Joan Miller | |
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Born | |
Alma mater | MIT (SB Biology) Harvard Medical School (MD) |
Known for | Development of Visudyne (verteporfin photodynamic therapy) Scientific basis of anti-VEGF therapy for eye disease |
Awards | Champalimaud Vision Award (2014) Mildred Weisenfeld Award (2015) |
Scientific career | |
Fields | Ophthalmology (vitreo-retinal surgery) Angiogenesis Neuroscience Genetics |
Institutions | Harvard Medical School Massachusetts Eye and Ear Massachusetts General Hospital |
Joan Whitten Miller is a Canadian-American ophthalmologist and scientist who has made notable contributions to the treatment and understanding of eye disorders (particularly diseases of the retina). She is credited for developing photodynamic therapy (PDT) with verteporfin (Visudyne), the first pharmacologic therapy for retinal disease. She also co-discovered the role of vascular endothelial growth factor (VEGF) in eye disease and demonstrated the therapeutic potential of VEGF inhibitors, forming the scientific basis of anti-VEGF therapy for age-related macular degeneration (AMD), diabetic retinopathy, and related conditions.
Joan Miller (née Whitten) was born in Toronto, Canada, and attended Bishop Strachan School. [1] She received her SB in biology from Massachusetts Institute of Technology, where she also rowed crew for four years, taking 2nd place in the Head of the Charles Regatta in 1978 and 3rd nationally in 1980. [2] She received her MD at Harvard Medical School in 1985 [3] and interned at Newton-Wellesley Hospital; she then completed residency training in ophthalmology in the Harvard Medical School Department of Ophthalmology in 1989, and a research and clinical fellowship in vitreoretinal surgery at Massachusetts Eye and Ear (the primary affiliate hospital of the Harvard Medical School Department of Ophthalmology) in 1991. [4]
In 1991, Miller joined Mass. Eye and Ear as an assistant in ophthalmology. She became an assistant surgeon in 1992, an associate surgeon in 1996, and a surgeon in 2002. Miller became chief of ophthalmology at Mass. Eye and Ear in 2003, and in 2009 she also became chief of ophthalmology at Massachusetts General Hospital. [5] Miller is the first woman to serve as chief of either department.
Miller is a faculty member of Harvard Medical School (HMS) in the Department of Ophthalmology, beginning with her 1991 appointment as an instructor in ophthalmology. She was promoted to assistant professor of ophthalmology in 1994, associate professor of ophthalmology in 1998, and professor of ophthalmology in 2002. In 2003, Miller became chair of the HMS Department of Ophthalmology and Henry Willard Williams Professor of Ophthalmology. In 2017, she was promoted to David Glendenning Cogan Professor of Ophthalmology. Miller is the first female ophthalmologist to achieve the rank of Professor at HMS and the first woman to chair the Department of Ophthalmology. [6]
In the 1990s, through a series of preclinical [7] [8] [9] [10] [11] [12] and clinical studies, [13] [14] [15] [16] Miller, Evangelos Gragoudas, and colleagues at Mass. Eye and Ear and Mass General Hospital (in collaboration with QLT PhotoTherapeutics Inc. and Novartis) developed photodynamic therapy (PDT) with verteporfin (Visudyne). Verteporfin, a light-sensitive dye, is injected systemically, and a laser specifically activates the drug in the choroidal vessels, blocking vessel leakage and preventing further vessel growth. [17] On April 12, 2000, verteporfin became the first drug approved by the Food and Drug Administration (FDA) for treating AMD. [18] [19]
In 2000, Visudyne was selected by Popular Science magazine for the "Best of What's New" Award, [20] and by Business Week as one of the "Best Products of 2000." [21] For her role in pioneering the pharmacologic treatment of retinal disease, Miller delivered the 2002 Jules Gonin Lecture, [22] an award that recognizes individuals "for making a significant contribution to the understanding and treatment of eye diseases." [23]
During the development of Visudyne, Miller and colleagues also examined the molecular mechanisms of ocular neovascularization. In 1994, using a primate model, Miller (along with Anthony Adamis, Patricia D'Amore, and others) were the first to correlate VEGF with ocular neovascularization in vivo. [24] That same year, Miller and colleagues (including Adamis and Judah Folkman) were the first to report increased levels of VEGF in the eyes of patients with vascular eye disease (diabetic retinopathy). [25] These findings were replicated in a larger study by Lloyd Paul Aiello and George King of Joslin Diabetes Center and Napoleone Ferrara of Genentech. [26] Drs. Miller, Gragoudas, Ferrara, and Adamis also demonstrated that introducing VEGF into normal primate eyes could cause several intraocular vascular disorders, such as retinal ischemia [27] and neovascular glaucoma. [28] These studies strongly correlated VEGF protein with pathological ocular neovascularization both in patients and in experimental models.
In a series of parallel and collaborative preclinical studies, Miller and colleagues effectively blocked ocular neovascularization with a VEGF-neutralizing antibody (bevacizumab), [29] a VEGF-neutralizing antibody fragment (ranibizumab), [30] [31] and a VEGF-neutralizing aptamer EYE001 (later known as pegaptanib). [32] These studies not only reinforced VEGF's key role in ocular pathology, but also provided the scientific foundation for clinical trials of multiple anti-VEGF therapies. In July 2005, Miller presented data from the Phase III MARINA trial of ranibizumab (Lucentis) at the 23rd Annual Meeting of the American Society of Retina Specialists (ASRS) in Montreal, Canada. [33]
In the annual Breakthrough of the Year awards by the journal Science , anti-VEGF therapy for AMD was recognized as one of the top ten scientific distinctions of the year 2006. [34] In 2014, the Champalimaud Foundation awarded the António Champalimaud Vision Award to Napoleone Ferrara, Joan Miller, Evangelos Gragoudas, Patricia D'Amore, Anthony Adamis, George L. King, and Lloyd Paul Aiello "for the development of anti-angiogenic therapy for retinal disease." [35] [36] Considered the highest distinction in ophthalmology and visual science, the €1 million Champalimaud Vision Award is among the world's largest scientific and humanitarian prizes and often referred to as the "Nobel Prize for Vision." [37] [38]
Miller's scholarly contributions include more than 150 original research articles, 20 clinical trial reports (as a member of the investigative team), 40 reviews, and 30 book chapters. [39] Miller is an editor of the journal Ophthalmology [40] and several textbooks, including Albert and Jakobiec's Principles and Practice of Ophthalmology (3rd ed), [41] Retinal Disorders: Genetic Approaches to Diagnosis and Treatment, [42] and Endophthalmitis. [43]
Miller is married to John B. Miller, a construction attorney and 2014 Republican candidate for Massachusetts Attorney General. [64]
Retinopathy is any damage to the retina of the eyes, which may cause vision impairment. Retinopathy often refers to retinal vascular disease, or damage to the retina caused by abnormal blood flow. Age-related macular degeneration is technically included under the umbrella term retinopathy but is often discussed as a separate entity. Retinopathy, or retinal vascular disease, can be broadly categorized into proliferative and non-proliferative types. Frequently, retinopathy is an ocular manifestation of systemic disease as seen in diabetes or hypertension. Diabetes is the most common cause of retinopathy in the U.S. as of 2008. Diabetic retinopathy is the leading cause of blindness in working-aged people. It accounts for about 5% of blindness worldwide and is designated a priority eye disease by the World Health Organization.
Macular degeneration, also known as age-related macular degeneration, is a medical condition which may result in blurred or no vision in the center of the visual field. Early on there are often no symptoms. Over time, however, some people experience a gradual worsening of vision that may affect one or both eyes. While it does not result in complete blindness, loss of central vision can make it hard to recognize faces, drive, read, or perform other activities of daily life. Visual hallucinations may also occur.
Central serous chorioretinopathy, also known as central serous retinopathy (CSR), is an eye disease that causes visual impairment, often temporary, usually in one eye. When the disorder is active it is characterized by leakage of fluid under the retina that has a propensity to accumulate under the central macula. This results in blurred or distorted vision (metamorphopsia). A blurred or gray spot in the central visual field is common when the retina is detached. Reduced visual acuity may persist after the fluid has disappeared.
Neovascularization is the natural formation of new blood vessels, usually in the form of functional microvascular networks, capable of perfusion by red blood cells, that form to serve as collateral circulation in response to local poor perfusion or ischemia.
Eales disease is a type of obliterative vasculopathy, also known as angiopathia retinae juvenilis, periphlebitis retinae or primary perivasculitis of the retina. It was first described by the British ophthalmologist Henry Eales (1852–1913) in 1880 and is a rare ocular disease characterized by inflammation and possible blockage of retinal blood vessels, abnormal growth of new blood vessels (neovascularization), and recurrent retinal and vitreal hemorrhages.
Rubeosis iridis is a medical condition of the iris of the eye in which new abnormal blood vessels are found on the surface of the iris.
Presumed ocular histoplasmosis syndrome (POHS) is a syndrome affecting the eye, which is characterized by peripheral atrophic chorioretinal scars, atrophy or scarring adjacent to the optic disc and maculopathy.
Optic disc drusen (ODD) are globules of mucoproteins and mucopolysaccharides that progressively calcify in the optic disc. They are thought to be the remnants of the axonal transport system of degenerated retinal ganglion cells. ODD have also been referred to as congenitally elevated or anomalous discs, pseudopapilledema, pseudoneuritis, buried disc drusen, and disc hyaline bodies.
Angioid streaks, also called Knapp streaks or Knapp striae, are small breaks in Bruch's membrane, an elastic tissue containing membrane of the retina that may become calcified and crack. Up to 50% of angioid streak cases are idiopathic. It may occur secondary to blunt trauma, or it may be associated with many systemic diseases. The condition is usually asymptomatic, but decrease in vision may occur due to choroidal neovascularization.
Choroidal neovascularization (CNV) is the creation of new blood vessels in the choroid layer of the eye. Choroidal neovascularization is a common cause of neovascular degenerative maculopathy commonly exacerbated by extreme myopia, malignant myopic degeneration, or age-related developments.
Jeffrey W. Berger was an American vitreoretinal surgeon and engineer.
The Fuchs spot is a degeneration of the macula in cases of high myopia. It is named after the two persons who first described it: Ernst Fuchs, who described a pigmented lesion in 1901, and Forster, who described subretinal neovascularization in 1862. It occurs due to proliferation of retinal pigment epithelium associated with choroidal hemorrhage. The size of the spots are proportionate to the severity of the pathological myopia.
Gholam A. Peyman is an Iranian American ophthalmologist, retina surgeon, and inventor. He is best known for his invention of LASIK eye surgery, a vision correction procedure designed to allow people to see clearly without glasses. He was awarded the first US patent for the procedure in 1989.
Branch retinal vein occlusion is a common retinal vascular disease of the elderly. It is caused by the occlusion of one of the branches of central retinal vein.
Radiation retinopathy is damage to retina due to exposure to ionizing radiation. Radiation retinopathy has a delayed onset, typically after months or years of radiation, and is slowly progressive. In general, radiation retinopathy is seen around 18 months after treatment with external-beam radiation and with brachytherapy. The time of onset of radiation retinopathy is between 6 months to 3 years.
Microperimetry, sometimes called fundus-controlled perimetry, is a type of visual field test which uses one of several technologies to create a "retinal sensitivity map" of the quantity of light perceived in specific parts of the retina in people who have lost the ability to fixate on an object or light source. The main difference with traditional perimetry instruments is that, microperimetry includes a system to image the retina and an eye tracker to compensate eye movements during visual field testing.
Pachychoroid disorders of the macula represent a group of diseases affecting the central part of the retina of the eye, the macula. Due to thickening and congestion of the highly vascularized layer underneath the macula, the choroid, damage to the retinal pigment epithelium and the retinal photoreceptor cells ensues. This leads to impaired vision. The best known representative of the pachychoroid disease spectrum, central serous chorioretinopathy, is the fourth most common cause of irreversible damage to the macula:.
Conbercept, sold under the commercial name Lumitin, is a novel vascular endothelial growth factor (VEGF) inhibitor used to treat neovascular age-related macular degeneration (AMD) and diabetic macular edema (DME). The anti-VEGF was approved for the treatment of neovascular AMD by the China State FDA (CFDA) in December 2013. As of December 2020, conbercept is undergoing phase III clinical trials through the U.S. Food and Drug Administration’s PANDA-1 and PANDA-2 development programs.
Polypoidal choroidal vasculopathy (PCV) is an eye disease primarily affecting the choroid. It may cause sudden blurring of vision or a scotoma in the central field of vision. Since Indocyanine green angiography gives better imaging of choroidal structures, it is more preferred in diagnosing PCV. Treatment options of PCV include careful observation, photodynamic therapy, thermal laser, intravitreal injection of anti-VEGF therapy, or combination therapy.
Justine R. Smith AM is an Australian ophthalmic surgeon and vision researcher. Today she is based at Flinders University and Flinders Medical Centre in Adelaide, Australia. Smith was awarded Member of the Order of Australia "for significant service to ophthalmology, particularly research and education" in the 2023 King's Birthday Honours. She received the Flinders University Alumni Convocation Medal in 2022, the Gold Medal of the International Ocular Inflammation Society in 2023, and the Joanne Angle Service Award from the Association for Research in Vision and Ophthalmology in 2024.
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