Development of anti-VEGFs has revolutionized our management of patients with neovascular age-related macular degeneration, diabetic macular edema and other vascular diseases by improving vision or markedly slowing down the worsening. Nevertheless, in my opinion, there are still a number of important unmet needs in management of these conditions. One such area is the heavy treatment burden. In many patients, intravitreous injections need to be given as often as every month. Even when the patient does not need to be treated monthly, continuous frequent follow-up is needed to detect recurrences as early as possible. Furthermore, the real-world data show that our patients do not gain as much visual acuity with anti-VEGF treatments compared with the pivotal clinical trial outcomes, thought to be due to undertreatment. In the “real world,” long-term frequent follow-up visits and treatments may be difficult for many patients due to various barriers. In addition, every intravitreous injection carries small but potential risks, including endophthalmitis and IOP elevation. Therefore, developing drugs that have longer durable effect in the eye and/or drug delivery mechanism that allows sustained drug delivery is important. This is why I am quite excited about the phase 3 clinical trials investigating faricimab in DME and the Port Delivery System (PDS) with ranibizumab in neovascular AMD. Faricimab can attack two different pathways in angiogenesis, which may be better than addressing only the VEGF pathway. While the initial implantation of PDS needs to be performed in the operating room, the refill of the drug can be performed in the office. This method of delivery has a potential of not only reducing the number of injections but also avoiding undertreatment. If either or both studies show efficacy and safety, it will be a significant step toward improving treatment burden and visual outcome for our patients.
Judy E. Kim, MD
OSN Retina/Vitreous Board Member
Disclosures: Kim reports she is a member of the advisory board for Alimera Sciences, Bausch + Lomb, Carl Zeiss, EyePoint Pharmaceuticals, Gemini, Genentech, Kodiak and Notal Vision.