The retina is our bridge to the visual world, transforming the light that enters our eyes into the images we see. Dr. Eduardo Navajas, clinical associate professor and director of resident research at UBC’s department of ophthalmology and visual sciences, is working to preserve this precious gateway for thousands of British Columbians.
Dr. Navajas is a leading subspecialist in vitreoretinal surgery — a group of intricate procedures performed deep inside the eye that help maintain and improve vision for patients with various conditions of the retina. As a clinical researcher at the Vancouver Coastal Health Eye Care Centre, he is part of the first clinical trial for a gene therapy to treat wet age-related macular degeneration. He’s also a clinical preceptor training the next generation of physicians and eye care specialists.
We spoke with Dr. Navajas about his latest clinical trial, being a preceptor and what it all means for British Columbians.
What is wet age-related macular degeneration?
Age-related macular degeneration (AMD) is the leading cause of vision loss in older adults, affecting approximately 2.5 million Canadians. It’s a progressive condition that impacts the macula, a part of the retina located at the back of the eye, which lets you see small details and focus on subjects in front of you. Ultimately, AMD can lead to blurred central vision or a blind spot in a person’s central vision.
There are two main types of AMD. Dry AMD is more common and occurs when the cells of the macula gradually break down. Wet AMD, on the other hand, is less common but more severe. It is caused by abnormal blood vessels growth in the macula and the accumulation of fluid or blood. If left untreated, wet AMD can result in irreversible vision loss.
How is wet AMD currently treated, and how might your research change that?
Currently, patients with wet AMD need frequent injections into the eye of what’s called anti-VEGF drugs, such as ranibizumab, which slow the growth of new blood vessels. In many cases, patients need shots every four to six weeks to prevent further vision loss, which can be very burdensome.
Our clinical trial is the first to explore the use of gene therapy for patients with wet AMD. Rather than repeated injections of the drug ranibizumab, we inject a single shot with copies of the gene that produces ranibizumab. The gene incorporates into the pigmented layer of the retina and starts producing ranibizumab inside the retinal tissue — essentially turning the cells into miniature drug-producing factories.
How could this benefit patients?
With the drug being produced by the patient’s own retina, this therapy has the potential to significantly reduce the need for eye injections. In preliminary studies, some patients with wet AMD haven’t had an injection for 5 years while maintaining vision.
In B.C., approximately 6,000 anti-VEGF injections are performed each month during visits to ophthalmologists’ offices across the province. This is a significant burden to both patients and the health care system. If we can reduce this down to potentially a single shot per patient, we can greatly improve quality of life and free up health care resources for other urgent needs.
What have you learned while teaching medical students, resident doctors and post-graduate fellows?
The most surprising revelation has been the profound impact on my own learning journey. Regardless of the quality of courses, conferences or readings that I do, teaching is my best opportunity to learn. It introduces fresh ideas, acquaints me with the latest research, and reignites my passion for the subject matter. Our learners are curious and driven. Fielding their questions is an opportunity to contemplate and perceive problems in new ways.
What impact do you hope to have on the next generation of physicians?
I hope to able to pass on the same inspiration and selfless sharing of knowledge that my mentors have given to me. Beyond clinical skills, I hope they carry forward a sense of gratitude to our patients for giving us the privilege of learning through them. My ultimate goal is to nurture a generation of eye care physicians who approach their work with humility, empathy and an unwavering commitment to lifelong learning.
What advice to you have for learners?
My advice is to select a career path that brings daily joy and fulfillment. Every case, no matter how seemingly routine, deserves the same systematic approach, level of attention and curiosity. Never underestimate the value of even the simplest encounters. Dedication to consistently applying oneself to each task will not only enrich your expertise, but also fuel your passion for the lifelong pursuit of knowledge.
For you, what sets B.C. apart in ophthalmology research and education?
UBC’s department of ophthalmology and visual sciences is unique by bringing together educators, clinicians, research scientists and learners in the same building at the Eye Care Centre at Vancouver General Hospital, operated by Vancouver Coastal Health. Such integration is invaluable as it allows clinicians to directly contribute their practical insights to research endeavors, while enabling learners to gain a comprehensive understanding of both patient care and cutting-edge research. This creates a synergistic and collaborative environment that promotes excellence in research, education and care, which ultimately benefits patients across British Columbia.
The clinical trial mentioned in this story is currently enrolling participants age 50 to 89 who have previously been treated for wet AMD. For more information, contact the Vancouver Coastal Health Eye Care Centre, Retina Division, at 604-875-5475 or email@example.com.