2025 Preferences and Trends Survey Results

Thanks to all who participated in the 27th Annual PAT Survey

1066 respondents

Demographics

1. Are you a medical retina specialist, a surgical retina specialist, or both?

Fellows
(n = 75)

In Practice
(n = 991)

1

2. Where is your primary practice?

Fellows
(n = 75)

In Practice
(n = 991)

2

3. What is your primary practice setting?

Fellows
(n = 75)

In Practice
(n = 991)

3

4. How long have you been in practice?

Fellows
(n = 75)

In Practice
(n = 991)

4

Macular Diseases

5. What is your preferred first-line anti-VEGF therapy for wet age-related macular degeneration (AMD) in the absence of any payer access restrictions?

Fellows
(n = 75)

In Practice
(n = 985)

5

6. What modifications do you typically recommend in a patient with active wet AMD undergoing anti-VEGF therapy who has had a recent heart attack or stroke? (Select all that apply.)

Fellows
(n = 75)

In Practice
(n = 986)

6

7. In 2024, Susvimo (Port Delivery System with ranibizumab, Genentech, Inc) returned to the market in the United States. Assuming availability where you practice, what would be your plan for Susvimo usage?

Fellows
(n = 75)

In Practice
(n = 986)

7

8. In your patient with good vision and a remote history of wet AMD, but who is no longer receiving anti-VEGF injections due to disease inactivity, what is the longest follow-up (F/U) interval you would typically consider between visits?

Fellows
(n = 75)

In Practice
(n = 987)

8

9. What do you think is the biggest unmet need in wet-AMD therapeutics? (Select all that apply.)

Fellows
(n = 75)

In Practice
(n = 987)

9

10. Which of the following pipeline treatments for wet AMD excites you most?

Fellows
(n = 75)

In Practice
(n = 987)

10

11. What is your treatment of choice for patients newly diagnosed with geographic atrophy (GA)?

Fellows
(n = 75)

In Practice
(n = 986)

11

12. What percentage of your patients with GA are you currently treating?

Fellows
(n = 75)

In Practice
(n = 986)

12

13. What treatment frequency do you usually recommend when administering Syfovre and/or Izervay for GA?

Fellows
(n = 75)

In Practice
(n = 987)

13

14. How would you manage an eye that develops wet AMD in the setting of ongoing GA treatment?

Fellows
(n = 75)

In Practice
(n = 986)

14

15. Which of the following reflects your usual approach for bilateral, same-day injections of
the same therapy (ie, same anti-VEGF therapy in both eyes or same complement inhibitor
in both eyes)?

Fellows
(n = 75)

In Practice
(n = 988)

15

16. What is your non-steroidal anti-inflammatory drug (NSAID) of choice for postoperative cystoid macular edema (CME) treatment, including cataract surgery and vitrectomy?

Fellows
(n = 75)

In Practice
(n = 989)

16

17. Following intraocular surgery, a patient develops macular edema (ME), which fails to resolve with maximal topical anti-inflammatory therapy. Fluorescein angiography shows petaloid leakage in the macula. Which intervention are you most likely to recommend next?

Fellows
(n = 75)

In Practice
(n = 986)

17

18. What is your impression of Ryzumvi (phentolamine ophthalmic solution, Viatris, Inc), a nonselective alpha-1 and alpha-2 adrenergic antagonist, which the US Food and Drug Administration (FDA) approved for treatment to reverse pharmacologically induced mydriasis? (Select all that apply.)

Fellows
(n = 75)

In Practice
(n = 988)

18

Retinal Vascular Diseases/Diabetes

19. What is your preferred first-line anti-VEGF therapy for diabetic macular edema (DME) and visual acuity (VA) worse than 20/40 in the absence of any payer access restrictions?

Fellows
(n = 75)

In Practice
(n = 987)

19

20. How would you treat a DME patient with an inadequate treatment response after 3 to 4 monthly injections of an anti-VEGF agent?

Fellows
(n = 75)

In Practice
(n = 988)

20

21. Which of the following non-injection treatment strategies do you currently employ in treating patients with DME? (Select all that apply.)

Fellows
(n = 75)

In Practice
(n = 988)

21

22. A 25-year-old phakic female with type 1 diabetes and previously normal vision presents with center-involved diffuse DME in both eyes (OU). Her VA is 20/100 in both eyes. She informs you that she is 12 weeks pregnant. After discussing the theoretical risks of anti-VEGF therapy in pregnancy, the patient asks what initial treatment you would recommend if she were your daughter. How would you advise this patient?

Fellows
(n = 74)

In Practice
(n = 986)

22

23. Which of the following best describes your current approach to a patient with very severe nonproliferative diabetic retinopathy (NPDR) without DME?

Fellows
(n = 75)

In Practice
(n = 985)

23

24. A patient presents to your clinic with high-risk proliferative diabetic retinopathy (PDR)
and center-involved DME. If your plan is to treat the DME with anti-VEGF therapy, do you
typically still recommend panretinal photocoagulation (PRP)?

Fellows
(n = 75)

In Practice
(n = 985)

24

25. How long do you typically wait before considering surgery in a diabetic patient with non-clearing vitreous hemorrhage (NCVH)?

Fellows
(n = 75)

In Practice
(n = 986)

25

26. Have you seen diabetic patients on GLP-1 agonists (eg, Ozempic [semaglutide, Novo
Nordisk A/S]) for diabetes and/or weight loss have their retinopathy worsen on this
class of drugs?

Fellows
(n = 75)

In Practice
(n = 984)

26

27. Which of the following is the greatest challenge you currently face in treating patients with DME?

Fellows
(n = 75)

In Practice
(n = 985)

27

28. What percentage of your patients require step therapy for anti-VEGF drugs?

Fellows
(n = 74)

In Practice
(n = 986)

28

29. Macular edema from RVO (MEfRVO) has higher VEGF upregulation than wet AMD and DME. If all treatments below were commercially available, which anti-VEGF agent would you select first to maximize vision and anatomic improvements?

Fellows
(n = 75)

In Practice
(n = 984)

29

30. After 1 to 2 years of anti-VEGF therapy for RVO with ME, your patient has achieved 20/20 vision and has been extended to q12-week dosing with no ME recurrence. How are you likely to treat the patient going forward?

Fellows
(n = 74)

In Practice
(n = 986)

30

31. How would you treat a patient who has RVO with ME and an inadequate treatment response after multiple monthly anti-VEGF injections?

Fellows
(n = 74)

In Practice
(n = 985)

31

32. If a new treatment were approved that slowed vision loss from macular telangiectasia (MacTel), how quickly would you plan to adopt this into your practice?

Fellows
(n = 74)

In Practice
(n = 987)

32

Pharmacology and Therapeutics

33. Which intravitreal (IVT) injection do you believe delivers best anatomic outcomes and disease control in wet AMD, DME, and RVO?

Fellows
(n = 74)

In Practice
(n = 983)

33

34. Which of the following factors are important considerations when selecting an anti-VEGF agent? (Select all that apply.)

Fellows
(n = 74)

In Practice
(n = 984)

34

35. Since the approval of Vabysmo, what benefits have you experienced over the existing anti-VEGF agents across its indications? (Select all that apply.)

Fellows
(n = 74)

In Practice
(n = 984)

35

36. Which of the following characteristics of Eylea HD do you find meaningful to your patient care? (Select all that apply.)

Fellows
(n = 74)

In Practice
(n = 982)

36

37. You decide to switch anti-VEGF agents in a patient with an insufficient response to the first-line anti-VEGF agent. On average, how many additional agents do you need to try before achieving desired results?

Fellows
(n = 74)

In Practice
(n = 984)

37

38. Several aflibercept biosimilars were approved in 2024. How do you anticipate these will be incorporated into your clinical practice when made available? (Select all that apply.)

Fellows
(n = 74)

In Practice
(n = 984)

38

39. Who usually draws up your IVT injections from vials (medications not in prefilled syringes)?

Fellows
(n = 74)

In Practice
(n = 984)

39

40. Does the availability of a prefilled syringe affect your anti-VEGF agent choice?

Fellows
(n = 74)

In Practice
(n = 984)

40

41. Do you think a prefilled syringe reduces endophthalmitis risk following IVT injection?

Fellows
(n = 74)

In Practice
(n = 984)

41

42. What type of anesthesia do you use for most of your intravitreal injections? (Select all that apply.)

Fellows
(n = 74)

In Practice
(n = 984)

42

Surgery and Retinal Detachment

43. Do you usually document fovea status or macula status (ie, on or off) for retinal detachments
(RDs) requiring surgery?

Fellows
(n = 70)

In Practice
(n = 891)

43

44. For a patient with a recent macula/fovea-off detachment with symptoms for less than 1 day,
when would you operate?

Fellows
(n = 70)

In Practice
(n = 891)

44

45. If you have a patient who presents with an acute superior macula-on retinal detachment (RD) that will require pars plana vitrectomy (PPV) for repair but the soonest access to the operating room is over 72 hours later, do you recommend a temporizing injection of gas?

Fellows
(n = 70)

In Practice
(n = 887)

45

46. Of all rhegmatogenous retinal detachments (RRDs) you treated in the past year, how often did you perform pneumatic retinopexy?

Fellows
(n = 70)

In Practice
(n = 889)

46

47. When performing a PPV alone (without a scleral buckle) for repair of a primary pseudophakic RD, how much peripheral vitreous do you typically remove?

Fellows
(n = 70)

In Practice
(n = 890)

47

48. In a 68-year-old pseudophakic patient with an RRD and a star fold in the mid-periphery without an epiretinal membrane (ERM) overlying the macula, what is your surgical approach to peeling?

Fellows
(n = 69)

In Practice
(n = 889)

48

49. Do you administer intravitreal methotrexate in any of your recurrent RD patients with significant proliferative vitreoretinopathy (PVR)?

Fellows
(n = 69)

In Practice
(n = 890)

49

50. Which adjuvant do you prefer as an aid in internal limiting membrane (ILM) peeling?

Fellows
(n = 69)

In Practice
(n = 890)

50

51. For a 63-year-old pseudophakic patient with a persistent macular hole (MH) of 750 microns
in width that failed recent PPV with ILM peel (360 degrees to the arcades surrounding the hole),
what type of surgery would you recommend?

Fellows
(n = 69)

In Practice
(n = 890)

51

52. How would you manage a 48-year-old man with high myopia (-18 diopters spherical
equivalent) who has progressive unilateral vision loss (VA was 20/40, now 20/200)
from myopic macular schisis?

Fellows
(n = 68)

In Practice
(n = 889)

52

53. At the end of a routine PPV and membrane peel for ERM in a pseudophakic patient without any retinal breaks noted intraoperatively, how do you leave the eye?

Fellows
(n = 69)

In Practice
(n = 889)

53

54. A 65-year-old phakic patient found to have an asymptomatic schisis-detachment incidentally
on routine exam presents to your clinic. The detachment is adjacent to the temporal margin
of the macula and previous images demonstrate slight progression over the last 2 years.
What do you recommend?

Fellows
(n = 69)

In Practice
(n = 890)

54

55. A 59-year-old phakic patient presents with a fovea-involving schisis-detachment and an outer retinal break noted at the equator temporally. What do you recommend?

Fellows
(n = 68)

In Practice
(n = 891)

55

56. Which suture do you prefer to close sclerotomies that require closure at the end of vitrectomy?

Fellows
(n = 69)

In Practice
(n = 891)

56

57. In what percentage of your surgical cases do you use a digital heads-up display instead
of microscope oculars?

Fellows
(n = 69)

In Practice
(n = 891)

57

58. Over the past few years, have you experienced challenges with adequate operating room (OR)
availability or access?

Fellows
(n = 69)

In Practice
(n = 889)

58

59. In what setting do your after-hours (eg, weekend) emergent surgeries usually occur?

Fellows
(n = 69)

In Practice
(n = 891)

59

60. If an office-based surgery (OBS) suite (ie, non-ASC OR suite in an office/clinic setting) were available in your clinic and OBS procedures were adequately reimbursed by insurance, would you adopt OBS?

Fellows
(n = 68)

In Practice
(n = 890)

60

61. If a patient needing emergent surgery is already NPO (nothing by mouth or nil per os) and otherwise cleared for surgery, what obstacle most hinders your ability to take this case to the OR? (Select all that apply.)

Fellows
(n = 69)

In Practice
(n = 889)

61

62. What proportion of your vitreoretinal surgeries do you perform under general anesthesia?

Fellows
(n = 69)

In Practice
(n = 890)

62

Socioeconomics

63. Over the past 3 months, in how many patients did you rely on anti-VEGF samples to provide care due to access issues (eg, prior authorization requirements, specialty pharmacy issues, Avastin unavailability, etc)?

Fellows
(n = 73)

In Practice
(n = 980)

63

64. Which best characterizes the impact of geographic atrophy (GA) drug approval on
your clinic volume?

Fellows
(n = 73)

In Practice
(n = 980)

64

65. What is your perspective on direct-to-consumer (DTC) television advertising for intravitreal
injections, including new anti-VEGF and GA treatments, when you’re presenting a treatment
plan to a patient?

Fellows
(n = 73)

In Practice
(n = 982)

65

66. A patient stable on bimonthly anti-VEGF treatment requests a switch to a specific agent after
seeing it on a commercial. Assuming insurance is not an issue and you do not have safety/efficacy concerns, how often do you comply?

Fellows
(n = 72)

In Practice
(n = 978)

66

67. Do you participate in community-based screening for diabetic retinopathy (DR), and if so, where do you send participants for follow-up?

Fellows
(n = 73)

In Practice
(n = 982)

67

68. How does your practice manage an underinsured or uninsured patient with high-risk proliferative diabetic retinopathy (PDR) who cannot afford to pay for treatment? (Select all that apply.)

Fellows
(n = 73)

In Practice
(n = 981)

68

69. If a medical student asked you if they should go into ophthalmology, how would you respond?

Fellows
(n = 73)

In Practice
(n = 982)

69

70. In the past 12 months, has your practice been approached by a private equity (PE) firm, corporation, or a hospital/health system for consideration of purchase?

Fellows
(n = 73)

In Practice
(n = 983)

70

Imaging and Technology

71. Are you utilizing artificial intelligence (AI) in your retina practice, and if so, how? (Select all
that apply.)

Fellows
(n = 73)

In Practice
(n = 985)

71

72. Would you consider using AI-assisted software, if approved, to assist in monitoring retinal imaging for the progression of retinal diseases such as AMD or diabetic retinopathy (DR)?

Fellows
(n = 73)

In Practice
(n = 984)

72

73. How often do you typically use your patients’ retinal images to educate them about their
condition during consultations?

Fellows
(n = 73)

In Practice
(n = 985)

73

74. Home optical coherence tomography (OCT) appears to be around the corner. How do you predict this technology will change your management of wet AMD?

Fellows
(n = 73)

In Practice
(n = 984)

74

75. What future advances in retinal imaging do you think will significantly change the way you practice? (Select all that apply.)

Fellows
(n = 73)

In Practice
(n = 984)

75

76. What is your opinion of intraoperative OCT?

Fellows
(n = 73)

In Practice
(n = 984)

76