Patient and Physician Perspectives on Oral Treatment in Ophthalmology

Antivascular endothelial growth factor (anti-VEGF) intravitreal (IVT) therapy injections are routinely used to treat retinal diseases, including diabetic macular edema (DME), proliferative diabetic retinopathy (PDR), and neovascular age-related macular degeneration (AMD [nAMD]). Despite their robust efficacy, IVTs may not be effective for all patients and can impact patient quality of life due to the need for frequent injections, ocular adverse events (AEs), and challenges around the injection itself. Oral therapy enabling fewer injections may have a beneficial impact on patients’ lives. Several are currently in development for retinal diseases, and existing data suggest that patients would prefer oral to injectable therapies. However, challenges around this possible paradigm shift include potential systemic AEs, adherence and polypharmacy issues, and difficulties specifically targeting the eye with oral therapy. Additionally, it is unclear which healthcare professionals (HCPs) will be prescribers and how healthcare systems will adapt to provide oral therapy to patients. As oral treatment would be a new therapeutic modality for retinal disease, patient perspective studies on its use in this setting are limited. This commentary provides the perspectives of patient authors living with retinal diseases and those of expert clinicians involved in retinal disease management. We explore the potential future role for oral therapy in retinal disease alongside IVT, including possible barriers to uptake, a review of relevant existing literature, and lessons from oncology where a paradigm shift from parenteral to oral therapy has already happened. While challenges will arise for the introduction of new oral therapies, the benefits may be considerable, and some potential barriers may be less significant than the literature suggests. We hope this article will inform and educate patients and physicians about potential benefits and challenges for oral therapy in retinal disease and facilitate discussion around how best to support patients with the introduction of these novel therapies. Video abstract available for this article. Diseases affecting an area at the back of the eye called the retina are treated using drugs injected directly into the eye. They are effective for many but not all patients and can have negative impacts on quality of life because of the need for frequent injections, eye-specific side effects, and challenges with the injection itself. Oral treatment allowing fewer injections could greatly benefit these patients; existing research indicates most patients would prefer it to injections. However, introducing new oral treatments into retinal disease faces challenges, including side effects in body areas outside the eye and difficulties for patients already taking several pills/tablets for other illnesses. Our article provides commentary on oral treatment using the perspectives of patient authors living with retinal diseases and expert doctors who manage these diseases. We look at the possible role for oral treatment in retinal disease (alongside existing injectable treatments), including reasons that might prevent patients from using it, a review of relevant scientific studies, and a look at what we can learn from oral treatments when they became available in cancer therapy. Challenges will exist for patients and healthcare systems when bringing oral therapy into retinal disease treatment, but the benefits may be large and some potential barriers may be less significant than studies suggest. This article hopes to inform and educate patients and healthcare professionals about potential benefits and challenges for oral therapy in retinal disease and highlight ways we can support patients with this new approach once available.