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‘Thinking outside the box’ leads to major advances in eye care
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 Michael D. DePaolis |
“Think outside of the box.” While this concept has become a bit of a cliché, largely due to indiscriminate overuse in the world of business consulting, it actually has an interesting history.
Thinking outside the box involves conceptualization and creativity – uninhibited by the shackles of boundaries and conventional wisdoms. In short, it is an intellectual exercise free from the rigidity and restrictions imposed by the proverbial “box.” While its origin is debatable, one of the earliest citations is found in the science publication, Aviation & Space Technology (July 1975). Indeed, thinking outside the box is well rooted in science.
Of course, medicine – and eye care in particular – has a rich history of thinking outside of the box. It was in the early 1950s that Drs. Wichterle and Lim began experimenting with a water-absorbing plastic called hydroxyethyl methacrylate (HEMA), leading to the first commercially available soft contact lens. Then, again, in the early 1980s, Drs. Srinivasan and Trokel began looking at biomedical applications of the excimer laser, including sculpting the cornea – a concept that led to today’s LASIK.
In a similar fashion, in 1989 Dr. Napoleone Ferrara first conceptualized vascular endothelial growth factor (VEGF) as a driver in tumor growth. While early VEGF work was aimed primarily at inhibiting vascular supply in tumors, researchers also recognized the importance of pharmacologically inhibiting neovascularization in wet age-related macular degeneration. This ultimately led to the commercialization of pegaptanib as Macugen by Pfizer and ranibizumab as Lucentis by Genentech, as well as – perhaps the most pleasant surprise – the off-label application of bevacizumab (Avastin, Genentech) in our war against AMD.
I think most would agree that anti-VEGF agents represent a true paradigm shift in the management of wet AMD. They have transformed wet AMD from a condition in which therapeutic strategies were aimed at slowing an inevitable devastating loss of vision, to one in which we are able to recover vision loss for many. And it is all because researchers took the initiative to think outside the box.
In this month’s issue of Primary Care Optometry News, Len Hua, PhD, OD, FAAO, provides an exceptional overview of the history, development and clinical efficacy of anti-VEGFs and other contemporary measures for managing wet AMD. Additionally, Dr. Hua provides a glimpse into what roles emerging technologies play in future AMD management – both wet and dry.
I encourage you to take the time to read Dr. Hua’s article. It is an inspiration for all of us to occasionally think outside the box.