At CIME 2025, Luke Lindsell, OD, MD, shares thoughts on comanaging challenging retina cases

Luke Lindsell, OD, MD, speaks about new and emerging therapies in retinal care at the recent Controversies in Modern Eye Care meeting.

Luke Lindsell, OD, MD, recently chatted with the team at Ophthalmology Times to discuss his presentation at the Controversies in Modern Eye Care meeting, which took place on May 4, 2025, in Los Angeles, California. Lindsell presented on new and emerging retinal therapies in 2025, concentrating especially on strides made in geographic atrophy (GA), imaging, and comanagement of complex cases.

Lindsell is an optometrist first, and then went back to medical school and is now an ophthalmologist and retina specialist in Cincinnati. He practices at the Cincinnati Eye Institute and holds a teaching position at University of Cincinnati. His unique background bridges the optometry and ophthalmology communities, making him a strong advocate for collaborative care.

Q&A with Luke Lindsell, OD, MD

Q: The title of your talk at this year’s Controversies in Modern Eye Care meeting was “You’re my only hope: Retina therapy 2025.” So I ask you: What is new in retina in 2025?

A: Having any therapy at all for GA has been exciting. We now have two compounds being used extensively, and that’s gone very well. I’m also excited about the potential to prevent GA. The new Valeda device (LumiThera), which uses photobiomodulation, has shown some promising preliminary data suggesting GA might be preventable. That’s really exciting. There are also clinical trials exploring at-home therapies, where patients could receive a subcutaneous injection instead of intraocular, possibly achieving the same benefit. What I’m most excited about is gene therapy. While nothing is FDA approved yet, the clinical trial results have been remarkable in reducing the injection burden for patients—something they ask about constantly. Having a treatment that could eliminate or significantly reduce the need for ongoing injections is very promising.

Q: Do you have any tips or tricks for more effective imaging?

A: Most of us now have OCT in our exam rooms, and many are beginning to use autofluorescence more. I encourage everyone to utilize that function—whether on a widefield camera or OCT—as it reveals information not visible on color fundus photography or OCT alone. Sometimes you need to combine autofluorescence with another modality, such as near-infrared or red-free imaging. GA can be difficult to detect at the fovea due to natural hypoautofluorescence in that area, but combining OCT with near-infrared imaging can help identify small GA lesions at the fovea.

Q: How do you determine when it’s time to refer a patient to a retina specialist vs. managing the case in an optometry setting?

A: It depends on the comfort level of the provider. Some optometrists are comfortable managing early to moderate diabetic retinopathy or macular degeneration. I encourage optometrists to lead in the early stages of retinal care—discussing supplements and glycemic control. But when vision is at risk or there's a need to consider new therapies, that’s the time to start a referral conversation. Obvious cases, like retinal detachments, need immediate referral. However, I think we need better collaboration in managing early to moderate cases of macular degeneration and diabetes. Instead of referring immediately, optometrists can often manage these cases effectively in their own offices.

Q: What is your best pearl for comanagement of patients with retinal disease?

A: I make it very clear to referring doctors that the patient is not solely mine. I don’t want them to feel like I’m taking over the patient, especially since I’m in a multidisciplinary practice with many doctors who could also provide care. I always tell both the patient and the referring physician that we are comanaging their care. I’m treating one aspect of the patient’s eye health, and their optometrist is managing the rest. Establishing that shared decision-making process among the patient, myself, and the referring doctor is key.

Q: Is there anything that you, as a retina specialist, wished more eye care providers knew about managing retinal cases?

A: It often comes down to understanding what we can and cannot do. It’s never wrong to refer, but sometimes I’ll see a patient with count fingers vision and geographic atrophy from arcade to arcade. At that stage, there’s not much we can do to restore vision. Stem cell therapy might be an option in clinical trials, but nothing definitive is available. It's important to set realistic expectations. When optometrists recognize that treatment may no longer be effective due to the disease stage, setting that expectation helps the patient understand the limits. Sometimes patients just need to hear the same thing from a second provider to feel confident. I even encourage my own patients to get second opinions. It’s not a bad thing—it’s part of helping them process their condition and care options.