For those of you who missed it, this year’s Vit-Buckle Society (VBS) meeting included an inspiring three-way debate on wet AMD therapy options: the port delivery system (PDS) with ranibizumab (Susvimo, Genentech/Roche) versus gene therapy versus intravitreal anti-VEGF injections (Figure). Despite excellent presentations on the PDS by Ashley M. Crane, MD and gene therapy by yours truly, R.A., the room overwhelmingly decided Esther Lee Kim, MD, won the debate with her rousing support for intravitreal injections.

<p>Figure. The wet AMD debate panel brought to light the challenges with anti-VEGF injections and the ways second-generation options are seeking to overcome them. From left to right: Esther Lee Kim, MD; Ashley M. Crane, MD; debate moderators Tarek S. Hassan, MD, and Sandra R. Montezuma, MD; and Robert L. Avery, MD.</p>

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Figure. The wet AMD debate panel brought to light the challenges with anti-VEGF injections and the ways second-generation options are seeking to overcome them. From left to right: Esther Lee Kim, MD; Ashley M. Crane, MD; debate moderators Tarek S. Hassan, MD, and Sandra R. Montezuma, MD; and Robert L. Avery, MD.

The outcome was to be expected, of course, and Dr. Kim had something of an unfair advantage. I (R.A.) am trying not to let the defeat get to me. A simple in-office anti-VEGF injection can stave off progression and improve vision for many patients—all without much in the way of a safety concern, at least for most agents. The treatment burden is high with anti-VEGF injections, but it works and has undoubtedly been a game changer for our wet AMD patients.

However. Most striking to us was the fact that we could even have that type of debate in the first place. After more than a decade of relatively stagnant treatment approaches to wet AMD, the winds of change are upon us. In fact, it feels as if almost every aspect of AMD care is shifting beneath our feet. VBS and other conference halls (finally crowded with friendly faces) have been ringing with questions: what do we do with all this innovation? Who is it going to help? How is it going to affect our day-to-day clinical practice?

Everyone is looking to leaders in the field for advice on how to incorporate the PDS, faricimab (Vabysmo, Genentech/Roche), biosimilars, and maybe gene therapy one day, into their treatment paradigms. Equally important, clinicians are wondering how to prepare for the potential approval of a therapy for geographic atrophy. Sure, we follow these patients now, but what if we could actually treat them? What would that mean for diagnostic timing? Disease staging? Long-term monitoring? Clinic flow?

Only clinical experience—and many more debates—will help us better understand how these new therapies fit into our practices. Who knows, maybe that same debate will have a different outcome in a few years.

This issue of Retina Today is dedicated to answering at least some of these questions for you. Within these pages, you will find advice on incorporating the new therapies, as well as a robust discussion on proper AMD nomenclature and a look at the biosimilar market.

As if new treatment options weren’t enough, we also have at-home monitoring to consider, and the possibility of artificial intelligence affecting how we diagnose and follow patients in the near future. Both topics are included in this issue to help you prepare for changes that are likely just around the corner.

While we do our best to absorb the onslaught of new information reshaping our clinics, we must turn right around and educate our patients on those very same changes. They have the right to be informed about all their treatment options, and it’s up to us to guide them toward the best management strategy. For many patients, it’s likely going to be a quick conversation simply making them aware that two new therapies exist; after all, our standard of care remains an exceptional option. But we all have a few patients for whom a longer-duration option just might be the change they need, and they will require an in-depth discussion of the benefits and risks of switching therapies. The newly approved therapies, tools, and techniques now provide a more personalized approach for patients who struggle with the treatment burden or aren’t seeing a benefit with the tried-and-true.

Charles C. Wykoff, MD, PhD, said it best in this issue’s roundtable discussion: We must instill within our patients a drive to maintain the best vision possible using today’s therapies because next-generation treatments are going to be even better.