Theodore Leng, MD: Perspective on the Past Year in Ophthalmology


A look at the defining moments of the past year and what is expected to come in 2023.

The past year in ophthalmology has been exciting, with new drug approvals and landmark trials defining the new treatment landscape.

In an interview with HCPLive, Theodore Leng, MD, Director, Clinical and Translational Research, Stanford Byers Eye Institute, provided perspective on where he thought the biggest moments 2022 were and what to expect in the coming year.

He noted the approval and launch of faricimab-svoa for the treatment of neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME) as an important moment of the year. The intravitreal bispecific antibody angiopoietin-2 (Ang-2) and vascular endothelial growth factor A (VEGF-A) inhibitor is the first of its kind indicated for treating the ophthalmic disease.

“I think it brings the potential for extended duration therapy, as well as maybe an upside as far as treating previous non responders,” Leng said. “I think bringing in the new mechanisms, the Ang-2 mechanism in addition to the VEGF mechanism, gives us more options for treating our patients with either recalcitrant disease or even some of our naive patients as well, using that new agent.”

Another important moment from the past year has been the potential to meet a currently unmet need in the form of a treatment for geographic atrophy (GA). Leng noted that based on natural history studies, GA progresses more rapidly than thought previously and patients lose significant vision. Two potential agents, avacincaptad pegol and pegcetacoplan, may be approved in the near future.

“Some people are less excited about these complement inhibitors, because they don't want to reverse disease, they don't restore vision,” Leng said. “But I do think that there is a role for slowing down vision loss, because that’s measured in real vision, real function, real time for our patients who currently don't have anything. They're slowly losing their vision and it's making a big impact in their lives.”

He noted his disappointment with the ranibizumab (Susvimo) port delivery system (PDS) voluntary recall from Roche Genentech due to the performance of the implants not meeting standards. Leng said it had the potential to be a good option for patients who were unable to come for monthly visits, with a Q6-month refill window. He added that the company is expected to make the implant more robust and launch it again.

“I do see that as a platform for future therapeutics as well in addition to the anti-VEGF that they currently have and so I think it's gonna be a long term play for Roche Genentech,” Leng said. “And so I'm looking forward to seeing what they come up with in the future.”

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