How FDA Alignment Is Shaping Opus Genetics' OPGx-LCA5 Development Strategy
A conversation between Opus Genetics CMO Sally Tucker, Ph.D., and Clinical Leader Executive Editor Abby Proch
Opus Genetics is advancing OPGx-LCA5, an investigational gene therapy for Leber congenital amaurosis type 5 (LCA5), an ultra-rare inherited retinal disease caused by mutations in the LCA5 gene. With the FDA agreeing on a streamlined registrational Phase 3 design, the study shows how sponsors can build rigorous, practical development plans for very small patient populations.
In this Q&A, Sally Tucker, Ph.D., chief medical officer at Opus Genetics, discusses what the company’s FDA interactions reveal about evidence generation in inherited retinal diseases, what must be in place operationally before regulatory alignment, and how Opus is approaching site readiness, specialized assessments, and patient identification for OPGx-LCA5.
Clinical Leader: What does the FDA's feedback on the LCA5 program tell you about its stance on evidence generation in inherited retinal diseases, especially when the patient population is so small?
Sally Tucker: Our recent interactions with the FDA were very encouraging and we agreed on a streamlined registrational Phase 3 study for OPGx-LCA5. What this reinforces is that there is recognition that ultra-rare inherited retinal diseases require development programs that are both scientifically rigorous and practical.
When you're working in a disease where only a small number of patients exist globally, the traditional randomized, controlled trial isn't always feasible. Instead, the emphasis shifts toward generating a comprehensive body of evidence that incorporates carefully selected endpoints, longitudinal assessments, and a study design that minimizes variability while still providing confidence in the treatment effect.
For LCA5, that led to a registrational study where each participant serves as their own control during a six-month run-in period before receiving bilateral treatment. We believe that approach appropriately balances scientific rigor with the realities of developing therapies for an ultra-rare disease and reflects a collaborative regulatory process focused on bringing meaningful therapies to patients with significant unmet need.
Before Opus sought alignment with the FDA on the LCA5 program, what had to be in place from a clinical operations standpoint?
Preparation for those discussions starts long before you actually meet with the FDA. We wanted to make sure every component of the program — from the clinical protocol to manufacturing and operational execution — was well developed and internally aligned.
That included selecting investigators and sites with deep expertise in inherited retinal diseases, ensuring consistency around specialized visual function assessments, identifying appropriate patients, and establishing a study design that could generate meaningful evidence despite the small patient population.
Manufacturing readiness was equally important. We expect to begin dosing patients using validated clinical drug supply manufactured with our intended commercial process, which is an important step as we transition from clinical development toward a potential registrational program. Ultimately, the objective is to present the FDA with not just a study protocol but a comprehensive development plan that demonstrates the program is ready for successful execution.
How does the Rare Disease Evidence Principles process change the way sponsors prepare for FDA discussions?
One of the biggest advantages of the Rare Disease Evidence Principles process is that it encourages sponsors and regulators to think holistically about the totality of evidence needed to support approval.
Rather than focusing exclusively on a single clinical endpoint or individual study element, the discussion encompasses how the entire evidence package fits together — including study design, natural history, functional assessments, manufacturing readiness, long-term follow-up, and the unique challenges of the disease itself.
For companies developing therapies in ultra-rare diseases, that earlier alignment can provide important clarity before significant resources are committed. In our case, those interactions helped us finalize a streamlined registrational study that we believe is appropriately designed for both the disease and the patient population.
When a regulatory strategy depends on specialized assessments such as microperimetry, imaging, and functional vision measures, how do you think about choosing the right sites and preparing investigators to execute those assessments consistently?
The success of these studies depends as much on operational excellence as it does on the therapy itself.
We look for centers that have extensive experience managing inherited retinal disease patients, performing gene therapy procedures, and conducting sophisticated visual function assessments. These are highly specialized evaluations, so consistency across sites is essential.
That means standardizing protocols, investigator training, ongoing quality oversight, and close collaboration with study sites throughout the trial. When you're working with relatively few patients, reducing variability wherever possible becomes incredibly important because every data point contributes meaningfully to the overall evidence package.
As Opus moves both LCA5 and BEST1 forward, where do the two programs help inform each other operationally?
There are significant operational synergies across our inherited retinal disease portfolio. Both LCA5 and BEST1 rely on specialized retinal surgeons, experienced inherited retinal disease centers, and sophisticated functional assessments, so we're able to build institutional knowledge that benefits multiple programs.
Each study helps strengthen our relationships with the investigators, refine our operational processes, and improve consistency across site activation, patient engagement, surgical planning, and longitudinal follow-up.
At the same time, every disease has its own biology and clinical characteristics, so while we leverage operational experience across the organization to optimize processes, each program maintains a development strategy tailored to its specific patient population. With BEST1 approaching its first clinical data readout and LCA5 preparing to begin registrational dosing later this year, we're continuing to build capabilities that will also support the broader pipeline, including RDH12, MERTK, and RHO.
On the other hand, does running LCA5 and BEST1 in parallel create any operational tension? If so, how are you managing those trade-offs?
Managing multiple inherited retinal disease programs simultaneously certainly requires thoughtful planning, particularly because these studies rely on a relatively small network of highly specialized investigators, surgeons, and clinical centers.
Rather than viewing that as a constraint, we've approached it as an opportunity to build a scalable operating model. Our clinical operations, regulatory, manufacturing, and medical teams work closely together to coordinate timelines, allocate resources efficiently, and maintain strong communications with our investigators and patient communities.
Importantly, our growing operational experience enables us to execute multiple programs without compromising quality. As our pipeline expands, we're continuing to invest in the capabilities needed to support parallel development while maintaining the high standards required for registrational gene therapy studies. We believe that disciplined execution will be an important differentiator as we advance multiple inherited retinal disease programs toward meaningful clinical milestones.
About The Expert:
Sally Tucker, Ph.D., is the chief medical officer at Opus Genetics and an independent prescribing optometrist with a Ph.D. in ophthalmology and a master’s in business management. Sally joined the ophthalmology industry in 2003, with her career spanning sales and marketing, training, medical affairs, and clinical. Her expertise and special interests include all phases of clinical research activities — from first-in-human and FDA investigational studies to numerous post-marketing evaluations — as well as developing relationships with international sites and KOLs.
Sally is a passionate patient advocate who is driven to bring ground-breaking treatments to those that need it the most, the patients and their families. She earned a Ph.D. and B.S. with honors in optometry from Aston University. She is a member of the British College of Optometrists and holds post-graduate diplomas in management and additional and supplementary supply therapeutics.