Sustained Suppression of VEGF for Treatment of Retinal and Choroidal Vascular Diseases

Clinical trials have demonstrated remarkable benefits from intravitreal injections of anti–vascular endothelial growth factor (anti-VEGF) agents in patients with retinal or choroidal vascular diseases, but observational studies have shown poor outcomes in the same patient populations treated in clinical practice, and this is associated with less frequent injections. Current treatment strategies in clinical practice are designed to minimize injection frequency, which involves imprecise estimates of when recurrent exudation might occur. An alternative strategy is to use treatments that provide sustained suppression of VEGF, but many retina specialists are concerned that such treatments may damage the macula and cause atrophy, particularly in patients with neovascular age-related macular degeneration (nAMD). Evidence regarding the potential benefits and risks of sustained suppression of VEGF is provided along with an overview of treatments aimed at achieving it, one that is currently available to treat patients with nAMD and diabetic macular edema and others that are in development. The overview of these various treatment strategies is an introduction to other articles in this special issue that provide detailed background and currently available data. We are entering a new era in the treatment of retinal and choroidal vascular diseases and this issue is designed to provide a guidebook of what is here and what is about to come.