The One Thing: IOL choices, gene therapy and TKI trials, the patient in the chair | Episode 5

From the cataract and refractive suite to the retina clinic to the patient in the chair, the options keep multiplying. The Eye Care Network put one question to three ophthalmologists in the latest episode of The One Thing: “What aren’t ophthalmologists talking about enough?” Their answers cover why understanding how intraocular lens (IOL) options differ is key, a retina pipeline filling with gene therapy and tyrosine kinase inhibitor trials, and what repeated treatment asks of patients.

Helping doctors sort through lens options

Uday Devgan, MD, FACS, of Devgan Eye Surgery, says ophthalmologists share a foundation in optics. “At the end of the day, we’re all scientists. We all study lots of science in school, especially optics, and so we understand that real well.”

He points to the growing list of choices: “We’ve got monofocal lens which you’re used to. Then now there are monofocal plus, and there are a few different flavors of that. Now there are EDOF, extended depth of focus lenses, a few different varieties of that one.” Understanding how the options differ, he says, can be “sometimes a little difficult.”

What the retina pipeline will bring

Jordana G. Fein, MD, MS, of Retina Group of Washington, says, “I’m excited about things like gene therapy, and the potential for tyrosine kinase inhibitors.” She adds, “some of these clinical trials are really relatively far along. And I think we’ll probably hear about some readouts” from phase 3 trials.

The landscape is also getting “a lot more complicated, as we have more options to pick from going forward,” she says, so “these discussions about what we use when is only going to grow.”

The patient experience of treatment burden

Carl D. Regillo, MD, FASRS, is a partner at Mid Atlantic Retina, former chief of the Retina Service at Wills Eye Hospital and professor of ophthalmology at Sidney Kimmel Medical College at Thomas Jefferson University. He is also cohost of The Wills Retina Report with Regillo & Garg podcast series powered by Modern Retina.

Regillo says, “I think we need to talk more about the patient experience.” Effective anti-VEGF therapies have left the field “still somewhat in the honeymoon phase,” he says, but for patients, “it’s really challenging. It’s difficult for the patients to get to the office, to get injections on a frequent to regular basis.”

“Decreasing treatment burden is the term we all use. But, sustained delivery is really the best way to approach that.” The patient experience, the burden and “maintaining the best possible vision,” he says, “needs to be always part of the conversation.”

What the responses share

Each answer asks for clearer conversation about what changes for the clinician or patient as options multiply: more lenses to explain, more retina therapies to weigh, and more demands on patients receiving care. The One Thing is an editorially independent KOL-voiced series from the Eye Care Network that asks ophthalmologists to name the issue they believe deserves more attention. The views and perspectives are those of the ophthalmologists.