The Last Miles of Retinal Care at APVRS 2025 Put Systems on the Retina Map

At APVRS 2025’s RETINA 360, speakers argued that access is the real endpoint.

On Day 2 of the 18th Congress of the Asia-Pacific Vitreo-Retina Society (APVRS 2025), the symposium The Last Miles of Retinal Care shifted the spotlight from procedures to pathways. Chaired by Prof. Taraprasad Das (India), Prof. Judy Kim (USA) and Dr. Jennifer Joy Santos-Rayos (Philippines), the session asked what it takes to deliver retinal care to the people who are least likely to reach it.

Prof. Kim set the stage for a comparative, solutions-first conversation. “We will discuss how we can provide the best care to those who need it the most by comparing and contrasting what’s going on in different parts of Asia as well as around the world.”

All eight speakers arrived at the same conclusion: The last mile is not one problem. It is a stack of problems, including geography, workforce, financing, follow-up, data and trust.

A public health definition of retina

Prof. Taraprasad Das (India) opened with a World Health Organization (WHO)-linked view of eye health as an enabler of education, work and broader wellbeing. For retina specialists, his point was blunt: no matter how advanced the therapy, outcomes are decided by whether care reaches peripheral populations consistently.

He offered a definition that turned “last mile” into a measurable responsibility. “I define last mile eye care as the process of extending comprehensive and quality eye care into the most peripheral populations, ensuring equitable access regardless of geography, poverty and social barriers.”

He described integrated population-based eye care (IPEC), a WHO-recommended model, and emphasized that implementation must be country-specific. What worked in Bhutan, he noted, cannot simply be copy-pasted into India. In the Q&A, he landed on a unifier that showed up repeatedly through the session: technology is finally capable of reaching farther than the system traditionally allowed.

India’s readiness gap is no longer clinical

Dr. Padmaja Kumari Rani (India) opened up ways around treatment road-blocks. India’s retinal services remain concentrated in cities, while a large rural population faces a familiar barrier course: distance, cost and too few trained specialists.

She focused on diabetic retinopathy (DR) as the dominant last-mile stress test. She cited Smart India findings showing diabetes prevalence at one in five adults, DR in roughly one in eight people with diabetes, and an estimated three million with vision-threatening disease.¹ Her proposed DR care model rested on four pillars: early detection tied to awareness, sustainability, continuous training and follow-up, and capacity building through task-sharing and task-shifting.

Her most useful data points were implementation lessons. Screening uptake doubled when a program moved from paid to free. She also reported real-world artificial intelligence (AI) performance improving after maintenance and algorithm upgrades, with specificity rising from 60% to 94%.

When the conversation moved to treatment, she highlighted a compliance cliff: patients with insurance adhere more reliably to intravitreal regimens than those paying out-of-pocket. Her closing line made the session’s theme feel personal rather than programmatic. “India is ready for the last mile retinal care. We now need to turn readiness into action so that no one goes blind simply because care was too far away.”

When continuity collapses, best practice changes shape

Prof. Tien-Yin Wong (Singapore) offered observations from China that reframed the last mile as a continuity problem, not merely a distance problem. In high-volume systems where follow-up cannot be assumed, retinal care becomes episodic and patient education becomes collateral damage.

His most striking line described how he practices under uncertainty. “I see every patient as potentially the last time I’ll see them. I tell them the plan, and I ask them to remember this and do their regular checkups independently because continuity cannot be assumed in this system.”

That reality forces difficult tradeoffs. A chronic disease like DR does not behave kindly in a system that cannot guarantee timely return visits, and evidence-building becomes harder when patients cycle rapidly between providers and therapies. Prof. Wong also pointed to China’s accelerating research engine and open-source AI ecosystem, but the message remained that clinical quality cannot float above system constraints.

Digital scale works only if it stays inclusive

Dr. Anna Tan (Singapore) tackled the operational question that many systems struggle with: which patients truly require specialist face-to-face care, and which can be managed safely through redesigned pathways.

She described national screening approaches using AI as a first pass with human graders, optometry-led primary eye clinics, and virtual clinic models where technicians and nurses collect investigations and doctors review results offline. In one example, a glaucoma observation clinic cut patient journey time by half, improving experience while expanding capacity.

Her caution was not anti-tech…it was anti-exclusion. As systems push appointments, payments and monitoring into apps, older and visually impaired patients risk falling out of the care pathway. She closed by asking the assembled physicians to “all do our part to build a digitally inclusive society.”

Islands make the last mile literal

In the South Pacific, Prof. Peter McCluskey (Australia) described vitreoretinal care as a service that remains scarce in places where diabetes is rising and resources are thin. He outlined hub-building, workforce upskilling and the need for affordable anti-vascular endothelial growth factor (VEGF) access, refurbished diagnostics and sustainable supply chains. He pushed the conversation toward access and equity, saying, “Vitreoretinal services should no longer be a luxury in the Pacific. They’re a necessity given the challenges we face and must be made as mainstream as cataract surgery.”

For the Philippines, Dr. Jennifer Joy Santos-Rayos laid out an archipelago reality where geography and politics shape access, and primary care remains underfunded.² She cited a universal health coverage index around 60 out of 100 and described persistent out-of-pocket burden.³ Her examples of last-mile innovation were practical and local: the Mulat Mata DR program shifting toward AI-enabled non-mydriatic screening, and an electronic medical records (EMR)-linked retinopathy of prematurity (ROP) tracker designed to eliminate missed referrals and delayed screening.⁴

Her summary captured the session’s theme without romanticizing it. “Last mile retinal care means improving primary eye care services. Beyond sight-saving surgeries, we extend to the last mile through non-medical projects: screening, tracking systems, specialist networks and governance advocacy.”

The evidence has to travel, too

To close, Prof. R.V. Paul Chan (USA) spoke on AAO approaches to disparities, emphasizing that vision loss both reflects inequality and worsens it. “Vision loss both contributes to inequalities and results from inequality. These are addressable concerns that require addressing multiple access dimensions concurrently.”

Prof. Neil Bressler (USA) then widened the lens to the role of journals in public health, arguing that peer review and effective dissemination are part of the last-mile pipeline. He stressed that physicians remain the most trusted health messengers, and that trust depends on rigor, transparency and clear communication, especially as AI tools introduce new risks of fabricated citations and errors.

He stressed that how science is shared matters just as much as the science itself. “Peer-reviewed journals must strive for scientific excellence and ease of dissemination because physicians—who are trusted most by the public for healthcare—depend on the peer-reviewed literature as the scientific backbone of medical knowledge and practice.”

The last mile is the real workflow

The solutions shared in Manila ranged from India’s task-sharing pipelines and decentralized injections, to China’s continuity constraints, to Singapore’s virtual clinic architecture and digital ambassadors, to Pacific hub-building and the Philippines’ screening and tracking systems. Different geographies, different constraints, same conclusion.

Retinal care will not be defined only by what is possible in the clinic. It will be defined by what is reachable, sustainable, auditable and understood in the places where patients actually live. The last mile is not the end of the journey. It is the part that decides whether the journey counted.

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.

References

Raman R, Vasconcelos JC, Rajalakshmi R, et al. Prevalence of diabetic retinopathy in India stratified by known and undiagnosed diabetes, urban-rural locations and socioeconomic indices: Results from the SMART India population-based cross-sectional screening study. Lancet Glob Health. 2022;10(12):e1764-1773.
International Diabetes Federation. Philippines country data: IDF Diabetes Atlas. Diabetes Atlas. Available at: https://diabetesatlas.org/data-by-location/country/philippines/. Accessed on December 13, 2025.
World Bank. Philippines human capital index 2-pager (includes UHC index score, 2017). Washington, DC: World Bank; 2018. Available at: https://databankfiles.worldbank.org/public/ddpext_download/hci/HCI_2pager_PHL.pdf. Accessed on December 13, 2025.
American Academy of Ophthalmology. Mulat Mata initiative overview. 2025. Available at: https://www.aao.org/young-ophthalmologists/yo-info/article/mulat-mata-diabetic-retinopathy-prevention. Accessed on December 13, 2025.