Dr Pierre-Henry Gabrielle, MD, PhD, from the University of Sydney School of Medicine, Discipline of Ophthalmology; Save Sight Institute, New South Wales, Australia; and the Department of Ophthalmology, Dijon University Hospital, Dijon, France, and colleagues from other European and Australian institutions reported that a comparison of ranibizumab (Lucentis; Genentech) and aflibercept (Eylea; Regeneron Pharmaceuticals) showed that both drugs are safe and effective for treating diabetic macular oedema (DMO).

The investigators retrospectively analysed treatment-naive eyes with DMO in which intravitreal treatment with either of the 2 medications (ranibizumab 0.5 mg or aflibercept 2 mg) began between January 1, 2013, and December 31, 2017. All data were collected in the Fight Retinal Blindness! registry.

A total of 534 eyes of 402 patients were included. Ranibizumab was injected intravitreally into 267 eyes and aflibercept into 267 eyes.

In this real-world observational study, data showed that the longitudinal adjusted visual acuity change over the 3-year period between ranibizumab and aflibercept using all eyes differed significantly (

< .001). However, the investigators believe that this was the result of the significantly larger gains achieved with aflibercept in the first 12 months. “The adjusted visual acuity change at 3 years after this initial superiority had diminished was similar,” they said, ie, adjusted visual acuity change +1.6 (−0.1 to 4.2) letters for ranibizumab compared with +2.4 (−0.2 to 5.1) letters for aflibercept.

However, the adjusted mean changes in the central subfield thickness (CST) remained significantly (

< .01) different throughout the 3-year period in favour of aflibercept, ie, −87.8 microns (range, −108.3 to −67.4 microns for ranibizumab)compared with −114.4 microns (range, −134.4 to −94.3 microns for aflibercept).

The investigators also reported that when patients had moderate baseline visual impairment (visual acuity ≤68 Early Treatment Diabetic Retinopathy Study letters), the vision improved faster in eyes treated with aflibercept up until 18 months of treatment compared with eyes treated with ranibizumab, which then stayed similar until 36 months of treatment. No difference was observed in patients with mild baseline visual impairment (visual acuity ≥69 Early Treatment Diabetic Retinopathy Study letters).

They concluded: “Aflibercept and ranibizumab were both safe and effective for DMO over 3 years in daily practice, although aflibercept had better anatomical outcomes. The faster and larger visual gains at 1 year observed in eyes treated with aflibercept when the presenting visual impairment was moderate (visual acuity ≤68 letters or 20/50) were no longer significant by 18 months as already described in a [randomised clinical trial (RCT)]. The medium-term real-world treatment outcomes of ranibizumab or aflibercept for DMO seemed to be somewhat inferior to those reported in RCTs.”

1. Gabrielle PH, Nguyen V, Creuzot-Garcher C, et al. Three-year treatment outcomes of aflibercept versus ranibizumab for diabetic macular oedema. Data from the Fight Retinal Blindness! registry. Retina, 2022;42(6):1085-1094; doi:10.1097/IAE.0000000000003428

Articles

The investigators retrospectively analysed treatment-naive eyes with DMO which received intravitreal treatment with either ranibizumab 0.5 mg or aflibercept 2 mg. All data were collected via Fight Retinal Blindness! registry.

Fight Retinal Blindness! registry data: Ranibizumab and aflibercept safe for treating DMO over 3 years 

Growth in the clinical and commercial development of gene therapies for retinal degenerative diseases has been explosive over the past decade. 

The rapid expansion of the field has been led by dramatic vision restoration for virtually blind patients made possible by voretigenene parvovec-rzyl (Luxturna; Spark Therapeutics), which the FDA approved in December 2017. It is the first gene therapy for the eye or any inherited retinal disease to cross the regulatory finish line in the United States. 

Developed by gene therapy pioneer Dr Jean Bennett, MD, PHD, for children and adults with Leber congenital amaurosis (LCA) or retinitis pigmentosa (RP) caused by biallelic RPE65 mutations, the therapy provided immediate and impressive vision improvements in a phase 1/2 clinical trial at Children’s Hospital of Philadelphia. Those initial results, reported in 2008, sent a strong signal to investigators and biotechnology companies that gene therapy could be a powerful modality for treating retinal diseases.

Now, dozens of companies are in the retinal gene therapy development space and more than 20 clinical trials for genetic therapies are underway for patients with a broad range of retinal degenerative diseases. These include RP, LCA, choroideremia, achromatopsia,and the dry and wet forms of age-related macular degeneration (AMD).

The Foundation Fighting Blindness, a leading private funder of retinal degenerative research, has played a pivotal role in advancing retinal gene therapies into clinical development. As an early funder of the modality for myriad retinal diseases, the foundation began investing in RPE65 gene therapy research in the mid-1990s and ultimately invested $10 million in the research that eventually led to voretigenene parvovec.

“We were very early adopters, recognizing that the retina was an ideal gene therapy target. It’s a small, accessiblepiece of tissue, and many conditions that affect the retina are monogenic. We knew that if we could directly address the patient’s mutated gene by augmenting or modifying its activity, we had an excellent opportunity to save and restore vision,” said Dr Benjamin Yerxa, PhD, chief executive officer at the foundation. “Furthermore, we see gene therapy’s potential for gene-agnostic applications such as neuroprotection and optogenetics to help a broad range of patients, regardless of the mutated gene causing their vision loss.”

The foundation currently funds a broad range of gene therapies and other treatment modalities at both early and late stages of development. Its RD (Retinal Degeneration) Fund, a venture philanthropy fund with nearly US$120 million in commitments, was launched in 2018 to help investigators and start-up companies move their emerging therapies into and through early-stage clinical trials. 

The fund’s goal is to attract additional investments frompharmaceutical and biotechnology companies to fund the more expensive, late-stage trial phases. Furthermore, all returns on the fund’s investments are put back into the foundation to support additional research and investments.

“The ultimate goal of the RD Fund is to get more treatments across the finish line and out to patients. We can’t afford to fund late-stage clinical research, which often costs a hundred million dollars or more, but we can afford the earlier-stage research to attract those major investments from biotechs and big pharma,” said Yerxa.

In fall 2021, the RD Fund took the step of launching its own company, Opus Genetics, to develop gene therapies for orphan retinal diseases, those rare conditions not being addressed by other companies. Opus’ US$19 million in seed financing included investments from the Manning Family Foundation and Bios Partners. Its first 3 targets are for LCA caused by mutations in LCA5, RDH12, and NMNAT1. 

The LCA5 and RDH12 therapies were developed preclinically by Opus cofounder Bennett and licensed from the University of Pennsylvania. The NMNAT1 treatment was developed in the laboratory by cofounder Dr Eric A. Pierce, MD, PhD, and licensed from Harvard Medical School’s Massachusetts Eye and Ear. Opus plans to launch a clinical trial for LCA5by the end of 2022. In April 2022, the company signed a collaboration agreement with Resilience to provide manufacturing services for its gene therapy pipeline.

In October 2020, the RD Fund realised its first financial win when Novartis acquired Vedere Bio for around US$280 million. In 2019, the fund had helped launch Vedere Bio to advance an optogenetic therapy developed by its scientific cofounders Dr John G. Flannery, PhD, and Dr Ehud Isacoff, PhD, from the University of California, Berkeley. 

The investigators’ approach—a gene-agnostic gene therapy—provides potential vision restoration for patients who have lost all their photoreceptors to a condition such as RP by delivering a gene that expresses a light-sensing green cone opsin in surviving ganglion cells. In essence, the treatment enables ganglion cells to work like a back-up system for lost photoreceptors. 

The approach holds promise for restoring vision for patients who are completely or nearly blind, regardless of the mutation causing their disease. A new incarnation of the company, VedereBio II, was subsequently launched after the Novartis acquisition to continue development of other retinal gene therapies.

Also in 2020, the RD Fund invested in the gene therapy start-up Atsena Therapeutics, which reported early, encouraging vision improvements for 3 patients in a phase 1/2 clinical trial for its LCA (GUCY2D mutations) gene therapy. Cofounded by Dr Shannon E. Boye, PhD, and Sanford L. Boye, MS, both of the University of Florida in Gainesville, Atsena also has preclinical gene therapy programs for X-linked retinoschisis and Usher syndrome type 1B.

SparingVision, another RD Fund investment, is planning to launch a clinical trial in 2022 for its gene-agnostic, cone-preserving therapy for patients with RP, Usher syndrome, and related conditions. 

Nearly 2 decades ago, Dr José-Alain Sahel, MD, and Dr Thierry Léveillard, PhD, investigators from the Institut de la Vision in Paris, France, identified a protein secreted by rod photoreceptors that is critical to the survival of cones. Aptly named rod-derived cone-viability factor, it is the protein expressed by SparingVision’s cone-preserving gene therapy. The company is also developing a gene therapy that restores light sensitivity to cones that have lost their ability to process light due to advanced forms of RP, Usher syndrome, and related diseases.

The RD Fund’s other gene-related therapy investments include SalioGen Therapeutics, whose Saliogase technology seamlessly inserts new DNA of any size (eg, the Stargardt disease gene ABCA4) into precise, defined genomic locations.The fund also invests in ProQR Therapeutics, which has an RNA therapy in a phase 2/3 clinical trial for individuals with Usher syndrome 2A and nonsyndromic RP caused by mutations in exon 13 of the USH2A gene.

“We are off to a great start with our investments and working to continue to expand our portfolio with the strategy of investing in strong science being developed by well-managed companies,” said Yerxa. “I think our coinvestors recognise and appreciate our commitment to making every shot on goal really count.”

Foundation Fighting Blindness is a driving force in advancing retinal gene therapies into clinical trials.

Gene therapy research ushers in new therapy options for retinal diseases

Dry eye disease (DED) was first defined in 1995. Since then, its definition has been revised to include a complex, multifactorial aetiology that includes hyperosmolarity, tear film instability, ocular surface inflammation and damage and neurosensory abnormalities.

A characteristic feature of DED is disruption of the epithelial barrier at the ocular surface. Exposure of the corneal epithelium to increased osmolarity promotes inflammation, causing a cascade of events leading to apoptosis. Neurogenic chronic inflammation and disease severity worsen with inflammation induced by tear film instability and hyperosmolarity.

Cryopreserved amniotic membrane (CAM) is a promising therapy for corneal nerve regeneration and accelerated recovery of ocular surface health in patients with DED. CAM helps to improve a number of problems, such as pain, corneal staining, overall dry eye signs and symptoms (eg, discomfort, visual disturbances), corneal nerve density and corneal sensitivity.

CAM is a biologic corneal bandage designed to treat damaged corneas by creating an environment for regenerative healing. Prokera is the only US Food and Drug Administration-cleared CAM product and supports the corneal healing process without harmful adverse effects. With early intervention, its CryoTek preservation method maintains full biologic components to help rapidly restore the cornea’s own healing capabilities.

Ocular surface disease (OSD) is an underrecognized and underappreciated problem that is difficult to treat. It often affects the cornea, and treating it is not in the typical retina specialist’s skill set. Anti-VEGF therapy has become the standard of care for treating macular oedema and a range of other retinal diseases. However, intravitreal (IVT) injections require proper access and antiseptic techniques, which can cause corneal problems.

Betadine is the biggest culprit. Although it has a good track record of being a great antimicrobial and antiseptic, it can cause corneal toxicity, especially with repeated use. When patients have post-injection pain, it’s typically related to ocular surface disruption due to the betadine application. Although patients complain about the pain of the IVT shot at first, this quickly dissipates, and it’s common for patients to call in even after a few hours following injection, when they suddenly notice incredible pain (usually from the betadine) in their eye.

I have made some modifications in my practice. Rather than using a lot of betadine all over the eye, I use a more targeted approach. In some patients, for example, I will soak a Q-tip in betadine and place it over the affected area.

OSD symptoms are rarelydue to nonadherence. Instead, when patients read, watch TV, drive a car, or use a computer, they stare; and when they stare, they don’t blink, which exacerbates OSD symptoms. This eventually leads to DED and OSD. Patients who undergo IVT therapy are more likely to have blurry vision due to their retinal pathology. It is human nature to stare when you don’t see well.

When patients present with dry eyes, I tend to start them on artificial tears. If a patient shows persistent signs and symptoms despite using tears frequently, then I use punctal plugs. If the patient is having dry eye problems and needs IVT shots, this process may exacerbate their symptoms. If the patient is very symptomatic, I would potentially give the patient a trial of Prokera or anther amniotic membrane. I explain that it may be uncomfortable for a few days but it’s going to give them between 9 and 12 months of relief. Although this isn’t a perfect solution, we do not have an approved alternative to betadine at this time, so we’re trying to make the best of the situation.

I prefer this algorithm because we start with trying therapies that are least invasive and most cost-effective first, and then if these do not work, we move our way up. This process also increases adherence in patients who need injections to maintain their vision.

I like CAM because I know that, when I put it on, it is centred on the cornea. The problem with other amniotic membranes is that they may fold or not fitwell, requiring a lot of logistics, which makes the process more complicated. Amniotic membranes are not something I do on a daily basis as a retina specialist, so using CAM makes the process much easier, even if it’s abit more uncomfortable for some patients.CAM is easy and fast, and I know I’ve done it right. Retina clinicians are busy, so anything to make the process easier with the least amount of hassle is better for my patients and I.

CAM is for patients who continue to complain about their OSD signs and who are symptomatic, even though they’re using drops and plugs. These are high-need, corneal-sensitive patients. CAM won’t change the IVT therapy patients undergo, but it will make it better.

Although we are not looking to replace the general ophthalmologist or cornea specialist in managing DED, once patients start with retina specialists, most don’t see their regular ophthalmologist routinely. Retina specialists should understand that what they do can contribute to worsening dry eye. At minimum, we can recommend artificial tears for all our patients, and if they have persistent signs and symptoms, we might continue moving up the algorithm I described. Of course, conferring with their referring eye care provider is very important, as different providers have varying views on who should manage these patients’ DED.

Retina specialists need to be more aware of OSD and what patients are going through. They also need to know that giving IVT shots can have unintended consequences. One of the secondary benefits of managing DED is that retina specialists will end up with higher patient adherence. One long-term issue with current therapies is that patient adherence wanes over time. Patients don’t want to come into the doctor’s office several times. If the process of getting an IVT injection is more comfortable, then we will have better patient adherence andbetter outcomes, which make our patients, their family and our community better.

Michael A. Singer, MD, is a clinical professor of ophthalmology at The University of Texas Health Science Center in San Antonio, and director of clinical research at Medical Center Ophthalmology.

1. Craig JP, Nichols KK, Akpek EK, et al. TFOS DEWS II definition and classification report. Ocul Surf. 2017;15(3):276-283.doi:10.1016/j.jtos.2017.05.008

2. Bron AJ, de Paiva CS, Chauhan SK, et al. TFOS DEWS II pathophysiology report. Ocul Surf. 2017;15(3):438-510.doi:10.1016/j.jtos.2017.05.011

3. John T, Tighe S, Sheha H, et al. Corneal nerve regeneration after self-retained cryopreserved amniotic membrane in dry eye disease. J Ophthalmol. 2017;2017:6404918.doi:10.1155/2017/6404918

4. Prokera. BioTissue. Accessed May 19, 2022. 

CAM encourages corneal healing in patients with ocular surface disease.

Applying cryopreserved amniotic membrane following intravitreal injection

I have been on the faculty at Bascom Palmer Eye Institute for nearly 6 years since completing my fellowship in 2016. I love being an academic retina specialist because it enables me to manage complex cases in a collaborative manner while also being involved in teaching and research at a level that might not always be feasible in a private practice setting. Regardless of practice type, the patients we see are similar—those with macular degeneration or diabetic retinopathy, for example, and those seeking surgical consultations. But in the university setting, we see more patients coming for third and fourth opinions, often from great distances. I thrive on that complexity and the opportunity to work with other specialists as well as trainees.

With medical students around, a lot of teaching is woven in with patient care. This requires some delicacy in the patient interaction and can slow things down a bit. But the reward is ongoing learning and access to the fresh perspective that students, residents, and fellows can bring. Additionally, we get to work alongside glaucoma, cornea and other retina colleagues to manage complex cases.

These challenging casesare gratifying because of the collaboration: a huge benefit of academic practice is having access to other specialties in the same institution, under one roof. In addition, ideally, this mode of care enables us to come up with the best treatment plan possible for these underserved patients.

If a treatment that addresses a retinal issue also exacerbates the patient’s glaucoma, for example, there may not be a straightforward solution, so close collaboration helps us ensure we have accurately weighed the risks and benefits. The best way to address these cases is through extensive communication, investing time even before or after clinic hours to talk to colleagues, send notes, and make sure everyone is on the same page. An advantage of being in the same building is that I can sometimes pick up the phone and walk a patient over to see a colleague in the cornea or glaucoma service.

For example, recently I took care of a patient with complex and rare polymicrobial delayed postoperative endophthalmitis and retinal detachment after cataract surgery. With multiple retinal surgeries, the infection has cleared and the retina is attached; however, the patient’s cornea has decompensated and I am now working with one of my cornea colleagues 2 floors up on a plan for partial corneal transplantation.

In academia, we deal with a certain level of bureaucracy that may not exist in a private practice setting, so we give up some degree of control in exchange for other positive aspects of academic practice. On the other hand, we do not have to worry as much about managing employees, office overhead, rent, and staffing as someone in private practice might. In addition, we often have more opportunities to attend and present at conferences and greater access to educational activities, whether as a teacher or learner.

The clinic workload may also be somewhat less in academic vs private practice settings. I am in my own private clinic 2 days per week on average, whereas those in private practice may be in clinic 4 to 5 days per week. On my clinic days, I typically have 50 to 60 patients scheduled, of whom about 90% show up. I operate on an average of 1 day a week, and I spend 1 full day staffing a resident retina clinic. Finally, I have an average of 1 “academic” day per week, which is typically filled with administrative responsibilities for our fellowship and residency programs, clinical research, add-on surgical cases, and lectures for medical students.

My advice for those who may want to explore academic retina practice would be to think about the “why.” There are many advantages to being in private practice and some challenges inherent to the academic setting, so people who will thrive in academic retina are typically passionate about teaching, seeing complex and tertiary referral-type cases, and being involved in multidisciplinary care. We are fortunate as retinal specialists that research is possible in both the academic and private worlds; however, basic science and translational projects are typically easier to access in the university setting.

Dr Jayanth Sridhar shares a day in the life of an academic retina specialist.

A window into the world of academic retina practice today

Today, more than 50% of patients with wet age-related macular degeneration (AMD) are treated off-label with repackaged intravenous bevacizumab (Avastin) that was formulated and packaged for oncologic use. This anti-VEGF chemotherapy agent is approved for systemic administration in multiple cancers but has no approved indications in ophthalmology, despite its widespread use in treating a variety of retinal diseases.

Other anti-VEGF therapies that are US Food and Drug Administration (FDA)-approved specifically to treat retinal diseases—including ranibizumab (Lucentis), aflibercept (Eylea), brolucizumab-dbll (Beovu), and faricimab-svoa (Vabysmo)—are much more expensive than off-label bevacizumab. The result: Many clinicians are forced by insurance companies to use the much-less-costly systemic bevacizumab for many of their patients.

Because bevacizumab is not intended or packaged for intravitreal injection, it must be obtained from compounding pharmacies to be used in the eye. These pharmacies repackage very small quantities of oncologic bevacizumab into syringes for intravitreal injection for conditions such as wet AMD, diabetic macular oedema, and branch retinal vein occlusion.

Although these repackaged bevacizumab syringes appear to satisfy an urgent clinical and financial need for patients with a variety of retinal disorders, they are known to be associated with considerable public health concerns due to the risks posed to patients from compounding pharmacies’ lack of compliance with a variety of FDA requirements. This article will examine some of the dynamics of repackaging bevacizumab into syringes for intravitreal use and suggest a way to eliminate these risks to allow physicians to continue to use bevacizumab for their patients.

What is repackaging, and why does the FDA allow it?

Pharmacy compounding, including repackaging, is permitted under FDA regulations when a physician prescribes medication for an individual patient that is unavailable commercially in the dosage and/or form needed by that individual patient. Examples of compounding include creating liquid formulations of medications that a baby or older patient cannot swallow in solid form. Bulk compounding of medications is not legal if the medication is commercially available (eg, FDA approved) in a form or dosage that is appropriate to treat the patient.

In the case of repackaged systemic bevacizumab, with no approved ophthalmic formulation, the only way for retina specialists to use the drug for intraocular injection is through off-label pharmacy repackaging. Compounding pharmacies aliquot small doses to create prefilled syringes of bevacizumab from a large vial for intraocular injection. Through this mechanism, retina physicians have relied on repackaged systemic bevacizumab for nearly 15 years to provide a cost-effective anti-VEGF therapy to their patients.

Although repackaged bevacizumab has helped millions of patients maintain and even improve vision for a variety of previously blinding retinal disorders, the approach may, nonetheless, unavoidably put patients at risk. This situation is largely due to the process of drawing up multiple syringes from a single vial, as well as to the fact that bevacizumab—developed and packaged for oncologic use—is not formulated to meet the FDA’s specific standards for ophthalmic injectables. The agency’s chemistry manufacturing and controls standards are an integral part of the FDA requirements for any drug approval, and the syringes that contain aliquoted bevacizumab have not undergone this rigorous review and vetting.

Typically, 70 to 80 separate aliquots are taken from one bevacizumab vial and repacked for intraocular use. This repetitive process opens the door to contamination; one of the most serious risks from contamination is bacterial endophthalmitis. Unfortunately, cases of endophthalmitis caused by repackaging of bevacizumab have been reported.

Other problems can also present. The repackaging process relies on human judgment as to the quantity of drug aliquoted into each syringe, and given that only a tiny amount is needed, even a small variation due to human error can significantly affect the actual dosage that a retina patient eventually receives. Studies

 have shown that prefilled syringes vary in terms of how much bevacizumab is provided, with underdosing being common; the impact of underdosing, of course, is that patients may appear not to be responding appropriately to treatment, when in fact they simply may be receiving a subtherapeutic dose of the anti-VEGF medication. 

Other risks derive from lack of FDA-reviewed analytical methods, specifications, drug stability data, unknown quantities of particulates or bacterial endotoxins, unverified FDA-approved pH levels, or even the temperatures at which the syringes are filled, stored, and shipped. Faulty performance along any of these dimensions can damage the molecule and compromise its safety and efficacy.

The syringes used to draw up an aliquot of bevacizumab can also introduce problems, including precipitating agglomerations of the molecule’s proteins such that the osmolarity of the drug solution in the aliquoted vial is compromised.

 Moreover, the prefilled syringes themselves often do not meet the FDA’s standards for ophthalmic injectables, may contain silicone lubricant that can be expelled into the eye and cause permanent visual obstruction and increases in intraocular pressure,

 or are not ophthalmic syringes at all but rather ones created for other uses (such as insulin injection). There are no standards or guidelines for the syringes containing repackaged bevacizumab.

When the FDA approves a drug for commercial marketing, in addition to establishing safety and efficacy, it also reviews and regulates the actual manufacturing process, the specific manufacturing equipment employed, and the packaging that will be used for the finished drug product. Current Good Manufacturing Process, or cGMP, is the global gold standard for pharmaceutical manufacturing and a threshold that must be met to secure FDA approval. The FDA demands that manufacturers of approved medications comply with all cGMP protocols. Repackaging pharmacies may not abide by cGMP standards when individual syringes are drawn for intraocular use.

In the interests of providing their patients with a proven anti-VEGF therapy at a more workable pricepoint than is possible with the currently approved anti-VEGF retinal therapies, physicians have long relied on repackaged bevacizumab from compounding pharmacies—and indeed the molecule has proven itself a valuable therapy for many years. But a solution to the risks that repackaging entails, as delineated above, would be a bevacizumab molecule that is specifically developed and optimized to meet all the FDA’s rigorous requirements for an ophthalmic injectable, manufactured in a cGMP facility, packaged with a vial or syringe specifically designed for ophthalmic use, and introduced into the market via the established supply chain.

Such a product would bring retina physicians and their patients a safe and effective FDA-approved option, using a trusted and well-understood molecule, that mitigates the risks they currently face from repackaged bevacizumab from compounding pharmacies.

Szilárd Kiss, MD, is the Bob and Dolores Hope–Robert M. Ellsworth, MD, Distinguished Associate Professor in Ophthalmology and director of clinical research in ophthalmology at Weill Cornell Medical College in New York, New York. His clinical interests include complex vitreoretinal surgery and treatment of age-related macular degeneration and diabetic retinopathy.

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Although off-label repackaged bevacizumab syringes appear to satisfy an urgent clinical and financial need for patients with a variety of retinal disorders, they are known to be associated with considerable public health concerns due to the risks posed to patients from compounding pharmacies’ lack of compliance with a variety of FDA requirements.

Modern Retina Europe Summer 2022

Fight Retinal Blindness! registry data: Ranibizumab and aflibercept safe for treating DMO over 3 years

Gene therapy research ushers in new therapy options for retinal diseases

Applying cryopreserved amniotic membrane following intravitreal injection

A window into the world of academic retina practice today

Intravenous bevacizumab repackaged for intravitreal use: Making the sight-saving treatment safer