Wet macular degeneration, blood clots and diabetes are widely differing diseases, but they all have one thing in common: pathological blood vessel growth in the retina that causes haemorrhaging. But where do the vessels come from, how are they formed and why?
"These were the questions that we wrestled with during our basic research and clinical studies back in the 1990s," says Anders Kvanta, a professor at Karolinska Institutet and a senior consultant at St. Erik Eye Hospital.
He learned from oncology researchers that the roles played by different molecules in the formation of new blood vessels appeared to vary in terms of importance.
"There are countless possibilities when you study different molecules and proteins. It is almost always more complicated than you had hoped, and frequently it leads to more questions than answers."
However, in 1996 Anders Kvanta's research group was rewarded for its persistence with the publication of an article in the respected journal Investigative Ophthalmology and Visual Science. The article has since been cited more than 500 times, which is exceptional in the scientific community.
The article stated that a certain protein was present in very high levels in patients with wet macular degeneration. Could this be a good target protein for a new drug? The answer was yes, and pharmaceutical companies were able to begin manufacturing antibodies to the pathological protein.
"At St. Erik Eye Hospital alone we carry out more than 14,000 treatments a year. Obviously, it’s great to have been so involved in the basic research," says Anders Kvanta.
The current treatment can, however, only slow down the disease, not prevent it. It also requires regular intraocular injections.
"That’s clearly something we want to change in the long term. Which is why we have devoted a great deal of energy in recent years to refining and improving the treatment."
"The most beautiful eye surgery"
The majority of Anders Kvanta's time, around 80 per cent, is spent on meeting and treating patients. When he performs surgery, the operating theatre has to be dark, with a solitary ceiling light producing a weak red glow.
"The retina is located at the very back of the eye and must be illuminated from within to be visible. That is why we limit light levels. With the right equipment, what is normally invisible becomes visible. It all gets a little bit science-fictiony," says Anders, adding:
"The most beautiful eye surgery of all is performed on the retina. Our delicate optical systems provide fantastic possibilities. Of course, it depends on who you ask. Others prefer the cornea or cataract surgery."
The greatest reward
Biology and basic research have always appealed to Anders Kvanta.
"What drives me is biological inquisitiveness about our patients and what types of molecules make this patient in particular develop this type of disease. What are the genes controlling this?"
As for so many others, the competitive element of research is also important to Anders Kvanta – the kick from getting there first. And the fact that your work is appreciated within the scientific community.
"It tends to be said that the greatest reward for a researcher, unlike sports stars or pop stars perhaps, is to be recognised by other researchers, meaning those who can truly judge your work."
Stem cells could provide a new breakthrough
There is also a dry form of macular degeneration, which is unfortunately more common than the wet form and currently incurable. Here the problem arises not from haemorrhaging and swelling, but cell death which stops the retina from working. Hopes are now being pinned on the transplantation of new retinal cells engineered from stem cells, which are cells that can be turned into other types of cells.
"We are working on a project with the stem cell unit in Karolinska Institutet Huddinge, which is a global leader in embryonic stem cell research. The treatment we’re developing could be tested on patients within a few years."
The stem cell project has given Anders a mental boost at work.
"It may take five to ten years, but my gut feeling is that we will get there."
Text: Henrik Möller