Retina Round-Up: Christina Weng

This year has been full of discoveries, especially in the field of wet age-related macular degeneration (wAMD). With the emergence of next-generation anti-VEGF agents faricimab and aflibercept 8 mg, the return of the port delivery system with ranibizumab, the development of several new aflibercept biosimilars, and a bustling therapeutic pipeline that includes tyrosine kinase inhibitors, VEGF-C/D inhibitors, trispecific antibodies, and gene therapy, patients with wAMD have more treatment options than ever before!

While therapeutic options continue to evolve and improve, our treatment paradigms have remained relatively static for nearly two decades, with most retina specialists utilizing a treat-and-extend or pro re nata strategy for managing wAMD. But that could change with the emergence of Home Optical Coherence Tomography (OCT; Notal Vision), which became FDA-approved in the US in May 2024. Home OCT could transform the way we manage wAMD and is actively being studied in the Diabetic Retinopathy Clinical Research (DRCR) Retina Network’s Protocol AO, for which I am honored to serve as Protocol Chair. Protocol AO will randomize 600 eyes with treatment-naïve wAMD 1:1 to treat-and-extend or Home OCT-guided management; the co-primary outcomes are mean change in visual acuity and number of injections from baseline to week 104.

While I don’t have results to share yet, this study will show us the impact of truly personalized care wherein a patient receives an injection when and only when exudative activity  recurs. This might not only reduce treatment burden, but also could lead to better long-term visual outcomes and all at less risk to our patients. Protocol AO will also teach us about inter-injection fluid dynamics, fluid tolerance, and workflow integration of Home OCT; all of these learnings will become increasingly relevant amidst the growing presence of extended-durability therapeutics.

Innovation is ubiquitous across the retina landscape, and remote monitoring with Home OCT represents just one example. This issue highlights some of the many other promising advancements in our field, and I hope that the readership finds the collective contents informative and insightful as we continue to strive to provide the best care for our patients.

Wishing you all a joyful holiday season, and I hope to see many of you in the new year!