Loading Dose Adjustments and Treatment Switching Strategies in Retinal Vascular Diseases

This segment explores real-world approaches to loading dose protocols and dosing interval management when initiating or switching anti-VEGF therapies. The panel discusses how closely clinicians adhere to recommended loading regimens and the practical barriers to doing so, such as payer denials and label restrictions. They note that while loading doses may not always confer a clear pharmacologic benefit, they often improve patient engagement, adherence, and treatment predictability—especially in diabetic macular edema (DME) where consistent early therapy builds trust and compliance. The discussion highlights how under-treatment in real-world practice contributes to outcomes that lag behind clinical trials, reinforcing the importance of consistent dosing early in the treatment course. In the latter portion, the experts share strategies for transitioning patients who plateau on aflibercept 2 mg—such as reloading or maintaining short intervals temporarily—before extending dosing on higher-dose or dual-pathway agents to achieve improved drying, durability, and long-term disease control.