Retina World Congress 2026: Identifying real-world durability gaps in wet AMD treatment

Durability remains a defining unmet need in the treatment of wet age-related macular degeneration (AMD), particularly in real-world settings where adherence to frequent injection schedules is difficult to sustain. Patricio G. Schlottmann, MD, discussed the treatment burden associated with wet AMD in Latin America and emphasized durability as a central unmet need in retinal therapy at Retina World Congress 2026, May 14 to 17 in Fort Lauderdale, Florida. Schlottmann serves as the director of the Research Department at the Charles Ophthalmic Center and as the Ophthalmology Department Director at Organización Médica de Investigación in Buenos Aires, Argentina.

Based on his clinical experience, he noted that “the burden of the treatment is one of the main reasons for treatment failure,” particularly when patients require more than 6 injections annually. He noted that the challenge extends beyond health care systems and payers to include patients and families, many of whom must travel long distances repeatedly for care. According to Schlottmann, “having to sustain injections regularly for most of these patients is reason No. 1 why they fail the treatment.”

Moving beyond pulsatile treatment

Schlottmann highlighted current investigational strategies focused on extending durability, including intraocular inserts, gene therapy approaches, and refillable implanted devices. However, he added that the ideal therapy would provide long-term control without leaving material behind in the eye. “What we want is something that can last at least for a year,” he said, describing this interval as “the sweet spot for durability.” He added that “an ideal scenario will be one in which you have something that you can deliver consistently at least once a year.”

He also highlighted the discrepancy between clinical trial outcomes and real-world results. Although trial data in Latin America mirror outcomes observed in Europe and North America, he explained that adherence in routine practice is substantially different. “Within the sort of magic of the clinical trial where patients never miss any visits… the response is very good,” he said. In contrast, limited access in the real world often results in patients receiving only a few injections annually, with corresponding declines in vision outcomes. “A number of maybe three injections a year, that is extremely low, and the result that we see in vision are dramatic.”

Real-world gaps in access and adherence

He noted that pulsatile treatment patterns may contribute to fibrosis and poorer retinal outcomes over time. Ideally, therapies would provide “constant and steady” inhibition of VEGF or other pathways over extended periods without gaps in treatment effect.

Importantly, Schlottmann added that cost alone does not explain undertreatment. Diagnostic technology is widely available, including in Latin America, but maintaining frequent follow-up remains difficult regardless of drug pricing. “It’s not an economic factor,” he said. “It’s the reason that they need to come constantly for injection, the main driver for failure of treatment.” He concluded that therapies lasting longer than 6 months would address “the biggest gap when we treat patients with wet AMD today.”