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Subspecialties Cornea / Ocular Surface, Diabetes, Health Economics and Policy

A Meeting of Minds

sponsored by Allergan

Matias Iglicki, the latest recipient of the ICO-Allergan Advanced Research Fellowship, meets last year’s winner, Emilio Torres-Netto, to discuss the award, their work and the future of ophthalmology in the developing world.

Matias Iglicki: Emilio, how has the award helped you?

Emilio Torres-Netto: It has certainly supported me financially. Zurich [where Torres-Netto completed his masters] is an expensive city and the award was invaluable in helping me stay and continue my project. It also funded the eye rubbing machine we used to study the effect of pressure on keratoconus. Without the grant, it would have been very difficult to fund. Why did you apply for the Fellowship?

Iglicki: The project actually started in 2004 — 15 years ago – when we began working on an algorithm to detect diabetic retinopathy (DR). Like your project, costs are high as we need engineers and IT technicians to work on the database. The support will help us advance enormously by funding technicians to improve the algorithm we already have.

Torres-Netto: Where do you find your patients?

Iglicki: Mainly in general practitioner clinics and city halls. Our project works by identifying diabetic patients when they go to renew their ID or driving license. Our algorithm scans their picture for signs of DR – if any is found, they are sent to the ophthalmologist. It is our way of closing the link between patients and healthcare providers.

Torres-Netto: Does the technology work in remote areas? I’ve been to the Amazon a few times to perform surgery and I know it can be difficult to send data.

Iglicki: The process itself is quite simple – patients only require an ID to take part. It is also simple from a clinical point of view, there is no need for a specific device – an iPhone could take the retina photo – so it could be done anywhere.                     

Torres-Netto: A direct approach! What would happen to the patients if they were not identified and did not have laser?

Iglicki: In Buenos Aires, vitrectomy is a first-line treatment for the majority of DR patients. The government even pays for patients in the north to fly to the capital for the procedure. The whole trip costs around $10,000 – excluding the cost of social security benefits – and the prognosis is not even good! Our approach would be significantly more affordable, costing just $50 for laser and avoiding 85 percent of vitrectomies. DR is a huge unmet need, not just in developing countries like Argentina. The US is currently experiencing a DR epidemic. Many patients don’t even realize they are diabetic, despite having had the condition for 30 years or more. But if they had just seen a physician, that wouldn't be the case. Timing is key with DR. The sooner the condition is identified, the sooner we can perform laser surgery and halt disease progression. That's what we set out to accomplish and we are very confident we will do it.

Torres-Netto: What are you working on now?

Iglicki: The algorithm still requires a little work. While it works perfectly with some patients, it struggles with lesions, such as exudates. We hope that the support provided by the Fellowship will allow us to perfect it soon.

Torres-Netto:That is exactly what the Fellowship is there for; allowing researchers to take their work to the next level.

Iglicki: And tackle unmet needs. It’s an altruistic program. Where are you with yours?

Torres-Netto: Last year, we ran a study in Saudi Arabia, which we are now amplifying worldwide. We have established that keratoconus is not a rare disease, merely underdiagnosed. Our study found a 100-times higher prevalence in some areas.

Iglicki: Do you treat the patients as well?

Torres-Netto: Because it's a global project, we cannot afford to cross-link every patient. We handle screenings – any patient between the ages of 6 and 21 – but the individual site is responsible for the treatment.

Iglicki: Because at 30, progression more or less stops, no?

Torres-Netto: Correct. Sometimes it is obvious that a person has keratoconus, but other times it takes more in-depth analysis. It can take a while to do.

Iglicki:You need an algorithm like ours…

Torres-Netto: We do – you are a worthy successor!

Iglicki: And we haven't even started yet!  Thank you so much for your feedback. Do you mind if we stay in touch? I would love to have you input.

Torres-Netto: Not at all. I would be happy to help.

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