Retina Society 2026: Exudate control similar in Coats disease and Coats-like disease in inherited retinal diseases

At the Retina Society 59th Annual Scientific Meeting, Emily Eton, MD, discussed a multicenter study comparing traditional Coats disease with Coats-like exudative vasculopathy in patients with inherited retinal diseases (IRDs).

The work built on preliminary data from Eton's institution. That early analysis suggested that patients with traditional Coats disease did slightly better anatomically. Progression to no light perception vision was similar in both groups, and patients with Coats-like reactions in IRDs tended to need more injections. Because the initial cohort was small, the investigators expanded to a retrospective, nonconsecutive study across 10 centers.

Demographics and stage at diagnosis

Traditional Coats disease tended to be unilateral and to affect males, whereas most bilateral presentations occurred in the IRD group. Traditional Coats disease was also diagnosed at a much younger age. The investigators suspect that many patients with IRDs had the condition detected on routine examination, possibly after vision had already declined. Early-stage Coats diagnoses were more common in the IRD group than in the traditional Coats group.

Treatment patterns and outcomes

Overall anatomic success, meaning control of exudate through stabilization or improvement, was the same in both groups. Laser was used much more often in traditional Coats disease. The rate of injection use was similar between groups, but patients in the IRD group received many more injections.

• Secondary analyses are exploring possible explanations:
• macular edema related to the underlying IRD
• reluctance to use laser in these eyes
• more posterior disease

The study was not large enough to compare outcomes by specific genetic mutation, which Eton identified as a question for future research.

Clues to a Coats-like presentation

Eton described typical Coats disease as unilateral, often located in the inferotemporal periphery, and more common in males. Other findings should prompt consideration of genetic testing for inherited retinal degeneration and for syndromic conditions such as telomeropathies, including Coats plus disease:

• more symmetric bilateral disease
• pigmentary changes
• subnormal vision with mostly peripheral findings

Counseling and gene therapy

When counseling families, Eton stressed that "we are now treating two different diseases." The Coats-related exudation can often be well controlled, while the underlying retinal degeneration continues to progress.

Eton noted that voretigene neparvovec-rzyl (Luxturna; Spark Therapeutics) is currently the only FDA-approved gene therapy. She said mild, peripheral stage 1 Coats disease that does not interfere with creating a subretinal bleb is probably acceptable. More advanced disease with posterior involvement could compromise delivery of a gene therapy agent.

Advice for general ophthalmologists

Eton urged general ophthalmologists not to hesitate: “If it even crosses your mind, you can write it in the chart, and you can refer." She noted that early treatment helps in both conditions.