October 30, 2020 Conference
Anti-VEGF therapy has revolutionized our management of diabetic eye disease, effectively addressing both diabetic macular edema and diabetic retinopathy. However, anti-VEGF therapy has limitations: it requires frequent injections, and only 30-45% of patients with diabetic macular edema achieve meaningful visual gains. Randomized clinical trials have demonstrated we are at the peak of the dose-response curve, with all current anti-VEGF agents achieving similar gains. New treatments focus on increasing efficacy and minimizing treatment burden. New targets beyond the anti-VEGF pathway are being studied. The angiotensin/TIE2 pathway and the plasma kallikrein pathway have been the focus of several studies, and 1 bispecific antibody targeting VEGF and ANG2 is in phase 3 study. Drug delivery, which has been elusive to date, has demonstrated promise, with the port delivery system having achieved efficacy in wet AMD, and currently being studied in diabetic eye disease. Gene therapy has also shown success in wet AMD studies, and is being studied in diabetic eye disease. Both the port delivery system and gene therapy have the potential to alleviate treatment burden and may offer some benefits over the conventional pharmacokinetics of intravitreal injections. The scope and breadth of these therapies highlight the potential of a new “revolution” of management of diabetic eye disease.