Anti-VEGF Therapies in Retinal Disorders: Current Landscape and Future Directions.

Area of Science:

• Ophthalmology
• Retinal Vascular Diseases
• Pharmacological Interventions

Background:

• Anti-vascular endothelial growth factor (anti-VEGF) therapy has revolutionized treatment for macular neovascularization and other retinal vascular disorders.
• Despite its success, challenges such as treatment burden, variable patient response, and high costs hinder optimal real-world outcomes.

Purpose of the Study:

• To synthesize evidence on key priorities for advancing anti-VEGF therapy in retinal care.
• To explore strategies for expanding access, optimizing treatment, and improving disease monitoring.

Main Methods:

• Evidence synthesis from a curated collection of articles.
• Focus on three intersecting priorities: biosimilars, individualized treatment, and quantitative imaging biomarkers.
• Review of advanced en-face optical coherence tomography (OCT) fluid metrics and other biomarkers.

Main Results:

• Biosimilars offer comparable efficacy and safety, potentially expanding access.
• Individualized agent selection and switching paradigms, like with faricimab, can optimize treatment.
• Quantitative multimodal imaging biomarkers, including advanced OCT metrics, enable refined disease monitoring and retreatment decisions.

Conclusions:

• A shift towards precision-guided, accessible, and evidence-based retinal care is emerging.
• Integrating patient-centered considerations and pragmatic algorithms is crucial for adherence and response durability.
• Prospective validation and implementation research are essential for sustainable clinical practice.