AAOpt 2022: Thinking about the variety of anti-VEGF modalities in the past, present, and future

Anthony DeWilde, OD, FAAO, adjunct instructor for the University of Missouri College of Optometry, and director of the Tele-Eye Imaging Program for VA [Veterans Affairs] Kansas City Health Care, speaks with Optometry Times®' Kassi Jackson on highlights from his discussion titled, "Anti-VEGF and the eye: Past, present and future," which he presented during the 2022 American Academy of Optometry (AAOpt) Meeting in San Diego.

Editor's note: This transcript has been edited for clarity.

Jackson:

Hi everyone. I'm Kassi Jackson with Optometry Times, and I'm joined today by Dr. Anthony DeWilde, adjunct instructor for the University of Missouri College of Optometry and director of the Tele-Eye Imaging Program for VA [Veterans Affairs] Kansas City Health Care. He's here to share highlights from his discussion titled, "Anti-VEGF and the eye: Past, present and future," which he is presenting during the 2022 American Academy of Optometry Meeting, held this year in San Diego. Thank you for being here, Dr. DeWilde.

DeWilde:

Thank you so much, Kassi, for having me. I appreciate it.

Jackson:

Absolutely. So would you please share with us the key takeaways from your presentation?

DeWilde:

So for the anti-VEGF in the eye, when we think about the modalities we have for this, there's a bunch of different applications that are coming up. I mostly focus on the posterior segment. So talking about treating wet AMD and creating retinal vein occlusions and treating diabetic retinopathy. So whether that's proliferative diabetic retinopathy or diabetic macular edema. Some of the key takeaways have to do with, as optometrists, when do we actually refer these patients? What are we looking for? And what kind of expectations should we expect for our patients when it comes to the outcomes? Are they going to have good outcomes or not? And how are we going to co-manage that with the ophthalmologists?

Jackson:

Great. And what does this mean for patient care?

DeWilde:

So for patient care, and this affects a lot of patients. So we have at least in the VA [Veterans Affairs], we have a ton of patients who have diabetic retinopathy, a ton of patients with AMD and vein occlusions. So from our standpoint of the VA [Veterans Affairs], and I'm sure with a lot of other optometrist and different patient care modalities, they're going to have a lot of these patients as well.

So for us, it's really important to understand, again, as I mentioned, when to refer them. But also for patient education, what's the patient going to be going through? How many of these injections are they going to get? What kind of expectations for how long they're going to get them? And then what should the patient expect from an endpoint? Is it something that's going to improve their vision, maintain their vision? Or should they expect any sort of change at all?

Jackson:

And what do you hope the audience took away from your presentation?

DeWilde:

No, for me, what's interesting is these anti-VEGF medications came out right about the end of my student internships and the beginning of my residency. And so about 2007 is when we started getting a lot of talk about this, especially with Lucentis and Avastin, for these treatments, especially, just at the start, with AMD. And at that time, it was really interesting to see that sort of shift in how we talk to patients and how we educate them and how we refer them.

At that time, really, there wasn't a whole lot we could do for them, there were laser therapies, we could do low vision therapies, but there just wasn't anything great to help them. So this was kind of a paradigm shift when it came to treatment modality for it. And what was so interesting is to see how this is now, gosh, 15 years later, and what we're talking about. So now we're talking about things like long-acting anti-VEGF, so we only have to give it every two or three months potentially. We're talking about different types of anti-VEGF, where you can maybe even implant it in the eye and not have to give a monthly injection.

So we've really come a long way in those 15 years. And what I hope people take away from this is that the future is pretty bright for this. It's a very good therapy. And there's a lot of potential future uses for this that don't even involve the posterior segment and maybe even involve the anterior segment.