A professor on a mission to fight against AMD

One in seven Australians over the age of 50 faces the grim reality of Age–related Macular Degeneration (AMD) and one person wants to make a difference.Professor Robyn Guymer hopes to turn the tide in the battle against AMD and has made it her quest to eliminate the fear of losing one of life’s valuable treasures – the gift of sight.Guymer leads the macular research team at the Centre for Eye Research Australia (CERA), which aims to improve people’s understanding of AMD and to develop highly effective solutions to treat the disease.The Melbourne-based research team is currently determining the risk factors involved in the various stages of AMD, from early signs to the advanced stages. The research analyses issues around the genetics, environmental association and biomarkers of AMD.Guymer first began her research in 1997 after returning to Australia from a fellowship study in England. She started to take an interest in the field while studying at the Moorfields Eye Hospital in London.Few studies and limited optionsDealing mostly with diseases of the retina, she realised there were very few treatments available for AMD. What struck a nerve was when patients with severe cases had to be turned away due to the lack of medical solutions.On reflection, Guymer says things didn’t initially turn out as planned. She wanted to return to her hometown of Shepparton, Victoria to practice ophthalmology and, at the time, research had never crossed her mind.Faced with the reality of an increasing incidence of AMD and with relatively no option for a cure, she believed this was an area in which she could make a difference.{{quote-A:R-W:450-Q: The technology for the bionic eye is really only at a level that will be useful for people with profound vision loss, such as those with retinal degeneration, }}Upon her return to Australia the first major focus of Guymer’s research was to identify the genes influencing AMD because, at the time, studies revealed that it was an inherited disease.The first point of attack was to determine which genes were influencing AMD therefore the team started with tracing the family history of people with AMD in order to collect gene samples for analysis.It wasn’t until publication of the first single nucleotide polymorphisms that allowed her research team to use its own gene collection to confirm that genetic changes not only increased the risk of disease but also increased the risk of progression from early to late disease, increasing the risk of loss of vision.Their role in unravelling the genetic associations with AMD now involve joining large collaborations with groups in Europe and the US.Guymer was then involved in trials for treatment of neovascular AMD. Also known as wet AMD, the process consisted of injecting drugs into the eye and was considered a significant shift in dealing with the disease and marked another highlight for her career.Her current research includes the development of a bionic eye, trials for a laser–based intervention method during the early stages of age–related macular degeneration (LEAD), and identifying biomarkers that can be used to monitor disease progression.The bionic eye project is developing an advanced prosthetic eye prototype to restore functional vision to people who have become blind from retinal degeneration such as retinitis pigmentosa (RP).The project is a collaboration between CERA together with the Bionics Institute, National Information Communications Technology Australia (NICTA), along with Melbourne University and UNSW. Guymer is a mber of the leadership team, which oversees the work of around 150 researchers across these five organisations.When asked how this will help those with AMD Guymer said, “The technology for the bionic eye is really only at a level that will be useful for people with profound vision loss, such as those with retinal degeneration, however in the future it might be possible that it reaches a level of sophistication so that those with less vision loss such, as in AMD, might benefit.”Concerns over laser therapyDuring the 1990s Guymer began research into lasers as a potential first treatment for solutions to AMD treatment. Initial trials used thermal lasers and while it reduced signs of early disease, concerns were raised over the likelihood of the process causing neovascular complications.Similar trials conducted throughout the US were stopped and thermal laser treatments were no longer considered an option however, Guymer saw that there might be some potential in harnessing the positive effects of laser without the negative effects.In 2012, together with the medical technology company Ellex, she took the lead as the principal investigator to conduct a first randomised clinical trial using a novel nanosecond laser to slow down AMD progression.The study is multi-centred and controlled trial of nanosecond laser intervention in high-risk AMD. Final results are not due for release until mid–2018. However initial findings of a pilot study based on a 12–month follow up showed signs of reduced progression of the disease.Understanding the causeGuymer also collaborates with basic scientists to investigate the underlying biological mechanisms involved in AMD. This currently involves testing the innate ability of people with AMD to rove debris that builds up in their retinae compared to normal aged matched participants.She says the works is very exciting work and is providing new insight into the potential cause, and therefore, potential treatment strategies for AMD to slow progression to vision loss.According to Guymer, the aim for research on AMD biomarkers is to develop tests that will assess the risk of vision loss early in the disease process by looking at both structural and functional markers.There are currently three clinical trials of treatments for atrophic AMD, also known as dry AMD. These trials are conducted around the world, in selected sites, with CERA involved in all three studies. . All trials require intra–vitreal injections, which are expected to slow down the progression of the atrophic disease.The team’s aim is to apply intervention through treatment before AMD begins to advance into a late stage and symptoms become irreversible. In order to achieve this outcome Guymer believes that eye care professionals must be up–to–date in analysing signs of early AMD, which is now made possible with multi–modal imaging techniques.“One of my current interests is to improve the ability to monitor people at risk by “in the home” monitoring. So we are working on developing an iPad delivered test that people can do in their home, [which] can be rotely monitored to pick up the earliest implications that someone may be starting to lose their vision,” she said.Professor Guymer is the recipient of the National Health and Medical Research Council (NHRMC) Elizabeth Blackburn Fellowship grant, recognising her as the top fale research fellowship grantee in Australia. The council is currently funding her ongoing research projects on AMD.