The value of real-world insights in ophthalmology and geographic atrophy (GA) treatment


Modern Retina’s interview with Aracelis Torres, PhD, MPH sheds light on how real-world insights empower researchers to see trends and develop new strategies, sometimes even new products, to meet the treatment needs of patients.

Image credit: AdobeStock/NicoElNino

(Image credit: AdobeStock/NicoElNino)

Data is power. With the ability to gather large datasets more accurately and easily for analysis, researchers can discover trends in the general health of the population and how subpopulations are, or are not, having their needs met. These analyses can empower better treatment and even motivate additional treatment options, or strategies, to fill the gaps in treatment needs.

To discuss how real-world insights impact ophthalmologists, researchers, and those developing treatments, Sydney M. Crago, editor of Modern Retina, spoke with Aracelis Torres, PhD, MPH, Senior Vice President of Data & Science at Verana Health about trends in eye health, geographic atrophy, and ophthalmology.

The following interview transcript has been edited for clarity and length.

Sydney M. Crago: What trends are you seeing in the general eye health of the population?

Aracelis Torres, PhD, MPH: At the macro level, it's hard to look anywhere without seeing some mention of artificial intelligence. I do think we've been seeing a growing trend of figuring out where it makes sense to insert it. Last year, we announced a collaboration with the FDA that involved the use of FDA-approved software to deploy artificial intelligence for screening diabetic retinopathy and understanding the difference in subpopulation engagement and utilization of the technology. I think there's definitely an interest to figure out how we can more effectively, more efficiently, and more objectively identify issues in terms of progression of eye health in the population overall. Within the ophthalmology setting, we've been seeing an increase in patients presenting with geographic atrophy overall over the past several years. So we are definitely trying to understand where we can accelerate the identification of disease, because certainly the earlier you're able to capture it, the more likely you're able to impact it in a more meaningful way.

SC: Are there trends related to geographic atrophy in particular, that you feel are important for ophthalmic professionals to keep in mind?

AT: 2023 was an exciting year in terms of therapeutic agents, since we did see newly approved therapies for geographic atrophy. This was a disease that until then, lacked any approved treatment. I do think it has been helpful to understand the adoption of these new therapies, along with any indication of their effectiveness and safety. While the clinical trials are designed to evaluate a new agent's efficacy over a certain period, they often don't provide the opportunity to observe long-term safety issues that might emerge years after a study concludes.We are certainly seeing an increase in the number of patients with geographic atrophy. I think these agents are coming at a really important time to try to at least slow down the progression of disease further in the context of this patient population.

SC: How can these real-world insights better inform the ophthalmologists that are providing care to patients?

AT: I think one of the biggest ways that real-world insights provide better information is a pulse on real-time practice patterns. The landscape and healthcare moves so quickly, whether it's a newly approved drug or a different sequence of treatments that can and should be considered. Sometimes it's hard for any treating clinician to keep up with what's the latest guidance that is reflective of routine clinical care. Sometimes they rely on more of their immediate network, maybe the practice patterns within the site that they are delivering care within. When we think about real-world insights, it really just zooms out to understand, holistically, what is the general use of a particular therapy, especially with newly approved agents like we have in GA. Are there certain types of populations or subpopulations that the therapy is more likely to be used in? Are we seeing early signs of effectiveness? Are there still areas of unmet need that are not responding in the way that we would want.

SC: How can these insights also empower researchers to develop new standards of patient care or therapeutics?

AT: I think that ends up enabling the development of more targeted therapies, therapies that are going to lend themselves better, because of that increased granularity of the understanding of patient phenotype. So, it really just gives us an understanding of unmet need. What if our latest and greatest therapeutic agents aren't resonating, or aren't enabling a good response in those subpopulations? Well, let's dive deeper into those subpopulations. Do they have common characteristics, whether that's demographic attributes, or clinical attributes, to drive the more specialized development and really advance patient care?

SC: In the data that you've gathered, were there any points in the research on geographic atrophy that were unexpected, or that you feel aren't being talked about enough in the community?

AT: In our work, particularly within electronic health record (EHR) systems, we've noticed that information exists in diverse formats and ways. There's common structured data points of categorizing a patient using ICD codes, CPT codes, classification systems that make it very easy, almost out of the box to use the data. What we have observed in geographic atrophy is that there is quite a bit of heterogeneity on where clinicians are documenting their geographic atrophy diagnoses. Sometimes that's either in the clinical notes or, in free text format, or in clinical images to extract diagnoses. This may shift and change, over time, now that we have 2 newly approved drugs, because sometimes the difference in documentation could be driven by an incentive to document in a certain way, whether that's billing requirements, or other requirements that helped to drive a specific type of documentation workflow. Overall I think the more we understand how clinicians document, the more that it enables us when we're organizing the data to be able to really flesh out a comprehensive picture of the underlying prevalence of geographic atrophy. If there is no difference in documentation, maybe it's been undercounted for a period of time using some of the more traditional data sources. At Verana, we've been able to extract the full picture from the EHR. Because we don't solely rely on structured data, we also pull from some of those clinical texts, which often has really meaningful clinical rich data and details within it. We've also been able to augment this and corroborate it with imaging data as well, really ensuring that there is alignment and corroboration across those different data sources and types, to be able to understand how many patients truly have this disease, because then that informs the broader impact that a newly approved drug can have.

SC: Is there anything else that you want to share about Verana’s work, geographic atrophy, or the data?

AT: Whenever there's a new therapy that comes to market, usually, there's going to be a bit of a period of time before there is sort of a unique code that's assigned to that therapy. Oftentimes, in the initial months, or several months, there could be more of an unspecified drug code that's assigned to it. What that means is it can limit understanding to a level of granularity the types of patients that are receiving the drug. What is the phenotype of early adopters? Is there a particular phenotype of clinicians that are likely to use the drug in certain types of patients versus others? The value of Verana's platform is that we're able to extract from clinical notes and other sources of information. We're able to apply that specificity early on before the rest of the coding system picks up on the assignment of a formal code. When we think about these early approvals, and the early users of that, the more we can hone in on the types of patients sooner, rather than later, I think it just unlocks the conversation of real-time, real-world insights, because the longer you wait to understand what that patient population looks like, the more stale the data becomes and the less useful the insights become. We want to make sure that, as much as we can, we can put robust real-time insights at the fingertips of the clinicians.

Photo courtesy of Verana Health

Aracelis Torres, PhD, MPH
Photo courtesy of Verana Health

Aracelis Torres, PhD, MPH

Aracelis Torres, PhD, MPH, is Senior Vice President of Data & Science at Verana Health, where she oversees the Quantitative Sciences team working on rigorous methodology to generate sound scientific evidence from real-world data as well as the commercial services and operations team that manage client deliverables. Torres is an epidemiologist with more than 15 years of academic and industry experience. Prior to joining Verana Health, she was a Director of Quantitative Sciences at Flatiron Health, where her work focused on translation of real-world oncology data to generate evidence. While at Flatiron Health, she led efforts related to the development of real-world endpoints, novel study designs, and prospective evidence generation while also serving as the Quantitative Sciences lead for the organization’s broader research collaboration with the Food and Drug Administration. She is also currently an Adjunct Professor at Columbia University Graduate School of Arts and Sciences, where she teaches a course on large-scale data processing and analysis.

Torres received a PhD in Cancer Epidemiology from Johns Hopkins Bloomberg School of Public Health, an MPH in Chronic Disease Epidemiology from Yale University’s School of Public Health, and a BS in Molecular, Cellular, and Developmental Biology from Yale University.

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