On this episode of Retina Mentor Moments, John W. Kitchens, MD is joined by David Chin Yee, MD, to discuss his journey into retina research.
Dr. Chin Yee is a vitreoretinal surgeon and physician partner at Georgia Retina, where he also serves as the Director of Clinical Trials.
Building a career in retina
Dr. Chin Yee explained how he grew up in a tight-knit community in Jamaica that was an ideal environment for him to experiment and find his passion. Having volunteered at a home for the blind from the age of 13, he developed an early understanding of the obstacles that visually impaired individuals face.
This left a lasting mark on his research in considering how to provide help to people before they get to the point where they are significantly dependent on others. As a result, at the age of 16, he moved to Miami alone to finish high school, which afforded him opportunities for scholarships and pathways to medical programs in the United States to fulfill his dream of being an ophthalmologist.
While attending the University of Miami for undergraduate studies in engineering, Dr. Chin Yee worked at Bascom Palmer in an ophthalmic biophysics lab with Jean-Marie Parel, IngETS-G, PhD, one of the co-inventors of the VISC.1 He was amazed by the medical devices they were working on in the lab, and appreciated Dr. Parel’s skill for big picture thinking and natural leadership skills.
After medical school, Dr. Chin Yee sought to pursue an ophthalmology residency, and in a twist of fate, Dr. Paul Edwards, who was the chairman of the ophthalmology department at Henry Ford Hospital, had gone to school with his mom in Jamaica. So, his mother looked Dr. Edwards up in Yellow Pages, called him asking for an opportunity, and Dr. Chin Yee was offered a 2-week externship in Detroit to get a feel for the program.
He ultimately completed his ophthalmology residency there, and noted that working with Dr. Paul Edwards inspired him to switch his focus to retina because it would enable him to treat as many patients as possible and hopefully prevent visual impairment at earlier stages of disease progression.
Subsequently, he completed a fellowship at Barnes-Jewish Hospital with Dr. Rajendra Apte, as a mentor, where he received a significant amount of hands-on experience at the VA in the fellows clinic. Dr. Apte instilled in him the importance of always trying different surgical techniques (even older ones), to give himself as many options as possible in his toolbox to use in the real world.
Tips for managing clinical trials in a busy practice
As the Director of Clinical Trials, Dr. Chin Yee emphasized the importance of sponsors providing free transportation for patients enrolled in clinical trials. At Georgia Retina, one of his responsibilities is to update partners weekly on which clinical trials are recruiting and the ideal candidates for each with a cheat sheet.
The doctors then talk to patients and give them an overview of what treatments are available, and if they are interested in a clinical trial, there is a robust shuttle system in place to get them to the clinical trial site.
“We tell patients that our study team is dedicated to their care and we treat them like the superstars and VIPs that they are," Dr. Chin Yee explained. "Any patient that has decided to jump into a clinical trial is making a huge difference not only for themselves, but for the future of other patients and our practice in general, so we want to make them feel appreciated and loved.”
Uptake of GA therapies in retina physicians
Dr. Kitchens highlighted a statistic that around half of retina specialists who treat neovascular age-related macular degeneration (nAMD) manage GA with complement inhibitors.2 Dr. Chin Yee noted that there is now almost 3.5 years worth of data that demonstrates a clear additive benefit to initiating treatment with complement inhibitors early in GA patients.3,4
Additionally, multiple studies have outlined the natural history of geographic atrophy,5 enabling providers to understand and compare the rate of GA progression between those who do and do not receive complement inhibitor injections.
He remarked that discussing the risks and benefits of GA treatment with patients can be difficult, especially because there typically is not a clear indication for the patients that the intervention is working. However, reviewing past and present imaging with patients can help provide a visual of the slowed progression of the disease.
Treat-and-extend regimens with second-generation VEGF agents
Dr. Kitchens mentioned a study published in the British Journal of Ophthalmology by Drs. Chin Yee and Apte in 2015 that was one of the sentinel articles on treat-and-extend regimens with anti-VEGF drugs.6
“The 2015 study demonstrated that first-generation anti-VEGF agents couldn’t get patients past 6- to 8-week treatment intervals, but I’ve found that second-generation anti-VEGF agents regularly extend patients to 12- to 16-week intervals, if not longer, in addition to the ability to provide these patients with faster symptom resolution,” explained Dr. Chin Yee.
Moreover, he noted that patients who respond fast sooner are also more likely to be extended, gaining durability, and decreased treatment burden for these individuals.7-10
Conclusion
In this time of exciting innovation in retina care, Dr. Chin Yee noted that he is interested in seeing the efficacy of tyrosine kinase inhibitors (TKIs) in the treatment of diabetic macular edema and more data on the durability of gene therapies for retinal diseases.
Hopefully in the future, these therapies will provide a safety net for retina specialists so they don’t have to administer injections as often. Additionally, he is interested in candidates in the FDA pipeline targeting GA, as he is still waiting for a therapy that demonstrates halted or reversed disease progression.
