the retina space, I would say that gene therapy is key. Being able to potentially provide patients with just one single injection for many different diseases – whether it is cancer or diabetes or other conditions that require lifelong treatment – that can change the trajectory of their lives is very exciting for me.