French doctor brings breakthrough vision treatments to Pitt
The University of Pittsburgh is rebuilding its vision programs around a top doctor from France as recent discoveries fuel hopes that new treatments could restore sight to many people who are blind.
Dr. José-Alain Sahel, 61, became chairman in June of Pitt's Department of Ophthalmology and director of UPMC Eye Center. Sahel plans to try to restore sight using several breakthrough treatments he helped pioneer at the Vision Institute, a research center he founded in Paris.
His work focuses on the retina and its photoreceptor cells, which in healthy eyes sense light and convert it to neurochemical signals the brain interprets as sight. The failure of that process is one way people go blind.
Sahel aims to treat rare genetic disorders and common causes of blindness such as glaucoma and age-related macular degeneration. The most promising treatments revolve around three strategies: cameras and processors that gather and translate light for the brain, genetic therapies that aim to improve some cells' ability to sense and process light, and stem-cell treatments to grow new photoreceptor cells.
The Food and Drug Administration already has granted limited approval for one of the camera devices, known as artificial retinas, to treat visual impairment caused by the rare genetic condition retinitis pigmentosa. The agency in 2013 approved the Argus II Retinal Prosthesis System under a humanitarian designation for people with rare diseases or conditions.
The device uses a camera to gather light, and a video processing unit converts the light into electronic data that is transmitted wirelessly to an artificial retina implanted at the back of the eye, which interprets it for the brain, according to an FDA news release.
The device can help perceive images and movement, the release states.
Sahel hopes to begin clinical trials within a year for a more advanced system, known as the IRIS II, that he developed at the Vision Institute. The IRIS II implant has more electrodes to create a clearer picture, uses a solar panel to power itself and relies on a safer surgery to implant, he said. It was designed with diamond, titanium and a new, ultra-light and strong material called graphene to better interface with neural tissue in the retina, he said.
He expects to use the device on people with retinitis pigmentosa and with age-related macular degeneration. Based on animal studies, he expects the IRIS II to improve vision above the World Health Organization threshold for blindness.
Sahel also plans in the next year to launch a trial testing a technique he said he has been working on for about 10 years. The technique, in a developing field called optogenetics, involves taking light-detecting proteins known as opsins from algae and bacteria, adapting them and injecting them into cells that are connected to optic nerves.
The vision produced by the process creates something like sight, but people need to undergo new training over two to three months to recognize what they are seeing, he said. Patients first see something like a starry sky, then recognize shapes, then learn to correlate those shapes with objects, he said — a door, for example, or a banana or an apple.
“The real organ for vision is the brain,” he said.
Stem cell therapy trials will take longer to launch, he said. In that approach, doctors take patients' skin cells and use them to grow retinal cells, then replace patients' damaged cells with the new ones. It is difficult to do safely — one risk is tumor growth — and so it will take more time to get off the ground, he said.
Researchers don't know which of the three approaches will be most effective, but several said in interviews that all are promising.
“It's a wonderful era for science and patients,” said Sahel, who said he initially wanted to be a pediatric oncologist but became intrigued with ophthalmology during rotations as a medical student.
In the decades since, he has distinguished himself among the world's vision researchers, said Dr. Donald Zack, the Guerrieri professor of ophthalmology at Johns Hopkins Wilmer Eye Institute.
Zack hesitated to talk about when blindness might be fully cured. But, he said, “It's fair to say that the (vision) community at large and Jose (Sahel) in particular have made major advances. ... It's suggestive that this could be translated to treatments that could dramatically help patients in the next 10 to 20 years, hopefully less.”
Sahel said he doesn't believe there will be an end to the quest to finally cure blindness.
In conjunction with the research, Sahel plans to streamline, improve and expand care for vision impairment across UPMC's network in Western Pennsylvania, in part through the Eye and Ear Foundation, a nonprofit that supports Pitt research. Early interventions and proper care are the best treatments for the visual deterioration from diabetes and glaucoma, he said.
He said he is working on access to care and ways to monitor changes in patients' conditions at home and ensure they get to the physician more quickly when appropriate.
“My focus is patients,” he said. “All the research I do is for patients. There is no discontinuity. There is absolutely no gap between the research and the patient activity.”
To develop his research and apply it to patient care, he has worked with private companies, founding several. He plans to work with UPMC Enterprises, the nonprofit hospital system's for-profit business development branch, to continue those approaches in Pittsburgh.
Stephen Rose, chief research officer for the Maryland-based Foundation Fighting Blindness, said Sahel has proven himself capable of the kind of collaboration and leadership that will be required to accomplish his goals.
Rose said he has known Sahel for 12 years. The foundation has funded Sahel's research, he said.
“He's looking at (treating blindness) from many different angles,” Rose said. “He's a strategic thinker and then implements the tactics to get to the end but is not totally focused on just the one path to get there.”
Venteicher is a Tribune-Review staff writer. Reach him at 412-380-5676 or firstname.lastname@example.org.