Steven Yeh, MD: The Promise of Suprachoroidal Injections

JULY 22, 2018
Matt Hoffman
At the 36th annual meeting of the American Society of Retinal Specialists (ASRS) in Vancouver, British Columbia, MD Magazine® sat with Steven Yeh, MD, the Louise M. Simpson professor of ophthalmology and the director of the Section of Uveitis and Vasculitis at Emory University School of Medicine to discuss a novel method of drug delivery in ophthalmology: suprachoroidal injections. 

Traditionally, the treatments for conditions such as uveitis, include mostly intravitreal or periocular corticosteroid injections. While effective, they often carry a risk of adverse events, such as the development of cataracts and glaucoma. However, through work done at Emory, Georgia Tech University, and Clearside Biomedical, this novel method has allowed for a more direct delivery of the medication.

Additionally, Yeh noted that in early phase studies, suprachoroidal injections have been shown to be promising for both retinal vein occlusion and macular edema associated with diabetic retinopathy.

Yeh also spoke about the highly discussed topic of treatment burden. While there are many models for therapies in this space, they often involve the patients undergoing many intraocular injections, prompting the retinal community to seek any way that could change those conditions. Thus far, Yeh said, as the community is learning more about suprachoroidal injections, they’ve found that in retinal vein occlusion they have shown an ability to reduce the number of injections patients need—indicating that they may be a favorable substitute.


Steven Yeh, MD:
When I think about uveitis, in the big picture, non-infectious uveitis is really a heterogeneous group of diseases that can sometimes be caused by systemic inflammation or systemic autoimmunity, as well as local diseases that are specific to the eye. 

There are different treatments that are available, both systemic immunosuppression and local medications in the form of, mostly, corticosteroid injections that either go outside the eye or inside the eye in an intravitreal fashion. These medications, unfortunately, have side effects including cataract and glaucoma. Through some leading work that was done at Emory University and Georgia Tech, as well as Clearside Biomedical, there was a development of a medication that was delivered into the suprachoroidal space. This is a potential space between the sclera and the retina that could effectively be delivered for the treatment of macular edema due to non-infectious uveitis. 

Macular edema is actually retinal swelling that is the leading cause of vision loss in uveitis. There is a lot of preclinical data, as well as some phase 1 and 2 studies that showed that suprachoroidal delivery was feasible and also was very effective and also had very favorable safety signals for the treatment of non-infectious uveitis.

There are other disease indications that have been studied as well with favorable efficacy signals. These include conditions like retinal vein occlusion—which can also lead to retinal swelling or macular edema—and also diabetes, or macular edema associated with diabetic retinopathy, which can also lead to vision loss in diabetic retinopathy. We know that retinal vein occlusions, which are associated with hypertension and diabetes [which are] certainly public health issues. With the span of disease indications, I think that this is a promising therapy for a number of different disease entities. 

What we're seeing in retina and uveitis practice is that there are many different paradigms for treatment. But, many of these paradigms often involve multiple injections given on a monthly basis with whatever the wait time at the doctor's office happens to be and significant treatment burden. If there were a way to deliver medications and reduce the number of patient visits [and] reduce the treatment burden, I think that would be favorable.

I think we're starting to learn more and more about suprachoroidal drug delivery and its potential durability in that one of the efficacy outcomes that's being studied for retinal vein occlusion is the ability to reduce the frequency of injections from a patient standpoint. I think that would be favorable for both patients and physicians—both in a treatment burden standpoint, as well as a risk standpoint, although we know that [with] intraocular injections, the risk for having a side effect is low with the injection itself.

Transcript edited for clarity.

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