Out of the eyes of babes

A new keratoconus eye drop allows the cornea to return to an embryonic state and regenerate

19 May 2016 by Olivia Wannan, Laurence Derbyshire

The fountain of youth has been discovered – for the keratoconic cornea.

A University of Auckland, New Zealand, team is now testing an eye drop that “turns back the clock” of keratoconic patients’ corneas for its safety and efficacy, medical researcher, Dr Trevor Sherwin, told OT.

He explained: “What these eye drops do is they act on the cells and they convince the cells that they are back at a much early stage of development, when you’re in the embryo … The cells [then] express a collagen type which is found in the developing cornea but is replaced after birth by a different collagen.

“This allows us to target keratoconic corneas and thicken them with the developmental collagen type and effectively regenerate the cornea,” he explained.

Five years ago, Dr Sherwin and his team found they had the ability to reprogramme corneal cells to make them think they were nerve cells. From there, getting the cells to make this developmental collagen was a goal – as was myopia control.

The eye drop – with very low levels of a steroid and a growth factor – is the outcome of that work. The therapy has worked on human corneal tissue in the lab, and is currently being tested in sheep, he said.

The team’s next goal is human clinical trials on keratoconic patients who are approaching corneal transplant, Dr Sherwin revealed.

The team hopes that the first patients could receive the drops in a trial late next year “if all progresses well.”

“One of the biggest hurdles was to show that the treatment could be switched off, once we had shown that we could express the developmental collagen and restore corneal thickness … We have now shown that this treatment is controllable and can be switched off,” he emphasised.

From there, Dr Sherwin hoped to aim the research at a much larger eye health issue worldwide – myopia.

“Ultimately, we would aim to develop the therapeutic for treating children who are showing the first signs of developing myopia – treating them at such a young age that they never even develop short-sightedness.”

Moorfields consultant ophthalmic surgeon, Dr Vincenzo Maurino, told OT that he welcomes this exciting research news that, once tried and tested, would expand the options of keratoconus treatment.

However, the cornea and keratoconus specialist said that, like any research, the treatment must be shown to be effective, and only clinical trials can confirm that. “There are issues in being able to reprogramme cells in general – and corneal cells as well – and I believe we will have to wait a few years longer before we will know it really is possible and if it works.”

Today’s keratoconic patients have a variety of options to treat the condition as it progresses including contact lenses, which are the primary way of improving sight. Dr Maurino highlighted that patients had benefited greatly from the recently introduced technology of collagen corneal crosslinking, being the only known way to stop keratoconus progression and avoid corneal graft surgery.

A non-invasive intervention like an eye drop could, if successful, become the new go-to treatment, he said. “It sounds revolutionary, almost unbelievable … It sounds like the future. If you could just put a drop in the eye, it would be great for our patients. Let’s wait and see if the promise can be safely delivered for the benefit of our patients,” he concluded.

Watch Dr Trevor Sherwin speak to OT about their work below

This article was first published on 21 April, 2016. 

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