From gene therapy to biosimilars and sustained delivery, experts weigh in what truly moves the needle for patients.
On the final day (Day 3) of the 18th Congress of the Asia-Pacific Vitreo-Retina Society (APVRS 2025), speakers explored how the future of retinal disease management is no longer defined by novelty alone, but by durability, affordability and real-world impact.
During the Upcoming Therapies for Retinal Disease session, international experts examined how emerging treatments for age-related macular degeneration (AMD), diabetic retinopathy (DR) and diabetic macular edema (DME) are reshaping care, while also confronting the practical realities that determine whether innovation succeeds beyond the clinic.
Chaired by Dr. Susan Bressler (USA), Dr. Catherine Dianne Delfino (Philippines) and Dr. Paisan Ruamviboonsuk (Thailand), the session moved beyond pipeline excitement to interrogate what actually matters to patients: visual function, treatment burden, safety and cost. Across all six talks, a common message emerged: progress in retina care must be patient-centered, system aware and evidence-driven.
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Gene therapy aims to rewrite treatment burden
Opening the session, Dr. Michael Singer (USA) outlined how gene therapy could fundamentally reshape the long-term management of neovascular AMD, DR and DME, not only by improving short-term anatomical outcomes, but by reducing the relentless cycle of injections many patients endure.
“Gene therapy is good because…it’s a small tissue volume, [requiring] relatively low dose requirement,” Dr. Singer explained, emphasizing why the retina is an ideal target for this approach. The central promise, he noted, lies in sustained intraocular protein expression, potentially easing the treatment burden for both patients and providers.
He also presented data across multiple adeno-associated (AAV)-based platforms and delivery routes, highlighting consistent reductions in injection frequency. In several studies, annualized injection rates fell by 65% to 90%, while visual acuity and retinal thickness remained well controlled.*
“These are high-need patients,” he said, noting that a substantial proportion remained injection-free for extended periods, particularly at higher doses. Importantly, safety signals—chiefly inflammation—were largely manageable.
While acknowledging that inflammation remains a consideration, Dr. Singer emphasized that growing clinical experience has improved clinicians’ ability to anticipate and manage these events.
When access determines whether treatment works
If gene therapy represents the future, Dr. Paolo Antonio Silva (USA) brought the discussion firmly back to present-day realities. Speaking from the Philippine context, he emphasized that the success of any retinal therapy ultimately depends on whether patients can afford to stay on treatment.
“A highly effective drug does nothing if the patient cannot afford the third, the fourth or the fifth injection. So this is the Philippine affordability baseline,” Dr. Silva said, citing data from the Philippine Statistics Office to illustrate the cumulative cost burden faced by patients with chronic retinal disease. Beyond medication prices, he noted that clinic visits, transportation and lost income all contribute to treatment discontinuation.
Dr. Silva positioned biosimilar anti-vascular endothelial growth factor (anti-VEGF) agents as a practical response to these barriers, particularly in low-resource settings. While biosimilars may not offer dramatic technological novelty, he emphasized their importance in closing the gap between what is clinically possible and what is realistically accessible for patients.
Addressing safety concerns, Dr. Silva was clear that outcomes often depend on process rather than product. “It’s not the drug. It’s the people compounding the medication,” he said, stressing the importance of validated sterile techniques and rigorous quality control.
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Why anatomy should not lead the conversation
Shifting focus to how new therapies are judged, Dr. Neil Bressler (USA) challenged the tendency to prioritize anatomical outcomes over patient-centered measures. While advances in imaging have sharpened clinicians’ understanding the disease, he cautioned against assuming that better scans can automatically translate into better vision.
“The patient may enjoy looking at a better OCT [optical coherence tomography], but what they most enjoy is that they’re reading better or if they’re able to see people better,” he said. For Dr. Bressler, functional outcomes should remain the primary benchmark for success: if the patients can see better and live more independently, the treatment has succeeded.
Dr. Bressler also questioned claims of superiority based on secondary or exploratory findings. “These anatomic outcomes should generate hypotheses,” he explained. “Even if it does represent a true anatomic difference, we still need to know whether it provides superior visual acuity outcomes.”
While acknowledging the value of innovation, Dr. Bressler urged restraint in interpretation. Without clear functional benefit, he noted, enthusiasm for new treatments should be tempered by rigorous evaluation.
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Sustained delivery and the burden of chronic care
Dr. Voraporn Chaikitmongkol (Thailand), discussed sustained-release technologies designed to reduce the frequency of intravitreal injections. She noted that for many patients, it is the ongoing demand for treatments—not lack of efficacy—that drives poor real-world outcomes.
“Most patients with these retinal diseases typically require regular injections to maximize their visual outcomes.” Dr. Chaikitmongkol said. Over time, she added, this treatment burden affects not only patients, but also the families and caregivers who support them.
Sustained-release implants and refillable systems aim to maintain therapeutic effect while spacing out clinic visits.
“[Sustained]-release therapeutic technologies can be beneficial in reducing clinic visits and injection frequency, while maintaining visual and anatomical outcomes for patients who suffer from these retinal diseases,” she explained.
At the same time, Dr. Chaikitmongkol acknowledged that these approaches are not without challenges. Surgical complexity, safety considerations and cost remain key factors influencing adoption across the diverse healthcare systems in the Asia-Pacific region.
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Photobiomodulation under a critical lens
Dr. Susan Bressler, offered a careful and critical assessment of photobiomodulation. She began by explaining the concept behind the therapy, which applies specific wavelengths of light to promote beneficial cellular effects.
“It is the application of light—both light within the visible and the near infrared spectrum—to a specific tissue, in this case the eye, to promote a beneficial cellular effect,” she explained.
However, Dr. Bressler cautioned against overinterpreting early results. “The magnitude of the improvement was small,” she noted, referring to reported visual gains, “and not supported by other functional differences.” Study limitations, patient selection and placebo effects, she added, further complicate interpretation.
Rather than dismissing the approach outright, Dr. Bressler stressed the need for further investigation. For now, photobiomodulation remains a developing option rather than a definitive solution for the large population of patients with dry AMD.
Diabetic retinopathy as a systemic disease
Closing the session, Dr. Ruamviboonsuk reframed diabetic retinopathy as a condition rooted in a systemic disease, arguing that effective management requires looking beyond the eye itself.
“Diabetic retinopathy is [an] ocular complication of a systemic disease,” Dr. Ruamviboonsuk said, reminding the audience that retinal findings reflect broader metabolic processes.
He highlighted evidence suggesting that systemic therapies may influence the course of DR, reinforcing the importance of closer collaboration with medical colleagues. “This means we may need to collaborate with other medical doctors in the future,” he said, pointing toward a more integrated model of care.
For Dr. Ruamviboonsuk, progress in managing DR will depend not only on ocular interventions but on coordinated management of the underlying disease.
*Ixo-vec (ixoberogene soroparvovec) intravitreal gene therapy for neovascular AMD: 3-year results from the Phase 1 OPTIC extension trial and preliminary data from Phase 2 LUNA trial. Adverum Technologies Data on File.
Editor’s Note: 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. Reporting for this story took place during the 18th Congress of the Asia-Pacific Vitreo-Retina Society (APVRS 2025) from 12-14 December in Manila, Philippines.