Management Approaches for Suboptimal Responders in AMD, DME, and RVO

In this segment, the discussion focuses on managing patients with suboptimal responses to faricimab or aflibercept 8 mg and determining when to switch or adjust treatment intervals. The panelists emphasize patience and persistence, noting that continued improvement—even without complete dryness—can justify staying with the same agent, especially for second-generation anti-VEGF therapies. They also highlight a more flexible approach in diabetic macular edema (DME), viewing steroid use as “adding” rather than “switching,” reflecting a multimodal strategy that complements longer-acting anti-VEGF agents. The panelists introduces the concept of “treating to stability” rather than absolute dryness, tolerating small amounts of persistent or stable fluid when vision is preserved. The panel agrees that clinical judgment, disease type, and patient factors (such as phakic status or glaucoma risk) should guide treatment intensity. They conclude that careful adherence to loading doses and avoiding premature switching can optimize long-term retinal outcomes.