Joan Miller (ophthalmologist)

Last updated
Joan Miller
Born
Toronto, Ontario, Canada
Alma mater MIT (SB Biology)
Harvard Medical School (MD)
Known forDevelopment 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.

Contents

Early life and education

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]

Medical and academic career

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]

Research and clinical innovations

Verteporfin Photodynamic Therapy (Visudyne)

Verteporfin Verteporfin.svg
Verteporfin

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]

Anti-VEGF therapy for ocular disease

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]

Publications

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]

Selected awards and honors

Joan W. Miller speaking at the 2014 Antonio Champalimaud Vision Award ceremony in Lisbon, Portugal, 10 September 2014. Joan W. Miller, MD, at the 2014 Champalimaud Vision Award ceremony.jpg
Joan W. Miller speaking at the 2014 António Champalimaud Vision Award ceremony in Lisbon, Portugal, 10 September 2014.

Personal life

Miller is married to John B. Miller, a construction attorney and 2014 Republican candidate for Massachusetts Attorney General. [64]

Related Research Articles

<span class="mw-page-title-main">Retinopathy</span> Damage to the retina of the eyes

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.

<span class="mw-page-title-main">Macular degeneration</span> Vision loss due to damage to the macula of the eye

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.

<span class="mw-page-title-main">Central serous chorioretinopathy</span> Eye disease characterized by leakage of fluid under the retina

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.

<span class="mw-page-title-main">Presumed ocular histoplasmosis syndrome</span> Medical condition

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<span class="mw-page-title-main">Optic disc drusen</span> Medical condition

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.

<span class="mw-page-title-main">Angioid streaks</span> Fissures in Bruchs membrane within the eyes retina

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<span class="mw-page-title-main">Choroidal neovascularization</span> Creation of new blood vessels in the choroid layer of the eye

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.

<span class="mw-page-title-main">Fuchs spot</span> Degeneration of the macula

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.

<span class="mw-page-title-main">Gholam A. Peyman</span> Iranian-American ophthalmologist and retina surgeon known for inventing LASIK eye surgery

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<span class="mw-page-title-main">Branch retinal vein occlusion</span> Medical condition

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.

<span class="mw-page-title-main">Radiation retinopathy</span> Medical condition

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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.

<span class="mw-page-title-main">Pachychoroid disorders of the macula</span>

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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.

References

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  2. Maxwell, Jill Hecht. "Joan Whitten Miller '80: Retina specialist advances her field—and the women in it". MIT Technology Review. Retrieved 3 June 2016.
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  7. Miller, JW; Walsh, AW; Kramer, M; Hasan, T; Michaud, N; Flotte, TJ; Haimovici, R; Gragoudas, ES (June 1995). "Photodynamic therapy of experimental choroidal neovascularization using lipoprotein-delivered benzoporphyrin". Arch Ophthalmol. 113 (6): 810–818. doi:10.1001/archopht.1995.01100060136048. PMID   7540388.
  8. Kramer, M; Miller, JW; Michaud, N; Moulton, RS; Hasan, T; Flotte, TJ; Gragoudas, ES (1996). "Liposomal benzoporphyrin derivative verteporfin photodynamic therapy. Selective treatment of choroidal neovascularization in monkeys". Ophthalmology. 103 (3): 427–438. doi:10.1016/s0161-6420(96)30675-1. PMID   8600419.
  9. Husain, D; Miller, JW; Michaud, N; Connolly, E; Flotte, TJ; Gragoudas, ES (1996). "Intravenous infusion of liposomal benzoporphyrin derivative for photodynamic therapy of experimental choroidal neovascularization". Arch Ophthalmol. 114 (8): 978–985. doi:10.1001/archopht.1996.01100140186012. PMID   8694734.
  10. Haimovici, R; Kramer, M; Miller, JW; Hasan, T; Flotte, TJ; Schomacker, KT; Gragoudas, ES (1997). "Localization of lipoprotein-delivered benzoporphyrin derivative in the rabbit eye". Current Eye Research. 16 (2): 83–90. doi:10.1076/ceyr.16.2.83.5088. PMID   9068937.
  11. Reinke, MH; Canakis, C; Husain, D; Michaud, N; Flotte, TJ; Gragoudas, ES; Miller, JW (1999). "Verteporfin photodynamic therapy retreatment of normal retina and choroid in the cynomolgus monkey". Ophthalmology. 106 (10): 1915–1923. doi:10.1016/s0161-6420(99)90401-3. PMID   10519585.
  12. Husain, D; Kramer, M; Kenny, AG; Michaud, N; Flotte, TJ; Gragoudas, ES; Miller, JW (1999). "Effects of photodynamic therapy using verteporfin on experimental choroidal neovascularization and normal retina and choroid up to 7 weeks after treatment". Invest Ophthalmol Vis Sci. 40 (10): 2322–2331. PMID   10476799.
  13. Schmidt-Erfurth, U; Miller, J; Sickenberg, M; et al. (1998). "Photodynamic therapy of subfoveal choroidal neovascularization: clinical and angiographic examples". Graefes Arch Clin Exp Ophthalmol. 236 (5): 365–374. doi:10.1007/s004170050092. PMID   9602321. S2CID   32104788.
  14. Miller, JW; Schmidt-Erfurth, U; SIckenberg, M; et al. (1999). "Photodynamic therapy with verteporfin for choroidal neovascularization caused by age-related macular degeneration: results of a single treatment in a phase 1 and 2 study". Arch Ophthalmol. 117 (9): 1161–1173. doi: 10.1001/archopht.117.9.1161 . PMID   10496388.
  15. Schmidt-Erfurth, U; Miller, JW; Sickenberg, M; et al. (1999). "Photodynamic therapy with verteporfin for choroidal neovascularization caused by age-related macular degeneration: results of retreatments in a phase 1 and 2 study". Arch Ophthalmol. 117 (9): 1177–1187. doi: 10.1001/archopht.117.9.1177 . PMID   10496389.
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  23. "Jules Gonin Lecturer of the Retina Research Foundation". Retina Research Foundation. Retrieved 22 June 2016.
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  27. Tolentino, MJ; Miller, JW; Gragoudas, ES; Jakobiec, FA; Flynn, E; Chatzistefanou, K; Ferrara, N; Adamis, AP (1996). "Intravitreous injections of vascular endothelial growth factor produce retinal ischemia and microangiopathy in an adult primate". Ophthalmology. 103 (11): 1820–1828. doi:10.1016/s0161-6420(96)30420-x. PMID   8942877.
  28. Tolentino, MJ; Miller, JW; Gragoudas, ES; Chatzistefanou, K; Ferrara, N; Adamis, AP (1996). "Vascular endothelial growth factor is sufficient to produce iris neovascularization and neovascular glaucoma in a nonhuman primate". Arch. Ophthalmol. 114 (8): 964–970. doi:10.1001/archopht.1996.01100140172010. PMID   8694732.
  29. Adamis, AP; Shima, DT; Tolentino, MJ; Gragoudas, ES; Ferrara, N; Folkman, J; D'Amore, PA; Miller, JW (1996). "Inhibition of vascular endothelial growth factor prevents retinal ischemia-associated iris neovascularization in a nonhuman primate". Archives of Ophthalmology. 114 (1): 66–71. doi:10.1001/archopht.1996.01100130062010. PMID   8540853.
  30. Krzystolik, MG; Afshari, MA; Adamis, AP; Gaudreault, J; Gragoudas, ES; Michaud, N; Li, W; Connolly, E; O'Neill, CA; Miller, JW (2002). "Prevention of experimental choroidal neovascularization with intravitreal anti-vascular endothelial growth factor antibody fragment". Archives of Ophthalmology. 120 (3): 338–346. doi: 10.1001/archopht.120.3.338 . PMID   11879138.
  31. Husain D; Kim I; Gauthier D; Lane AM; Tsilimbaris MK; Ezra E; Connolly EJ; Michaud N; Gragoudas ES; O'Neill CA; Beyer JC; Miller, JW (2005). "Safety and efficacy of intravitreal injection of ranibizumab in combination with verteporfin PDT on experimental choroidal neovascularization in the monkey". Archives of Ophthalmology. 123 (4): 509–516. doi: 10.1001/archopht.123.4.509 . PMID   15824225.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  32. Carrasquillo, KG; Ricker, JA; Rigas, IK; Miller, JW; Gragoudas, ES; Adamis, AP (2003). "Controlled delivery of the anti-VEGF aptamer EYE001 with poly(lactic-co-glycolic)acid microspheres". Invest Ophthalmol Vis Sci. 44 (1): 290–9. doi: 10.1167/iovs.01-1156 . PMID   12506087.
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  41. Albert, Daniel M.; Miller, Joan W.; Azar, Dimitri T.; Blodi, Barbara A. (2008). Albert & Jakobiec's Principles & Practice of Ophthalmology (3 ed.). Philadelphia: Saunders/Elsevier. ISBN   978-1416000167.
  42. Pierce, Eric A.; Masland, Richard H.; Miller, Joan W. (2014). Retinal Disorders: Genetic Approaches to Diagnosis and Treatment (1 ed.). Cold Spring Harbor, New York: Cold Spring Harbor Laboratory Press. ISBN   978-1621820178.
  43. Durand, Marlene L.; Miller, Joan W.; Young, Lucy H. (2016). Endophthalmitis. Switzerland: Springer. ISBN   978-3319292298.
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  45. "Jules Gonin Lecturer of the Retina Research Foundation". Retina Research Foundation. Retrieved 22 June 2016.
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  55. Reidy, Chris (December 14, 2011). "Pinnacle Awards honor local women leaders". The Boston Globe. Retrieved 23 June 2016.
  56. Miller, J.W. (2013). "Age-related macular degeneration revisited--piecing the puzzle: the LXIX Edward Jackson memorial lecture". American Journal of Ophthalmology. 155 (1): 1–35. doi: 10.1016/j.ajo.2012.10.018 . PMID   23245386.
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