Q&A: Mark Gillies the outcomes of injecting VEGF inhibitors

Mark Gillies, MD, PhD, introduced the Fight Retinal Blindness! Project, a comprehensive registry tracking VEGF inhibitor eye injection outcomes since 2007. Spanning 20 countries with 150 active practitioners, the project uniquely captures 100% data quality from every patient visit. The registry distinguishes itself by collecting complete information on multiple drugs, tracking adverse events, and providing detailed insights into new treatments like Eylea HD and Vabysmo, offering valuable research for ophthalmological interventions.

Note: The following conversation has been lightly edited for clarity.

Ophthalmology Times: You are part of a registry gathering data tracking VEGF inhibitor injection outcomes. Can you share what this registry is and how it differs from other data collection models?

Mark Gillies, MD, PhD: I direct the Fight Retinal Blindness! Project, which is a retinal treatment outcomes registry. We established this in 2007 to track the outcomes of injections into the eye of VEGF inhibitors. Since then, we've grown to include about 20 countries around the world, in Australia, Asia and Europe; and we have about 150 practitioners who are actively entering data.

The unique thing about our registries is we identified a minimum prospectively-identified outcome set that has to be tracked at every visit. If you try to finalize the data without entering all the in-range fields, then it won't accept it, and it tells you what you have to fill out. So, you get 100% quality data from every visit, for every patient, for the last 20 years. With this, we've been able to do many analyses. We've published about 100 publications over the last 15 years, and we distinguish ourselves from the other registries because they tend to scrape data. So the IRIS registry, for example, will just scrape electronic medical records, but they don't get complete data from every visit. Other registries, like Spectrum or Voyager will only do one drug. They can't compare with the other drugs, whereas we track all the drugs.

OT: What data from this registry are you presenting at EURTINA 2025?

Gillies: At this meeting, we've been presenting data on the new VEGF inhibitors, Eylea HD and Vabysmo. These drugs definitely have improved efficacy over the first generation inhibitors. They both seem to last longer, and they're both stronger. These things go hand in hand, the stronger drying effect, and you'll get longer duration between the injections. So that's very good news for all the practitioners. The question is, you know, which drug is going to be best for which patient. We also track uniquely the adverse events associated with treatment. We grade atrophy at each visit, and we grade fibrosis at each visit. The data I'm presenting at this meeting suggests that Vabysmo may have lower rates of subretinal fibrosis in the eyes treated compared with first-generation VEGF inhibitors. We haven't got the data yet to see if that also occurs with Eylea HD. There's a bit more inflammation associated with these second generation inhibitors. Whether that's clinically significant or not, we don't know, because generally, it's fairly mild and transitory.

We also track inactivation rates, which the other registries don't track. We find much stronger rates of inactivation. So we need to run these data out longer. But what we're finding, initially, from these new second generation inhibitors is that they do give you better effects, and you get longer duration between the treatments for our patients with similar visual acuity outcomes. We will accumulate more data as we go. These things become stronger as you go. So at the moment for Vabysmo, it's 2 years, and for high dose Eylea it's just 1 year. But in 3 or 4 years, it will have really good amounts of data so that we can tell which drug is going to be best for which patient. We will also track the biosimilars as they come out. They haven't really been through such a thorough evaluation process, but we'll be tracking them just like the other drugs, and we'll see whether they really are as efficacious as they claim to be and as safe as they claim to be.

OT: Where are the sites located that are compiling this data?

Gillies: We've already [collected data from] 20 countries, most of them in Europe. We probably won't penetrate the US market. Observational studies in ophthalmology in in the United States, are not that highly regarded, and they think they've got it covered with IRIS, but we don't think the data is a good enough quality to get the answers that we really need. We're starting a site in Mexico. We're starting some sites in India, at the moment. We may pick up a couple more European countries. But we've got pretty well, pretty strong, diverse worldwide coverage as it is.

It's possible to contribute to this project pretty easily. The database has been designed by clinicians. We're working on single-point data entry. We're supported by pharma, but they don't get patient-level data. We just give them high-level analysis of their drug every couple of months, which they're happy with, and we do pre-agreed reports on the efficacy at 1- or 2-year outcomes of their drugs. The doctors who participate cannot be associated with their data. It's free of charge. I think it's probably the best system that there is available at the moment, if you'd like to track your own data.