Recent advances in ocular injectables for age-related macular degeneration, diabetic macular edema, and macular edema due to retinal vein occlusion

IntroductionOver the past decade, advancements in ocular drug delivery systems, particularly anti-vascular endothelial growth factor (VEGF) injections, have improved the management of various ocular conditions. However, their short half-life necessitates frequent injections, burdening both patients and the healthcare system. This review examines recent developments in ocular injectables designed to extend dosing intervals, enhance adherence, and improve outcomes.Areas coveredThis review examines clinical trials and studies assessing two recently FDA approved medications, faricimab, and high-dose aflibercept, for the treatment of wet age-related macular degeneration (wet AMD), diabetic macular edema (DME), and macular edema due to retinal vein occlusion (RVO-ME). Additionally, we review existing data that exist for pegcetacoplan and avacincaptad pegol for dry AMD.Expert opinionMost studies evaluating new ocular injectables focus on faricimab for wet AMD. While further studies are necessary, both faricimab and high-dose aflibercept seem to improve anatomical outcomes, with varying significant improvements in BCVA. Faricimab is approved for RVO-ME and is non-inferior to aflibercept; trials are ongoing for high-dose aflibercept. Pegcetacoplan and avacincaptad pegol slow the progression of geographic atrophy size; however, concerns remain regarding increased risk of macular neovascularization and lack of data supporting clinically relevant improvement in secondary visual outcomes.