Challenges in Care: Managing Fluid in DME

So we're gonna talk a little bit about managing fluid and DME.

So, uh, to set the stage, and again, we have retina doctors listening.

We also have a lot of comprehensive ophthalmologists, referring doctors, or people in training listening, Durga.

You know, we've gone through a lot of evolution in the treatment of DME.

You know, nowadays the gold standard, as many of the people listening know, is anti-VEGF therapy.

Um, we've had a history with anti-VEGF therapy and DME for al-essentially two decades, but it's evolved quite a bit as we've gone through generations and now we have newer generation drugs, um, high dose aflibercept eight milligram and faricimab, um, that are kind of the next step in the treatment of DME.

So give the listeners a little bit of background.

You know, obviously we've had these drugs now for a couple of years.

Um, when did you start incorporating this in your practice? How did you sort of assess trial data when you were thinking about how these drugs would fit into the treatment of DME?

That's a great question, Jay.

Um, you know, I think the trial data was really compelling for both sets of, um, for both medications.

And I think also I'll admit that when I first started using this drug, I, I used both of them, you know, right when they came out.

In an academic setting, we aren't as, um, we don't always wait for a permanent J-code to come out.

We do often have it in our hands as soon as the pharmacy committee will approve it.

Um, I, I really started using this more in patients who had been treated for a while-

Mm-hmm

... which is a little bit different than the trials.

You know, I think we'll, we'll talk a little bit about this, but the, the trials, although there were some treatment-experienced patients, it was predominantly still treatment naive, particularly in YOSEMITE and RINE for faricimab.

And so this was, was very different.

It was an opportunity, I guess, to see how patients do that are more refractory, and I, I think unfortunately, that's often what we do in these, um, cases where we get new medications in our hands.

We aren't always using them in a patient population that's identical to clinical trials.

Yeah, that's a fantastic point, and we'll get into the treatment, as you mentioned, of refractory patients versus treatment-naive patients in the real world.