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Rather than speculating in a vacuum about the future of remote monitoring in ophthalmology, it is better to explore how other specialties in medicine adopted and integrated remote monitoring into their care plan frameworks.

Listening to the heart: Lessons from cardiology in remote monitoring and AI

Technology that allows consistent monitoring could be useful tools in 2022—and may be the key to tracking nAMD progression in fellow eyes among patients who have had intervals extended due to new technology. 

Monitoring patients for neovascular AMD in the office and at home

Angiogenesis, Exudation, and Degeneration 2021 Virtual Symposium highlights and thoughts on current treatments options for DME and exudative AMD are discussed. 

Angiogenesis 2021 Virtual Symposium Takeaways & Final Thoughts

Anat Loewenstein, MD, MHA, explores dual Ang-2/VEGF-A inhibition in the management of diabetic macular edema and exudative age-related macular degeneration. 

Ang-2/VEGF-A Inhibition Synergistic Effect in DME and AMD

Significance of the Higher Molar Dose of Aflibercept 8 mg

Video content above is prompted by the following: 

Aflibercept 8 mg was recently approved for treating age-related macular degeneration and diabetic macular edema. Could you discuss the significance of the higher molar dose?

Panelists discuss how the aflibercept 8 mg higher molecular concentration enables extended durability through increased VEGF binding capacity and longer intraocular drug levels, potentially allowing for less frequent dosing while maintaining efficacy.

clinical

Video Series

A European study found that temperature changes have the potential to adversely affect anti-vascular endothelial growth factor (VEGF) drugs when patients store them in their homes. These changes can result in bacterial contamination, loss of drug activity, and inflammation,1 according to first author Inès Ben Ghezala, MD, PhD. She is from the Ophthalmology Department, Dijon University Hospital, and Inserm, CIC 1432, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, Dijon University Hospital, both in Dijon, France.

Increasing numbers of patients are being treated with anti-VEGF drugs worldwide. In some cases, according to the investigators, patients are instructed to obtain the drugs from a pharmacy, store them in their homes, and then bring them to their physicians for intravitreal injection.

Because of this step in the treatment process, the researchers conducted a quality improvement study to determine both if patients were adhering to the drugs’ storage guidelines and the effectson the drugs if they were not adhering to the storage guidelines. The study included all consecutive patients with new or renewed prescriptions for intravitreal anti-VEGF agents prescribed to treat any macular disease.

The investigators gave the participants a time-temperature indicator that changed color according to brief (2-12 hours), moderate (12-48 hours), and prolonged (≥48 hours) exposure over 8 °C. The indicator was activated at the time of the anti-VEGF agent delivery to the participant in community pharmacies, they explained.

During the study period that ranged from May 27 to June 7, 2024, 50 participants who were treated with intravitreal anti-VEGF agents received a time-temperature indicator. Of those, 38 participants (24 [63.2%] women; median age, 79.3 years) returned with their drugs to undergo an intravitreal injection with an analyzable indicator.

The authors reported, “Of the 38 analyzable indicators, all showed temperature excursions above the threshold of 8 °C, including 26 (68.4%) for 12 to 48 hours and 11 (28.9%) for 48 hours or longer.”

After the injection of the anti-VEGF drugs, no ocular adverse effect developed that might be associated with development of severe intraocular inflammation.

In commenting on their findings, the authors pointed that the anti-VEGF agents were exposed to temperatures above 8 °C for 48 hours or longer in 28.9% of participants while the drugs were stored in their homes.

“While it is unknown how these 38 participants relate to other patients worldwide who are required to obtain their own anti-VEGF agents, these findings suggest that patients need to be educated about the importance of rigorous maintenance of cold storage of their anti-VEGF agents,” Dr. Ben Ghezala and colleagues concluded.

1. Ben Ghezala I, Steinberg L-A, Sibert M, et al. Temperature excursion of intravitreal anti-VEGF agents during home storage. JAMA Ophthalmol. 2025; published online January 16. doi:10.1001/jamaophthalmol.2024.5884

Home-stored anti-VEGF drugs face risks from temperature changes, pointing to a need to protect efficacy and avoid dangerous contamination.

Potential effect of temperature changes on anti-VEGF drugs

Overview of Novel Treatments for Retinal Vascular Diseases

Video content above is prompted by the following: 


Could you briefly provide an overview of the new treatments available for retinal vascular diseases?

A panelist discusses novel treatments for retinal vascular diseases, including faricimab, aflibercept, and port delivery system with ranibizumab.

Retinal Disease 

Advantages of the molecular structure of aflibercept

Aflibercept 2 mg is considered the standard of care for retinal vascular diseases. Can you briefly explain the structure of the aflibercept molecule and its significance?

Panelists discuss how aflibercept’s molecular structure contributes to its clinical efficacy as a standard treatment for retinal vascular diseases.

Evolution of anti-VEGF agents and unmet needs in retinal diseases

Anti-VEGF treatments have been available for age-related macular degeneration and diabetic macular edema for over a decade. Can you discuss how they have impacted patient outcomes and what barriers remain to achieving optimal results?

Panelists discuss how anti-VEGF therapies have dramatically improved visual outcomes in patients with age-related macular degeneration and diabetic macular edema over the past decade. Key challenges persist, including treatment burden, adherence, and identifying optimal dosing regimens for individual patients.

Evolution of Anti-VEGF Agents and Unmet Needs in Retinal Diseases

Aaron Nagiel, MD, PhD, gave an interview discussing the work that he and the team at Children’s Hospital Los Angeles (CHLA) have been doing in the retinal gene therapy space. This interview comes at the team celebrates its 100

Since 2018, Nagiel and his team at the Vision Center of CHLA have been treating these patients with the gene therapy, Luxturna, for the treatment of Leber congenital amaurosis (LCA). CHLA was the first center on the West Coast to administer this treatment after it was approved by the Food and Drug Administration in 2017.

, Nagiel shared how he found a path to working in pediatric retinal diseases and his firsthand experience seeing patients improve following treatment at CHLA. When it comes to determining if treatment is right for a patient, he shared the process that CHLA follows including the following eligibility criteria for treatment with Luxturna. He said, “patients must be older than 12 months and show mutations in both copies of a gene called 

. If a patient has one healthy copy of this gene, they don’t have the disease. We lean on CHLA’s Center for Personalized Medicine for this part of the screening. CHLA is one of the only pediatric medical centers with in-house genomic and molecular pathology support. This is critical because more than 300 genes can cause these retinal degenerations. We need to be sure beyond a doubt that patients have this particular form of LCA before we treat them.”

Nagiel spoke to the impact of preserving and restoring vision are significant. He said, "Some patients start observing significant improvements within the first week. They’re essentially seeing things that they could never have seen before. I've had patients who, during their first follow-up visit, can make out the fish in the fish tank for the first time. Parents have also told me the stories of their kids noticing a bird flying, or a cloud in the sky, for the first time in their lives.”

As this interview reflected on the progress in pediatric gene therapy thus far, Nagiel was also asked to comment on the future of the gene therapy space: “We continue to recruit people for several clinical trials advancing the leading edge of gene therapy treatment. There are a number of adults, for whom gene therapies weren’t available when they were young, who come to CHLA for treatment and also participate in these trials. Today, these diseases are often diagnosed in childhood, so there's no reason we should even be treating adults in the future. In 10 years, we hope that all patients with these diseases can be identified when they’re young, treated when they’re young—and experience life-changing vision improvements for their lifetimes.”

1. Children’s Hospital Los Angeles Celebrates 100th Retinal Gene Therapy Procedure. Children’s Hospital Los Angeles. December 6, 2024. Accessed December 9, 2024. https://www.businesswire.com/news/home/20241206063665/en/Children%E2%80%99s-Hospital-Los-Angeles-Celebrates-100th-Retinal-Gene-Therapy-Procedure

This interview comes at the Children's Hospital Los Angeles team celebrates its 100th retinal gene therapy procedure.

Anat Loewenstein, MD, MHA

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