From anti-VEGF debates to gene therapy dreams, this retina session delivered a masterclass in precision, progress and perspective.
The retina world lit up on Day 1 of the American Academy of Ophthalmology Annual Meeting 2025 (AAO 2025), where lasers, genes, implants and a pinch of AI took center stage.
It wasn’t your average science fair. This was retina’s version of a rock concert with four powerhouse speakers who dropped insights that blurred the lines between art and algorithm.
Balancing between science and art in macular edema care
When it comes to macular edema, it turns out there’s as much artistry as anatomy involved.
Kicking off the session, Dr. Mark Johnson (USA) took the audience on a thoughtful—and at times philosophical—journey through the delicate balance between science and intuition in patient care.
“We need both art and science in treating macular edema,” Dr. Johnson began.
He focused on what he called the “art” of management, noting how the field has changed with new imaging and treatment, but warned against overuse of anti-vascular endothelial growth factor agents (anti-VEGFs) if the underlying mechanisms are ignored.
“Start with the simplest and least invasive approach. Stop treatment if there’s no visual benefit,” Dr. Johnson advised. “Avoid the cost and risk of unnecessary treatment. And treat the patient, not the OCT.”
He illustrated these principles through several case examples. From a branch retinal vein occlusion (BRVO) patient who improved to 20/25 vision nine months after a single focal laser treatment, to a diabetic physician whose macular edema resolved spontaneously after years of observation.
“A rational therapeutic approach to macular edema requires a clear understanding of the underlying pathophysiologic mechanisms,” Dr. Johnson concluded. “Customized treatment is safer, more effective and less costly.”
Smarter screening leads to smarter treatments
Next up, Dr. Barbara Blodi (USA) discussed how digital tools and improved drug options are transforming diabetic eye disease care. Her talk on non-proliferative diabetic retinopathy (NPDR) and diabetic macular edema (DME) spotlighted the growing role of AI screening and next-generation anti-VEGF therapies.
“Now in 2025, we have even better methods to control blood sugar, continuous glucose monitors, insulin pumps, and better control of hemoglobin A1C with new systemic medications.” she stated.
Since 2018, there are three U.S. Food and Drug Administration (FDA)-approved AI algorithms that have entered real-world use for detecting diabetic retinopathy. According to Dr. Blodi, the Centers for Medicare and Medicaid Services (CMS) data in 2025 showed a steady increase in billing for AI-based screening, especially for large health systems.
When it comes to treatment, anti-VEGF therapy remains standard. Yet surveys reveal that about 60% of retina specialists still prefer monitoring and blood sugar control for severe NPDR over injections, a trend that hasn’t changed much since 2021.1
On the other hand, new options like aflibercept 8 mg and faricimab are reshaping dosing patterns, with trials showing that many patients can extend intervals to 12 to 16 weeks without compromising outcomes.2,3
According to Dr. Blodi, combination steroid use also continues to play a role for persistent DME cases, offering longer gaps between visits.
“In 2025, the treatment of DME is non-perfect,” she concluded. “Persistent DME remains an issue,” she added.
Hope for inherited retinal diseases
Dr. Jason Comander (USA) outlined the rapid progress in genetic testing and gene-based therapies for inherited retinal diseases (IRDs).
He explained that genetic testing is no longer limited to research centers and can be done via telehealth with programs like My Retina Tracker Registry by Foundation Fighting Blindness (Maryland, USA).
“You do have to sign up and register each patient, but you can outsource the genetic counseling to explain the results to the patient,” he said. “There’s no cost.”
He discussed RPE65 gene therapy, noting long-term vision gains even in patients who already developed chorioretinal atrophy and shared updates on other programs for retinitis pigmentosa GTPase regulator (RPGR), leber congenital amaurosis (LCA), and optogenetics and stem-cell strategies.
“Prevention is the ultimate cure,” he said, emphasizing the importance of offering genetic counseling and family planning discussion to at-risk patients.”
READ MORE: Gene Therapy Shows Promise for AIPL1-Associated Retinal Dystrophy in Children
Longer-lasting vision gains on the horizon
To conclude the session, Dr. Jennifer Lim (USA) presented an update on neovascular age-related macular degeneration (nAMD).
She focused on three major Phase III extension studies—AVONELLE-X, PULSAR and PORTAL—and their implications for durability.
- In AVONELLE-X, patients on faricimab maintained stable best-corrected visual acuity (BCVA) and central subfield thickness (CST) over four years, with 80% on 12-week or longer dosing and no new safety concerns.
- In PULSAR, aflibercept 8 mg delivered comparable vision results to 2 mg with fewer injections.
- In PORTAL, the ranibizumab Port Delivery System (Genentech; California, USA) maintained consistent CST control for five years.
Dr. Lim then introduced emerging modalities such as tyrosine kinase inhibitors (TKIs) and gene therapy. Phase II studies of EYP-1901 (EyePoint Pharmaceuticals; Massachusetts, USA) and OTX-TKI (Ocular Therapeutix; Massachusetts, USA) reported up to 89% reductions in treatment burden, and early gene therapy trials—RGX-314 (Regenxbio; Maryland, USA) and Ixo-vec (Adverum Biotechnologies; California, USA)—showed similar reductions in injection frequency without new safety signals.
“Our current treatments for wet AMD are indeed effective and durable,” Dr. Lim concluded. “However, there are emerging new treatments that have the potential for even greater durability due to novel mechanisms of action, including TKIs, gene therapy and bispecific agents.”
Editor’s Note: The American Academy of Ophthalmology Annual Meeting 2025 (AAO 2025) is being held on 17-20 October 2025, in Orlando, Florida. Reporting for this story took place during the event. This content is intended exclusively for healthcare professionals. It is not intended for the general public. Products or therapies discussed may not be registered or approved in all jurisdictions, including Singapore.
References
- Eliott D. Global Trends in Retina. ASRS. 2021. Available at: https://www.asrs.org/content/documents/2021-global-trends-survey-highlights.pdf. Accessed on October 18, 2025.
- Two-year PULSAR trial results for aflibercept 8 mg demonstrate durable vision gains at extended dosing intervals in wet age-related macular degeneration. Regeneron. August 10, 2023. Available at: https://investor.regeneron.com/news-releases/news-release-details/two-year-pulsar-trial-results-aflibercept-8-mg-demonstrate/. Accessed on October 18, 2025.
- Khanani AM, Kotecha A, Chang A, et al. TENAYA and LUCERNE: Two-year results from the Phase 3 neovascular age-related macular degeneration trials of faricimab with treat-and-extend dosing in Year 2. Ophthalmology. 2024;131(8):914-926