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Revisiting a classic tool that still gets you out of a jam works best when you understand its powers and limitations.

Knowing when the diamond-dusted membrane scraper is (and isn’t) the right tool

Retina World Congress 2025 will take place May 8-11. As researchers prepare for their, presentation, we are highlighting the upcoming sessions that are scheduled for this meeting, which will be held in Fort Lauderdale, Florida.

Note: The following list of presentations are in alphabetical order by company. Updates will be added to this article as new information becomes available.

The company highlight Phase 2 results for migaldendranib (MGB), Ashvattha’s investigational subcutaneous treatment for wet age-related macular degeneration (wet AMD) and diabetic macular edema (DME). The presentation, entitled, "Emerging Data om Anti-angiogenic Nanomedicine (Migaldendranib MGB/D-4517.2) for AMD and DME" will be given by Michael Singer, MD on Sunday, May 11, 2025; 11:11 – 11:16 am ET.

Phase 2 clinical data demonstrated that MGB administration lowered production of subretinal fluid reducing or eliminating the need for intravitreal anti-VEGF treatment in both the study eye and fellow eye in wet AMD and DME subjects with bilateral disease. New data indicates that MGB may be the first safe systemic therapy for the treatment of wet AMD and DME without ocular adverse events.

Huma Qamar, Chief Medical Officer at Ocugen will represent Ocugen at Retina World Congress to share a presentation and join retinal surgeons and industry peers during a panel discussion.

Inherited and Rare Retinal Diseases Session
Moderated by Rishi P. Singh, MD, FASRS and Kourous A. Rezaei, MD on Thursday, May 8, 2025, 10:35 – 11:12 AM ET

Ocular Therapeutix will present information at the meeting in Fort Lauderdale regarding the axitinib intravitreal hydrogel clinical trials, the use of its candidate OTX-TKI for diabetic retinopathy, and the HELIOS clinical trial for diabetic retinopathy.

Axitinib Intravitreal Hydrogel: Update on Clinical Trials

Presented by Carl C. Awh, MD, FASRS, on Friday, May 9, 2025, 4:33 – 4:38 PM ET.

Presented by Dilsher S. Dhoot, MD, FASRS on Saturday, May 10, 2025, 8:44 – 8:49 AM ET

Volumetric Macular Fluid Analysis of the Impact of a Single Axitinib Intravitreal Injection (OTX-TKI) from the HELIOS Clinical Trial for Diabetic Retinopathy

Presented by Carl J. Danzig, MD on Saturday, May 10, 2025, 8:52 – 8:57 AM ET

The company will present further insights from Stage 1 of the Phase 3 DIAMOND program reinforcing the efficacy and safety profile of OCS-01 eye drops for DME will also be shared. OCS-01 is being developed to be the first non-invasive treatment for DME, addressing key unmet needs for earlier treatment intervention and for inadequate responders to the current standard of care.

Ashvattha Therapeutics to Present at ARVO, Retina World Congress, and AOS Annual Meeting. Ashvattha Therapeutics. April 15, 2025. Accessed April 16, 2025. https://www.globenewswire.com/news-release/2025/04/15/3061682/0/en/Ashvattha-Therapeutics-to-Present-at-ARVO-Retina-World-Congress-and-AOS-Annual-Meeting.html

Ocugen to Present on Modifier Gene Therapy Platform at Association for Research in Vision and Ophthalmology 2025 Annual Meeting and Retina World Congress. Ocugen Inc. April 29, 2025. Accessed April 30, 2025. https://www.globenewswire.com/news-release/2025/04/29/3070074/0/en/Ocugen-to-Present-on-Modifier-Gene-Therapy-Platform-at-Association-for-Research-in-Vision-and-Ophthalmology-2025-Annual-Meeting-and-Retina-World-Congress.html

Ocular Therapeutix™ to Participate in Upcoming Investor and Scientific Conferences. Ocular Therapeutix. April 29, 2025. Accessed April 29, 2025. https://www.globenewswire.com/news-release/2025/04/29/3070022/0/en/Ocular-Therapeutix-to-Participate-in-Upcoming-Investor-and-Scientific-Conferences.html

Oculis to Present its Innovative Late-Stage Pipeline Candidates at Upcoming Ophthalmology Conferences. Oculis Holding AG. May 1, 2025. Accessed May 1, 2025. https://www.biospace.com/press-releases/oculis-to-present-its-innovative-late-stage-pipeline-candidates-at-upcoming-ophthalmology-conferences

Companies working in the retina space have announced that data from clinical trials will be shared at this year’s meeting in Fort Lauderdale, Florida.

RWC 2025: Companies to share data at meeting in Fort Lauderdale

A recent study identified a large disconnect between patients with neovascular 

 who are treated with intravitreal injections. The survey results highlighted the significant treatment burden experienced by these patients and the need for targeted education and counseling to improve their satisfaction and outcomes.

 Katie Robinson, PhD, CHCP, and colleagues reported their findings in 

. She is from the Office of Medical Affairs, Vindico Medical Education, Thorofare, NJ.

“From the patient perspective, the burden of anti–vascular endothelial growth factor [VEGF] treatment extends beyond the clinical setting,” the investigators stated.

These “logistical challenges” to the regular visits include barriers to transportation, absenteeism from work, the need for a caregiver,

 adverse effects in approximately 50% of patients from the injections that require time off from daily activities and work to recover,

 and significant fear and anxiety related to the injection procedure.

 Additional emotional and psychological factors include fear of vision loss, depression, and anxiety about long-term disease management.

In some cases, patients may need psychotherapy, support groups, or services for those with low vision.

 They also may experience a financial strain associated with the direct and indirect costs of their care.

Patients reported dissatisfaction with the injection frequency and the cumulative toll of ongoing treatment for AMD and DME.

 “These factors, combined with the physical discomfort and anxiety around the injection procedure itself, contribute to a multidimensional disease burden,”² the investigators said.

On the flip side, physicians can underestimate the effects of these conditions on patient quality of life,

 barriers that can result in nonadherence and undertreatment, contributing to suboptimal patient outcomes that are observed in real-world studies compared with clinical trials.

Robinson and colleagues undertook this survey study to determine how patients with neovascular AMD or DME perceive their disease and its treatment and assess the degree of alignment between patient and clinician perceptions.

To that end, they developed 3 surveys: one tailored for patients with DME, one for patients with neovascular AMD, and one for clinicians who injected anti-VEGF agents. The surveys were completed by 101 patients (50 with AMD and 51 with neovascular AMD) and 100 ophthalmologists who treat these conditions.

What were the survey results of the patients with AMD and DME?

The investigators reported the following key points

Sixty-six percent and 86% of patients with DME and neovascular AMD, respectively, reported receiving intravitreal injections at least once every 8 weeks.

Eight-two percent required a caregiver and/or public transportation to get to their appointments.

Vision loss over time and blurred or double vision were the most significant symptoms for patients with DME, and for those with neovascular AMD, poor night vision, seeing in low-light conditions, and blurred vision.

Dissatisfaction levels with education and counseling about their disease were higher for those with neovascular AMD (31%), compared with those with DME (11%; 

Ophthalmologists overestimated the extent to which patients perceived that injections were necessary and that patients experienced insurance barriers to receiving treatment (

They also overestimated the extent to which patients became less nervous with subsequent injections after the first injection and underestimated their difficulty of getting to appointments (

Robinson and colleagues concluded, “The findings of this survey study call attention to key barriers to effective treatment for patients and critical areas where patient and clinician perceptions of disease and treatment burdens are misaligned. Overall, these results underscore the large burden that patients face in undergoing treatment for neovascular AMD and DME. In the future, therapy that provides greater durability, fewer injections, and fewer clinic visits can help reduce the burden for patients, improve adherence, and facilitate better overall patient outcomes. Furthermore, optimal treatment will require greater understanding and communication between patients and clinicians.”

Robinson K, Cooper SJ, Persaud S, Frederick JL, Singh RP. Discordance among patients and ophthalmologists regarding the burden of intravitreal injections. 

Holekamp N, Gentile B, Giocanti-Aurégan A, et al. Patient experience survey of anti-vascular endothelial growth factor treatment for neovascular age-related macular degeneration and diabetic macular edema. 

. 2024;67(1):311-321. doi:10.1159/000538975

Müller S, Junker S, Wilke T, et al. Questionnaire for the assessment of adherence barriers of intravitreal therapy: the ABQ-IVT. 

. 2021;7(1):43. doi:10.1186/s40942-021-00311-x

Reitan G, Haugen IBK, Andersen K, Bragadottir R, Bindesbøll C. Through the eyes of patients: understanding treatment burden of intravitreal anti-VEGF injections for nAMD patients in Norway. 

 2023;17:1465-1474. doi:10.2147/opth.S409103

Jamous KF, Jalbert I, Kalloniatis M, Boon MY. Australian optometric and ophthalmologic referral pathways for people with age-related macular degeneration, diabetic retinopathy and glaucoma. 

. 2014;97(3):248-255. doi:10.1111/cxo.12119

Mitchell P, Liew G, Gopinath B, Wong TY. Age-related macular degeneration. 

. 2018;392(10153):1147-1159. doi:10.1016/s0140-6736(18)31550-2

McClard CK, Wang R, Windham V, et al. Questionnaire to assess life impact of treatment by intravitreal injections (QUALITII): development of a patient-reported measure to assess treatment burden of repeat intravitreal injections. 

. 2021;6(1):e000669. doi:10.1136/bmjophth-2020-000669

Stein JD, Brown MM, Brown GC, Hollands H, Sharma S. Quality of life with macular degeneration: perceptions of patients, clinicians, and community members. 

. 2003;87(1):8-12. doi:10.1136/bjo.87.1.8

Robinson K, Cooper S, Persaud S, Singh R. Identifying discordance among patients and clinicians regarding the burden of intravitreal injections. Presented at: Retina World Congress 2025; May 8-11, 2025; Fort Lauderdale, FL. 

Polat O, İnan S, Özcan S, et al. Factors affecting compliance to intravitreal anti-vascular endothelial growth factor therapy in patients with age-related macular degeneration. Turk J Ophthalmol. 2017;47(4):205-210. doi:10.4274/tjo.28003

Kuo BL, Tabano D, Garmo V, et al. Long-term treatment patterns for diabetic macular edema: up to 6-year follow-up in the IRIS Registry. 

. 2024;8(11):1074-1082. doi:10.1016/j.oret.2024.05.017

A study reveals significant treatment burdens for patients with AMD and DME, highlighting the need for improved education and support to enhance outcomes.

Canonical

clinical

An eye on how patients perceive their retinal disease

Sally S. Ong, MD, presented research on how neighborhood social determinants affect patients with tractional retinal detachments (TRDs) from proliferative diabetic retinopathy at the 2025 American Society of Retina Specialists (ASRS) Annual Scientific Meeting. 

Researchers found that patients from areas with higher mobile home prevalence, minority populations, limited vehicle access, and housing cost burden had more severe disease and worse follow-up rates. Patients from neighborhoods with higher disability rates experienced longer surgical delays. Ong recommended that retina specialists consider these factors and connect patients with social workers to improve care access.

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

: What data did you present at ASRS 2025?

In this presentation, we were looking at associations between neighborhood level social determinants of health with a patient's likelihood of presenting with more severe disease or loss to follow-up, specifically in those patients with tractional retinal detachments associated with proliferative diabetic retinopathy. In this study, we looked at multiple neighborhood-level social determinants of health and their association with baseline severity and loss to follow-up in patients with tractional retinal detachments related to proliferative diabetic retinopathy. 

Our key findings are that patients who live in neighborhoods with greater mobile home prevalence had higher rates of presenting with foveal involving TRD. And those patients who lived in neighborhoods with again, higher mobile home prevalence, higher proportions of minority status, lack of access to vehicles, and increased household cost burden, defined as spending more than 30% of income on housing. Those patients had higher odds of being lost to follow-up, never returning for follow-up, or having longer durations of follow-up. Lastly, we found that for patients who lived in neighborhoods with more people reporting disability status, these patients had higher odds of having longer periods of time between the decision to have surgery and actually having the surgical repair itself. I think these data show us that neighborhood-level social determinants of health really do influence the severity of the disease when a patient comes to you with tractional retinal detachment related to PDR. On top of that, these factors also influence the likelihood of a patient returning for follow-up, and how long it takes before they come back for follow-up. And as well as you know the time when you decide to put a patient on your OR schedule and when they're actually able to have that surgery. We all know from practice that even if you decide to have patient under go surgery and you've put them on the schedule, sometimes, you know they have to reschedule multiple times before the surgery can proceed. So it just shows that there are all these factors that are somehow out of our control that can influence a patient's access to care. And we know that access to care does influence your surgical outcomes. 

How can ophthalmologists and retina specialists put this knowledge to use?

As a retina specialist, I think that being more cognizant of these factors can help you be a better advocate for your patient. Putting a patient in contact with a social worker if they're having difficulty coming to their appointments, if they have no vehicle access, if they lack support at home, or if they have to care for an individual in their home with who is disabled. I think those things can help your patients get better access to care, and on a more global level, I think these data also help policy makers know that there are social determinants of health that can influence a patient's access to care, that can ultimately influence their health outcomes. There must be some policies put into place that can help these patients do better and get better access.

Research reveals how neighborhood social factors impact patients with tractional retinal detachments, highlighting the need for improved access to care and support.

Q&A: Sally S. Ong, MD on the neighborhood-level characteristics associated with delay in surgery and loss to follow-up

Pars plana vitrectomy is the most common surgical procedure performed by retina specialists. Clear visualization plays a crucial role in the success of a vitrectomy procedure, whether it is performed to address complex conditions such as retinal detachment, macular hole, or epiretinal membrane, or to alleviate symptomatic vitreous opacities.

A slightly different distribution of vitrectomy cases may be encountered in an academic setting than in a private practice setting. In an academic setting, the main indications for vitrectomy are retinal detachments, macular holes, and epiretinal membranes. Other common indications include diabetic vitreous hemorrhages, tractional detachments, and other proliferative diseases.

In contrast, symptomatic vitreous opacity is increasingly becoming a leading indication in some private practice settings, catalyzed by greater patient awareness and a concerted effort to educate referring optometrists on the benefits of vitrectomy for patients whose floaters significantly affect their quality of life. It is not uncommon for private practices to treat several of these patients each week. Careful consideration is central to ensuring they benefit from the procedure to avoid an unnecessary surgery. In our experience, the best candidates for treatment of symptomatic vitreous opacities have pseudophakia, have had stable floaters for at least 6 months, and are not at high risk for retinal detachment.

It is essential to ensure that a complete posterior vitreous detachment (PVD) is induced during vitrectomy to decrease the risk of future retinal detachments and other complications. Complete vitreous removal, however, can be challenging. The vitreous is clear, and it is easy to be fooled by the movement of the vitreous in the eye. Therefore, reliable visualization is essential to ensure complete removal, minimize complications, and maximize postoperative outcomes.

Steroid-assisted visualization by staining the posterior hyaloid face, especially at the optic nerve, is a helpful technique to ensure complete and safe removal of the vitreous. It is also a great tool for teaching fellows, who benefit from a visual aid that helps them identify the hyaloid face and properly induce a complete PVD. Additionally, this technique may be used alone or in combination with a vital dye to stain the internal limiting membrane (ILM) or counterstain an epiretinal membrane.

Options for steroid-assisted visualization include off-label use of an injectable corticosteroid not approved for ocular indications, injectable compounded agents, and injectable preservative-free corticosteroids. Of these, an injectable preservative-free corticosteroid is not only our preferred method but also the safest option. Off-label use of a steroid not approved for ocular indications, such as triamcinolone acetonide injectable suspension (Kenalog; Bristol Myers Squibb) or compounded alternatives, raises safety concerns, especially now that a preservative-free corticosteroid is back on the market in the United States.

Alternatively, an intraocular corticosteroid such as preservative-free triamcinolone acetonide injectable suspension 40 mg/mL (Triesence; Harrow) promotes staining and identification of the vitreous and posterior hyaloid face. In clinical studies, the product was shown to effectively enhance visualization of posterior tissues and vitreous during vitrectomy.

Harrow relaunched Triesence in October 2024 following more than 5 years on the FDA drug shortage list. More recently, the Centers for Medicare & Medicaid Services (CMS) approved expanded reimbursement access across all care settings, including eye care practices, ambulatory surgery centers, and hospital outpatient departments, increasing access to all Medicare beneficiaries.

 Triamcinolone acetonide injectable suspension 40 mg/mL is currently the only FDA-approved, preservative-free corticosteroid indicated for visualization during vitrectomy. It is also indicated in an outpatient setting for uveitis and the treatment of patients with ocular inflammatory conditions that are unresponsive to topical steroids. It is available to health care providers directly through major pharmaceutical wholesale distributors using the J-code J3300.

Incorporating triamcinolone acetonide injectable suspension 40 mg/mL into a vitrectomy case is relatively straightforward, but technique and dilution vary by surgeon preference (see 

 The key is finding the concentration of the steroid that works best in the surgeon’s hands. We find the best approach is to administer small puffs of either diluted or undiluted triamcinolone acetonide injectable suspension 40 mg/mL precisely at areas where the vitreous needs to be identified.

Whether diluted or undiluted triamcinolone is used to stain the vitreous, the effect is the same: enhanced visualization that enables thorough removal of the vitreous and helps induce a complete PVD. Triamcinolone may also be used to stain epiretinal membranes as a direct visualization aid without using a vital dye to stain the ILM. If too much steroid is inadvertently injected into the eye, the infusion may cause it to disperse too widely, obscuring the view. Our advice is to limit the amount of undiluted intravitreal triamcinolone or consider diluting it with balanced salt solution in a ratio of 1:4 to 1:8.

When preservative-free triamcinolone was not available, many surgeons used preservative-containing Kenalog. Now that a preservative-free option is back on the market, we urge caution with the use of a preservative-containing product. If a preserved formulation is used, it is crucial to ensure it is washed out and completely removed from the eye to reduce the concerns of sterile endophthalmitis and toxic anterior segment syndrome. Other alternatives to stain the vitreous and improve visualization include indocyanine green (ICG) dye and brilliant blue G (BBG) dye, which can also help identify the posterior vitreous face. There are some instances, such as an epiretinal membrane or macular hole, for which it makes sense to combine visualization techniques. In these cases, starting with an intraocular corticosteroid and restaining the area with ICG or BBG dye to stain the ILM can be helpful.

Reliable visualization tools are critical in retina surgery. With preservative-free triamcinolone acetonide available and broadly reimbursed for all Medicare patients and in all care settings, we again have an on-label option directly indicated for visualization of the vitreous during retina surgical procedures.

Dyer D, Callanan D, Bochow T, et al. Clinical evaluation of the safety and efficacy of preservative-free triamcinolone (Triesence [triamcinolone acetonide injectable suspension] 40 mg/ml) for visualization during pars plana vitrectomy. 

. 2009;29(1):38-45. doi:10.1097/IAE.0b013e318188c6e2

Harrow announces transitional pass-through reimbursement status for TRIESENCE (triamcinolone acetonide injectable suspension) 40 mg/mL. News release. Harrow. March 24, 2025. Accessed June 18, 2025. 

https://investors.harrow.com/news-releases/news-release-details/harrow-announces-transitional-pass-through-reimbursement-0

Harrow executes five-year strategic supply and development agreement for Triesence. News release. Harrow. March 11, 2025. Accessed June 23, 2025. 

https://investors.harrow.com/news-releases/news-release-details/harrow-executes-five-year-strategic-supply-and-development

Kitchens practices at Retina Associates of Kentucky in Lexington. He speaks both nationally and internationally about new treatments for age-related macular degeneration, diabetes, and vascular disease and is listed among the 

 Retina Top 150 Innovators in Medical Surgical Retina.

Sharma is a retina and uveitis specialist at Cleveland Clinic’s Cole Eye Institute in Ohio and the enterprise vice chair of the Integrated Surgical Institute at the Cleveland Clinic.

Reliable visualization tools, especially those indicated for ocular use, are crucial for success.

Improving vitrectomy outcomes and patient care in academic and private settings

A recent longitudinal prospective study revealed that electroretinography (ERG)/pupillometry outperforms structural imaging in identifying patients at the highest risk of progressing to vision-threatening complications over 1 year. 

 and provided a post hoc analysis of 56 parameters from 4 testing modalities obtained in a multicenter US trial (

 Eighteen of these parameters were from the RETeval device’s 

 assessment protocol graded by manufacturer LKC Technologies, which was found to be the strongest predictor of DR progression.

“The DR score, based on a combination of ERG and pupillometry, offered the best predictive capability… These results suggest it is possible to improve the DR staging system, which in turn may enable better allocation of health care resources,” the study authors, led by C. Quentin Davis, PhD, of LKC Technologies, stated.

“This publication is a significant advancement in the quest to identify high-risk patients earlier and improve clinical outcomes,” said Dina Dubey, CEO of LKC Technologies, in the release. “The prospective study included patients with moderate to severe nonproliferative diabetic retinopathy (NPDR) and no center-involved DME at baseline, and it revealed that a single number—known as the DR Score – is the most powerful predictor of progression from NPDR to vision-threatening complications, including proliferative diabetic retinopathy, diabetic macular edema, or treatment.”

The trial used in the post hoc analysis for data collection was the prospective, double-masked, randomized, placebo-controlled TIME-2b study that evaluated the safety and efficacy of 48 weeks of subcutaneous AKB-9778 (a Tie2 activator) in patients with moderate to severe NPDR. Every 12 weeks, patients underwent a comprehensive ocular assessment, including a dilated slit lamp biomicroscopy, intraocular pressure, dilated indirect ophthalmoscopy, spectral-domain OCT, and 7-field FP. FA was conducted at weeks 0, 24, and 48. ERG/pupillometry, OCTA, and UWF-FA were performed using commercially available equipment at a subset of the 44 sites included in the study based on availability.

The DR Score of 26.9 demonstrated a relative risk of 5.6 for progression to vision-threatening conditions (

<.0001), surpassing other predictors including ultra-widefield fluorescein angiography (UWF-FA), optical coherence tomography angiography (OCTA), and fundus photography (FP). Comparatively, the UWF-FA total ischemia index ≥ 0.125 had a relative risk of 5.3 (

<.0001), the OCTA foveal avascular zone area ≥ 0.295 mm

<.05), and the fundus photograph-based diabetic retinopathy severity scale ≥ 27 had a relative risk of 2.1 (

<.05), each still proving statistical significance.

“There is mounting evidence that DR's effects on retinal neurons occur earlier and can progress somewhat independently of changes in retinal vasculature,” the study authors stated. “Thus, it is likely that combining measures of neuronal function with structural vascular information should enhance prediction of DR progression.

“This research suggests that the ERG provides value in defining how DR is staged and monitored, supporting mounting evidence that functional changes in the retina can precede observable vascular abnormalities,” said Mitchell Brigell, PhD, one of the study authors, in the release. “The findings clearly show the value of integrating objective functional testing into the management of diabetic retinopathy. This is also reflected in the inclusion of ERG in the American Academy of Ophthalmology’s Preferred Practice Pattern Guidelines for Diabetic Retinopathy.”

Limitations of the study include its unequal number of subjects across modalities, with fewer eyes tested with OCTA, UWF-FA, and ERG/pupillometry than FP due to equipment availability, in addition to the binary classification of high or low risk, according to the study authors.

 “Thus, performance differences may reflect sampling variation, although the reported uncertainties account for differences in sample size,” the authors stated.

Study identifies RETeval DR Score as the strongest predictor of diabetic retinopathy progression. LKC Technologies. August 4, 2025. Accessed August 12, 2025.

Davis CQ, Waheed NK, Brigell M. Predicting progression to vision-threatening complications in diabetic retinopathy. 

 2025;5(6). doi:10.1016/j.xops.2025.100859

A new study highlights the effectiveness of ERG/pupillometry in predicting diabetic retinopathy progression, surpassing traditional imaging methods.

Study identifies electroretinography/pupillometry as top predictor of DR progression, vision-threatening complications

 casts a shadow of blindness over millions of lives worldwide: 288 million people are expected to be affected by 2040.

 In the United States alone, 2% to 3% of those older than 50 years are already impacted.

 The impact extends beyond lost vision, with profound emotional, social, and economic consequences, including decreased independence, reduced quality of life, and incidences of depression.

In individuals diagnosed with AMD, a remarkable compensatory mechanism emerges to mitigate the detrimental effects of central vision loss. It involves the utilization of a preferred retinal locus (PRL), a location within the macula, outside the foveal region, which serves as the primary site for visual perception in the absence of foveal function. However, this novel visual pathway comes at the cost of compromised visual acuity, as the PRL does not replicate the same quality of vision afforded by the fovea, resulting in a noticeable reduction in visual clarity and definition.

 Despite this trade-off, the establishment of a PRL represents a vital means of preserving some visual function in individuals with AMD, offering a measure of resilience in the face of progressive vision loss.

In order to restore vision for those affected by central vision loss, proposed solutions have included implantable devices and intraocular telescopes. While these advancements have shown promise, they have some drawbacks: cumbersome surgeries, limited field of vision, and the need for intense rehabilitation training.

 The status quo—standard monofocal IOLs when cataract surgery is required—may offer temporary improvement of vision, but ultimately fall short, as they exacerbate the very issue by tightly focusing light on the diseased fovea.

The optical design for improving vision in AMD

An extended macular vision (EMV) IOL is a lens specifically developed to address the distinct challenges of dry AMD. By employing advanced optics to enhance image clarity across the entire macula, this device is designed to enable patients with retinal pathologies to make better use of a PRL, thereby improving their visual function without extensive rehabilitation.

At our facility in Milan, we have adopted the use of the EyeMax Mono IOL (Sharpview Ophthalmology) to address the unique visual needs of patients with dry AMD and retinal diseases in general. This clinical experience formed the basis for our recently published peer-reviewed study in 

, in which we present our long-term safety and sustained visual results in eyes with macular disease and visually insignificant cataract.

This extended macular vision IOL is specifically designed to revitalize image quality in areas of the retina that may still be unaffected by disease. Its optical design allows the light to focus across the entire 10 degrees of the macula, unlike the standard IOL or even the crystalline lens that focus the image on the central 4 degrees only, an area that is often compromised by the retinal condition.

 Besides the different optical design, it is a standard monofocal IOL, which requires no modification to standard cataract surgery technique, using the same incision size, injector system, and surgical approach. As such, it shares the same safety profile as standard monofocal IOLs (note that the EyeMax Mono is CE-marked and not approved in the United States as of May 2025).

The study: Long-term benefits of EyeMax Mono IOL in AMD

We conducted a study that uniquely targeted 113 eyes with 

 and intermediate to severe AMD (of which 9.7% of eyes were developing extensive atrophy) to evaluate the long-term efficacy and safety of the EMV IOL with a mean follow-up period of 48.3 months.

 Nearly 95% of participants gained at least 1 line of corrected distance visual acuity (CDVA), with 35% experiencing a 3-line improvement (

). Notably, even eyes with extensive maculopathy, a condition previously deemed unresponsive to treatment, demonstrated a significant increase in CDVA (0.32 logMAR improvement). The study’s findings also showed that the visual gains persisted even after several years, with participants followed up for as long as 9 years still experiencing significant improvements.

Indeed, beyond the immediate observable outcomes, this EMV IOL potential is more fully realized in its long-term impact on patients’ visual function. While previous studies have elucidated its short-term efficacy and safety,

 research indicates that the PRLs may require up to 6 months to fully develop. It is within this extended time frame that the optical design value may be demonstrated: a sustained and significant visual improvement, which can only be fully appreciated through longitudinal observation.

Interestingly, patients with poorer baseline vision experienced the most significant improvements, suggesting that the optical design helps maximize the use of remaining healthy areas in the macula. This makes it particularly valuable for individuals with advanced macular disease. No specific intraoperative or postoperative complications were reported, and vision loss was uncommon, affecting only 2.7% of eyes. This is a low rate given that these patients are inherently prone to vision deterioration due to the progressive nature of the disease.

Priya Sharma Vakharia, MD

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