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Masters of the Industry panel from Healthegy's OIS@ASRS 2016: Retinal disease remains a challenging target for drug and device makers, but a panel of senior executives at last week’s OIS@ASRS says the potential benefits of treating the back of the eye outweigh the difficulties. Frederic Guerard, worldwide business franchise head of ophthalmology at Novartis Ophthalmology, which now manages the pharmaceutical portfolio once held by Alcon, said “the benefit of being part of a larger R&D bucket is the costs [of retina research] are not very different than what we see in oncology or other areas. “There is little risk that retina will be deprioritized because everything we do in retina is big,” Guerard said. Any successful product will provide clear benefit to patients and address huge, unmet clinical needs. Large pharma companies won’t steer clear of retina. “Retina will always win because it is such a large segment growing so quickly. I see more risk for other areas of eye care ... because of [retina's] market size and the unmet medical need.” Bill Link, OIS co-chair and a founding partner at Versant Ventures, says the venture firm has invested in 20 ophthalmology start-ups since its founding in 2000. Half of them focus on the anterior segment, and the other half is split between glaucoma and the retina. Developing treatments for the back of the eye may come with higher costs, but the rewards are higher as well. “We do not need to fund a project as far as we do in the device and vision restoration side, so it can be relatively cost-effective,” Link said. “Versant and other venture firms have had a number of very handsome exits with early clinical and preclinical assets and that is where you need to be really sophisticated and thoughtful to sort which targets to go after. “If we’re right 60 to 70% of the time we’ll do great for our investors,” he said. Mazzo asked if the costs of retina development are too onerous for start-ups. Do larger corporations like Roche/Genentech rely more upon their own internal R&D? Tony Adamis, MD, is global head, I2O and metabolism, clinical science at. Genentech. He says of the firm's 180 late-stage projects, one third of the molecules have been in-licensed. “You can’t afford not to look outside,” Adamis stated. “We’re just not that smart. You can’t invent every next great molecule.” Companies such as Roche, Novartis, and Bayer need early-stage companies, he said. As for the cost of developing retina drugs, Adamis says they’re not more expensive than other complex drugs. In fact, the refining of imaging tools and biomarkers enables drug companies to see if molecules are performing as expected in early clinical trials. Mazzo asked panelists about one theme raised during the conference – how will the health care system pay for breakthrough technologies like those in the retina. Ludwin Monz, PhD, president and CEO of Carl Zeiss Meditec AG, agreed that cost-per-patient is “extremely important but it is always going to be coupled with efficacy.” Zeiss tries to offset those cost concerns by developing “dedicated products” for higher- and lower-end market segments,” he said. “This probably is not possible on the pharma side. But on the equipment side that allows us to make the product widely available.” For more on Ophthalmology Innovation News & Events visit: http://ois.net/ Video Highlights: 00:48 – Will genetic testing become routine in the future? 01:32 – Should we be genotyping our patients now? 01:41 – How does the recent movement at Alcon/Novartis impact the retina space? 03:12 – How will advances in diagnostics change the outcome for patients with retina disease? 04:25 – How do smaller companies play in the retina space? 06:00 – Data suggest US surgeons are treating patients more aggressively than their European counterparts. What could you attribute to that? 09:10 – How do you balance providing patient access to care while also growing a business and increasing shareholder value? 11:09 – How does pricing impact your approach? 14:50 – Is Gene Therapy something we’ll see in our lifetimes? 17:30 – Will programs in the retina follow other specialties where cost-per-case is weighed against efficacy? 19:00 – How do you answer concerns about the cost of retina research when product development in other disease areas within the eight are less expensive? 20:25 – How do you justify the costs and time invested in retina when product development of other conditions takes less time and money? 22:30 – Do big companies need to look outside for R&D? 25:10 – What is the next big thing?