term evidence based medicine (EBM) was first published in 1992, with the term defined in 1996 using a definition that is still widely used today: The conscientious, explicit and judicious use of current best evidence about individual patient care. practice of EBM allows the integration of available evidence from systematic research, specifically clinical research, and the best clinical judgment of the clinician(1,2). EBM is defined as the link between scientific research and good clinical practice(3,4). In other words, EBM trials use existing scientific data with good internal and external validity, to enforce the results in clinical practice. Evidence in this context is related to the effectiveness, efficiency, efficacy and safety of treatment. Effectiveness refers to how treatment functions in real-world conditions, efficiency to cheap and affordable treatment for patients, efficacy is how the treatment works in conditions of the ideal world, and safety means that an intervention is consistent and unlikely to cause any adverse effects(5). A study with high internal validity must comply with these characteristics(6). The concept of stem cell therapy has been advocated for more than 10 years and there has been a growing number of clinical reports documenting the use of stem cell therapies in humans in particular in respect to myocardial infarction(7-9). In respect to ophthalmology, several important cell types in the eye have little, if any, capacity for endogenous regeneration. As a result the only viable treatment option for patients with hereditary disorders that involve the loss of such cells is some type of cell replacement therapy. Although the replacement of highly differentiated cells, such as photoreceptors, poses challenges, a number of recent experiments suggest that the use of stem cells to achieve this goal is now feasible(10). Distinct stem cell types have been established from embryos and identified in fetal tissues and umbilical cord blood as well as in specific niches in many adult mammalian tissues and organs such as in the bone marrow, brain, skin, eyes, heart, kidneys, lungs, gastrointestinal tract, pancreas, liver, breast, ovaries, and prostate gland(11). Stem cell-based therapy has been tested in animal models for several diseases including neurodegenerative disorders, such as Parkinson disease, spinal cord injury, and multiple sclerosis. Replacing lost neurons which have not been physiologically replaced is pivotal to therapeutic success. Stem-cell therapy has the potential to treat a wide range of retinal diseases. neuroretina is a complex structure whose health depends on blood vessels and retinal pigment epithelium (RPE), each of which is affected differently in the spectrum of retinal disease. Therefore, three distinct cell types are conceivable targets for future cell therapy in the retina: the neuroretina (photoreceptors, bipolar cells, ganglion cells and glial cells), RPE and vascular endothelial cells. Depending on the type of retina disease, different cell replacement strategies will need to be developed(12). Degeneration of neural cells in the retina is a hallmark of such widespread ocular diseases as age-related macular degeneration (AMD) and retinitis pigmentosa (RP). In these cases the loss of photoreceptors that occurs as a primary event (as in RP) or secondary to loss of retinalpigment epithelium (in AMD) leads to blindness(11,13,14).
Read full abstract