Jay Duker
Chief Operating Officer
So I think you need to think about it in a couple of ways. There's really three kind of views of this and the first view is what does the FDA think because ultimately we need to get the product FDA approved. So the FDA -- if the FDA says that -- and again, this is I pick a number it doesn't matter 2,3,4,7,10 letters is an approvable endpoint even for a loss, and then the FDA has spoken. The second thing is what do the retina specialist feel, what is an acceptable safety profile and efficacy profile to use the product. Now remember, we report data across a large population or certainly the Phase 1, I wouldn't call it a large population, it's an equal 17. It's a small population. But that doesn't mean that you can't pick out even if in a large population, the efficacy doesn't look strong but in individual subgroups it does and you can identify those subgroups, then you can have a very successful product by choosing the patients you use it on well. And that's no different than any other drug product. What's different in this area is we didn't have an option before, it was an injectable anti-VEGF, LUCENTIS, EYLEA, Avastin and if you inject the monthly, they all work about the same, and they're all about the same safety. So this is a paradigm shift now, because what we hope to accomplish is true sustained release for many months, and not just a month or two. And it doesn't need to work perfectly at every patient as long as it's safe and one can identify the groups of patients that it does work well in. And so the last group that needs to be satisfied, of course, is the patients. They need to see the value in having a visit perhaps every four or five or six months, instead of every one or two months. I think that would be obvious. But if there's a change in their vision, plus or minus, it really needs to be something that they can live with. So back to the question specifically about visual acuity, if you follow this space, you know that for newly diagnosed wet AMD, all the visual acuity is made in the first three months. And if you look at the curves after that, they're basically flat wet AMD and in fact in the real world they go down. And a couple of real world studies show that after three months in the real world, where on average patients get six injections a year, by the first year out as a group, they've given back all the visual acuity gains. So that if you had a control group, which we do not in the Phase 1 that was standard of care, you would expect that there might be over six months some loss of wetters. How much is significant, again, you have to go back to those three groups. What's significant for the FDA, what's significant for the retina specialist to use, and what's significant for the patients yet to be seen. OCT is the same and in fact, OCT gains are almost always in the first month or two. So if you've got a group of patients who have been diagnosed for three or four months, they're stable, presumably, they may or may not have fluid, they've got another visual, and so that a successful product should be able to keep that group relatively stable. So that was a long winded answer but I hope I answered your question.