From stretching anti-VEGF durability to decoding IRDs, retinal specialists dissect breakthrough therapies and diagnostic challenges at APAO 2025.
The New Approaches to Retinal Diseases symposium on Day One of the 40th Congress of the Asia-Pacific Academy of Ophthalmology (APAO 2025), held in conjunction with the 83rd Annual Conference of the All India Ophthalmological Society (AIOC 2025), spotlighted the evolving landscape of retinal disease diagnosis and treatment.
Chaired by Dr. Raja Narayanan (India) and Prof. Dr. Hendrik Scholl (Switzerland), the session buzzed with global experts tackling challenges in retinopathy of prematurity (ROP), retinal vein occlusion (RVO), AI diagnostics, inherited retinal diseases (IRDs) and retinal toxicities from systemic therapy.
Presentations ranged from real-world data to pipeline innovations, highlighting how precision, access and vigilance are the triple threat keeping the retina world spinning (and retinal specialists on their toes) in today’s ever-evolving clinical landscape.
Stretching the injection timeline in RVO
Prof. Muna Bhende (India) opened the session with a focus on anti-VEGF therapy for macular edema from retinal vein occlusion (RVO). Her analysis emphasized the value of early and sustained treatment. Whether it was aflibercept 2mg (Regeneron/Bayer), faricimab (Roche) or the newer high-dose aflibercept 8mg (Regeneron/Bayer), the core message was clear: consistency counts.
“Anti-VEGF injections, regardless of the agent, when given monthly, show substantial improvements in visual acuity and CMT reduction. However, with PRN, there is loss of the initial benefit, which is more evident in central vein occlusion,” Prof. Bhende cautioned.
Highlighting results from the BALATON and CAMINO studies, she noted that more than half of branch RVO patients and just under half of central RVO (CRVO) patients could extend treatment intervals to 16 weeks with faricimab. Still, “about 50 percent of CRVO patients need treatment in year four,” she warned. “The newer injections may help us to increase the interval between injections.”
Masqueraders in ROP
Prof. Peiquan Zhao (China) presented diagnostic cases in retinopathy of prematurity (ROP) that revealed more than met the eye.
“The purpose of our work is to identify early lesions, particularly to prevent blindness caused by end stage ROP and other pediatric retinal disease,” he said, outlining several cases where presumed ROP turned out to be masquerading conditions such as retinoblastoma, Coats disease, incontinentia pigmenti or familial exudative vitreoretinopathy.
He concluded with a call for vigilance: clinicians must examine the entire retina—including the periphery—with an eye toward differential diagnosis.
“We need to identify the underlying disease masquerading as ROP, link heredity in every unexplained peripheral retinopathy, and make the right choice for treatment or referral,” Prof. Zhao advised.
Country-specific guidelines in ROP management
ROP remains a leading cause of childhood blindness, especially in middle-income countries, explained Prof. Mangat Ram Dogra (India). In these settings, heavier and more mature infants are still at risk, demanding localized screening criteria. His central insight: ROP is not a one-size-fits-all disease.
“Higher birth weight babies develop severe ROP in developing and middle income countries. This led to a change in guidelines. We finally had guidelines [for] 2 kgs in 34 weeks,” said Prof. Dogra.
The talk emphasized that traditional 1,500g/30-week cutoffs miss significant pathology in these settings.
Prof. Dogra advocated for updated, locally relevant protocols that reflect real-world demographics and healthcare realities. “Screening is the most important to identify treatable ROP,” he reinforced. “Manage all treatable ROP promptly with laser or anti-VEGFs as per the standard of care.”
IRD therapies gain momentum
Switching gears to the future of inherited retinal diseases (IRDs), session co-chair Prof. Scholl highlighted two complementary approaches: pharmacologic modulation and gene editing.
“The pharmacological reduction of the availability of vitamin A to the retina with tinlarebant [Belite Bio] has shown significant therapeutic effects with very good tolerability in Phase 2 studies,” he said, pointing to data from the Dragon 1 and Dragon 2 registration trials.
But the spotlight moment came when Prof. Scholl discussed base editing technology targeting the G961E mutation in Stargardt disease. “Base editing currently allows an editing rate of about 75% in cone photoreceptors in the primary retina with significantly lower editing in the fovea,” he said. While hurdles remain, these tools signal a new era in IRD precision medicine.
China’s blueprint for screening at scale
Prof. Haotian Lin (China) outlined how AI is being deployed to enhance both diagnosis and accessibility of retinal care in China. His team tackled AI’s weakest link—image quality—with an innovative three-dimensional quality control system for fundus photography.
“To achieve better performance of AI models in clinical practice, we collected representative fundus photographs from tertiary hospitals with abundant diseases,” he said. The model underwent validation in 35 medical institutions across 82% of China’s provinces, achieving an average AUC greater than 0.95.
The initiative goes beyond the clinic with AI-equipped mobile screening vehicles now bringing diagnostics to rural areas. “The application of AI technology for retinal disease… provides door-to-door eye disease screening service for residents in remote areas with scarce healthcare resources,” Prof. Lin concluded.
The hidden costs of cancer care
Closing the session with a dose of caution, Dr. Sruthi Arepalli (United States) shared insights into ocular complications from anti-cancer agents, particularly mitogen-activated protein kinase (MEK) inhibitors, checkpoint inhibitors and tyrosine kinase inhibitors.
“MEK inhibitors are guilty of causing a self-limited serous neurosensory detachment which is pathognomonic for MEK inhibitor associated retinopathy. Almost 90 to 100 percent of patients will develop this at some point,” she said, emphasizing the importance of accurate differentiation from other retinal conditions.
Checkpoint inhibitors bring a broader spectrum of inflammatory complications, including Vogt-Koyanagi-Harada (VKH)-like syndromes and posterior uveitis. Dr. Arepalli urged careful differential diagnosis: “While we learn about all of these new drugs and we learn about all of the sequelae that they can cause in the eye, including multiple types of uveitis, I always urge us to think about what else could be presenting even in a situation that seems like it’s a slam dunk.”
Eyes on the future
The New Approaches to Retinal Diseases symposium illustrated the dynamic, multilayered nature of retina care today.
Presentations spanned early intervention in ROP, molecular innovations in inherited retinal diseases, and the systemic interface of oncology and ophthalmology. AI models showed strong potential in real-world screening workflows, while evolving anti-VEGF regimens challenged long-held assumptions about treatment frequency.
As the field advances, these discussions reflect a broader shift in retinal care—toward earlier diagnosis, more tailored interventions and a deeper awareness of intersecting systemic factors. The work presented offered not just solutions, but a framework for ongoing refinement in both clinical practice and global strategy.
Editor’s Note: Reporting for this story took place during the 40th Congress of the Asia-Pacific Academy of Ophthalmology (APAO 2025), being held in conjunction with the 83rd Annual Conference of the All India Ophthalmological Society (AIOC 2025) from 3-6 April in New Delhi, India.
