Biomarker Enabled Specific Targeted Therapy In Ocular Surface Disease

To identify and treat specific biomarkers implicated in ocular surface disease (OSD) by employing a clinic-deployable, customized biomarker kit, and to evaluate clinical and molecular outcomes of targeted biomarker-based therapy against these.

Narayana Nethralaya Super-Speciality Eye Hospital, Bangalore, India

3,500 OSD eyes  and 7,500 control eyes were recruited for the study. Tear samples were collected using Schirmer’s strip.  Selected biomarkers (MMP-9, IL-6, IL-1b, I-CAM-1, IL-10, IL-17a, TNF-α, VEGF-A) were analyzed from tear samples using a customized ELISA based biomarker kit in clinics. Based on normative database generated, elevated levels of target biomarkers were identified, and specific targeted therapy against these biomarkers based on their severity was instituted. Reassessment of the clinical findings, patient satisfaction, quality of life and biomarker levels was performed 6 months after commencement of therapy.

60% of the OSD eyes demonstrated high levels of MMP-9. Of these, Of these 12% had 1 fold rise, 18 % had 2 fold rise and 30% had 3-fold rise in MMP-9 compared to normal. Eyes with 1-fold rise received immunomodulator therapy. Those with 2-fold rise or higher, received combined vector pulsation/intense pulsed light therapy along with immunomodulators. 10% of eyes showed high levels of ICAM-1, and were treated with lifitegrast. 20% of eyes had high TNF-α and IL-17a, and were treated with steroids and lubricants. Post-treatment eyes had significant reduced symptoms and signs, decreased levels of targeted biomarkers, shorter drug response time and lower treatment failure rate.

Conventional therapy of OSD, involves prescription of non-specific medication. A more streamlined approach is facilitated by customizing the treatment molecule to the aberrant biomarker. This would not only permit more economical management by avoidance of multidrug therapy, but also enable monitoring drug response and quantifying results.