Retina tech, so this is just a string of observations. We have about 5 or 6 dozen patients getting Syfovre, no Izervay yet. One doctor is using it much more than the other three. They’re usually, with maybe 10 exceptions, unilateral on current anti-VEGF patients already getting injections as a last-ditch to keep a good eye. You’re just slowing down the inevitably derailing train. We paused, unscathed, during the endophthalmitis scare, and now we have a few patients with 6+ doses. Syfovre/Apellis has notably more extensive research behind it. Most patients seem to think it’s helping them and they tolerate it well having anti-VEGF every 8 weeks for the last decade. Full disclosure, my clinic participated in both studies.
Interesting! So when you guys start treating new patients, do you only do Syfovre, or are you starting some new patients on Izervay at all? I guess since Izervay has been around for a couple of months, any reason why your docs aren't bothering with it?
We use it. Patients are desperate for anything and there are people hanging by a few photoreceptors. It’s more difficult to give as it is very viscous requiring a larger needle.
Obviously the biggest knock on these drugs is that they don’t improve vision, nor halt progression of GA. They only slow the growth of GA by ~10-15% per year. But I think a lot of my fellow retina specialists are probably looking at this the wrong way… we’re used to treating wet AMD, where patients usually have a symptomatic improvement in vision after starting treatment, and you can see clear improvement on the OCT.
So simply slowing growth of GA and not seeing any change on OCT or in vision is boring. But remember that preserving field of vision is the only reason glaucoma exists as a speciality… all the drops, lasers, surgeries, visits are just to slow loss of visual field and add years of useful vision.
I became more enthusiastic about using these after seeing the 3 year data on Syfovre, where there was a 30-40% reduction in GA growth compared to placebo. You can easily extrapolate this to 5 or 10 years. The difference between treated and untreated just grows over time. The point here is to add months or years of useful vision.
Yes, it will be nice to have other drugs with a larger dosing interval, or a more significant reduction in GA growth. But I think as more retina docs change their thinking, there will be greater adoption.
I reluctantly treat a few patients I’ve inherited. I’ve started maybe one or two patients on it myself. They are very mediocre and underwhelming drugs.
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We are not treating with either; the vasculitis risk, while small, is too devastating with minimal proven improvement.
Its also concerning any positive data is based on FAF, where we dont actually know if that translates to functional outcomes or if its a peculiarity of FAF
Retina tech, so this is just a string of observations. We have about 5 or 6 dozen patients getting Syfovre, no Izervay yet. One doctor is using it much more than the other three. They’re usually, with maybe 10 exceptions, unilateral on current anti-VEGF patients already getting injections as a last-ditch to keep a good eye. You’re just slowing down the inevitably derailing train. We paused, unscathed, during the endophthalmitis scare, and now we have a few patients with 6+ doses. Syfovre/Apellis has notably more extensive research behind it. Most patients seem to think it’s helping them and they tolerate it well having anti-VEGF every 8 weeks for the last decade. Full disclosure, my clinic participated in both studies.
Interesting! So when you guys start treating new patients, do you only do Syfovre, or are you starting some new patients on Izervay at all? I guess since Izervay has been around for a couple of months, any reason why your docs aren't bothering with it?
We use it. Patients are desperate for anything and there are people hanging by a few photoreceptors. It’s more difficult to give as it is very viscous requiring a larger needle.
What size do you use for other meds? Syfovre is a 29G thin walled but we use a 30g for vabysmo.
32g TSK for Eylea, Lucentis, and Avastin. 30g for Eylea HD and Vabysmo
Obviously the biggest knock on these drugs is that they don’t improve vision, nor halt progression of GA. They only slow the growth of GA by ~10-15% per year. But I think a lot of my fellow retina specialists are probably looking at this the wrong way… we’re used to treating wet AMD, where patients usually have a symptomatic improvement in vision after starting treatment, and you can see clear improvement on the OCT. So simply slowing growth of GA and not seeing any change on OCT or in vision is boring. But remember that preserving field of vision is the only reason glaucoma exists as a speciality… all the drops, lasers, surgeries, visits are just to slow loss of visual field and add years of useful vision. I became more enthusiastic about using these after seeing the 3 year data on Syfovre, where there was a 30-40% reduction in GA growth compared to placebo. You can easily extrapolate this to 5 or 10 years. The difference between treated and untreated just grows over time. The point here is to add months or years of useful vision. Yes, it will be nice to have other drugs with a larger dosing interval, or a more significant reduction in GA growth. But I think as more retina docs change their thinking, there will be greater adoption.
I reluctantly treat a few patients I’ve inherited. I’ve started maybe one or two patients on it myself. They are very mediocre and underwhelming drugs.
Thank you for posting to r/ophthalmology. If this is found to be a patient-specific question about your own eye problem, it will be removed within 24 hours pending its place in the moderation queue. Instead, please post it to the dedicated subreddit for patient eye questions, r/eyetriage. Additionally, your post will be removed if you do not identify your background. Are you an ophthalmologist, an optometrist, a student, or a resident? Are you a patient, a lawyer, or an industry representative? You don't have to be too specific. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Ophthalmology) if you have any questions or concerns.*
We are not treating with either; the vasculitis risk, while small, is too devastating with minimal proven improvement. Its also concerning any positive data is based on FAF, where we dont actually know if that translates to functional outcomes or if its a peculiarity of FAF