PAT Survey Results - The American Society of Retina Specialists

2025 Preferences and Trends Survey Results

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

991 respondents

Demographics

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

n = 991

2. Where is your primary practice?

n = 991

3. What is your primary practice setting?

n = 991

4. How long have you been in practice?

n = 991

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?

n = 985

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.)

n = 986

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?

n = 986

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?

n = 987

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

n = 987

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

n = 987

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

n = 986

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

n = 986

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

n = 987

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

n = 986

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)?

n = 988

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

n = 989

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?

n = 986

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.)

n = 988

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?

n = 987

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

n = 988

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

n = 988

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?

n = 986

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

n = 985

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)?

n = 985

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

n = 986

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?

n = 984

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

n = 985

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

n = 986

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?

n = 984

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?

n = 986

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

n = 985

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?

n = 987

Pharmacology and Therapeutics

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

n = 983

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

n = 984

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

n = 984

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

n = 982

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?

n = 984

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.)

n = 984

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

n = 984

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

n = 984

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

n = 984

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

n = 984

Surgery and Retinal Detachment

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

n = 891

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

n = 891

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?

n = 887

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

n = 889

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?

n = 890

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?

n = 889

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

n = 890

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

n = 890

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?

n = 890

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?

n = 889

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?

n = 889

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?

n = 890

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?

n = 891

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

n = 891

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

n = 891

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

n = 889

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

n = 891

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?

n = 890

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.)

n = 889

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

n = 890

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)?

n = 980

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

n = 980

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?

n = 982

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?

n = 978

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

n = 982

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.)

n = 981

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

n = 982

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?

n = 983

Imaging and Technology

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

n = 985

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)?

n = 984

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

n = 985

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?

n = 984

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

n = 984

76. What is your opinion of intraoperative OCT?

n = 984

Ocular Oncology

77. A 70-year-old male presents with an 8 x 9-mm diameter by 5.0-mm-thick melanocytic choroidal
melanoma without exudative retinal detachment located posterior to the equator and 3 mm
superior to the fovea. What is your preferred surgical approach for prognostic or diagnostic
biopsy of this medium-sized posterior melanoma?

n = 142

78. A 55-year-old patient with a medium-sized anterior uveal melanoma is undergoing radiation therapy and you are planning a tumor biopsy. What testing do you typically order? (Select all that apply.)

n = 127

79. A patient with a large (16 x 17 mm in diameter by 11.5 mm in thickness) posterior choroidal melanoma
with localized exudative retinal detachment presents to you for treatment. How would you typically
manage this patient?

n = 128

80. A 65-year-old female has a newly diagnosed small melanocytic indeterminate choroidal lesion (4 x 4 mm in diameter x 1.7 mm in thickness) with 1 dot of lipofuscin pigment, minimal subretinal fluid (SRF), and no retinal pigment epithelium changes. What is your initial management strategy?

n = 127

81. A 77-year-old phakic female presents with a 3-month history of unilateral floaters and decreased vision to
20/50 in the right eye with 2+ AC and vitreous cells and late disc leakage on angiography but no retinal
lesions. These findings did not resolve with steroid treatment. Right eye is normal. Bloodwork and brain
MRI were non-diagnostic. You perform a diagnostic vitrectomy. What testing do you routinely order on the vitreous specimen? (Select all that apply.)

n = 127

82. A 43-year-old male presents with metamorphopsia and a pale amelanotic choroidal mass in the temporal macula, 4 x 3 mm in diameter and 2.4 mm in thickness with overlying leopard-spot appearance and
subfoveal subretinal fluid. The fellow eye is normal. He is a non-smoker without history of systemic cancer, but a new lung mass is identified on workup. What is your next management action for the ocular lesion?

n = 126