Dr. Sambhara is the founder and Medical Director of Research for the Eye Clinic of Wisconsin’s clinical trial program.

Deepak Sambhara, MD

Advice on Maintaining Flexibility with Second-Generation Anti-VEGF Agents in Retinal Vascular Diseases

In this closing segment, Dr. Harit Bhatt and Dr. Deepak Sambhara reflect on the importance of collaboration, mentorship, and lifelong learning in the evolving field of retina. Dr. Sambhara shares heartfelt advice for new retina specialists, emphasizing that “availability is the best ability.” He encourages early-career physicians to stay present and engaged—whether by attending meetings, collaborating with colleagues and industry partners, or studying emerging clinical data to remain on the leading edge of innovation. He highlights the value of building relationships with mentors and peers, noting how the retina community’s openness and collegiality have been vital to his own growth. Dr. Bhatt echoes these sentiments, reinforcing the importance of curiosity and continuous learning as the field rapidly advances. The discussion concludes on an inspiring note, celebrating the shared mission of improving patient outcomes through teamwork, innovation, and dedication to lifelong education.

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Dr. Sambara emphasizes the importance of collaboration and continuous learning for new retina specialists to thrive in their practice.

Integrating Gene Therapy and TKIs with Current Second-Generation Anti-VEGF Agents in Clinical Practice

In this forward-looking segment, Dr. Harit Bhatt and Dr. Deepak Sambhara discuss the rapidly evolving next generation of retinal therapeutics, focusing on tyrosine kinase inhibitors (TKIs) and gene therapy. Dr. Sambhara anticipates being an early adopter, recognizing these innovations as potential solutions to the increasing treatment burden and capacity challenges facing retina specialists. He underscores key considerations such as cost, coverage, and patient selection, predicting that judicious, individualized use will be essential for maximizing benefit and sustainability. Dr. Bhatt echoes these sentiments, emphasizing that optional therapy pathways foster innovation and patient-centered care. Both clinicians agree that as durability becomes the defining goal of retinal disease management, emerging modalities will complement existing anti-VEGF agents—helping to meet the needs of a growing, aging patient population. The conversation closes on an optimistic note, highlighting how innovation, flexibility, and access will define the next decade in retina care.

Experts discuss the future of retinal disease treatments, highlighting the promise of new therapies and the need for personalized patient care.

 Integrating Gene Therapy and TKIs with Current Second-Generation Anti-VEGF Agents in Clinical Practice

Treat-and-Extend Strategies with Second-Generation Anti-VEGF in Patients with Retinal Vascular Diseases

In this segment, Dr. Harit Bhatt and Dr. Deepak Sambhara discuss the evolution of treat-and-extend (T&E) protocols for AMD and DME in the era of durable, second-generation anti-VEGF therapies. Dr. Bhatt explains his growing confidence in extending intervals more aggressively, using OCT stability as the key determinant for decision-making—favoring anatomical plateau and visual maintenance over absolute dryness. Dr. Sambhara agrees, noting that pivotal trials such as PULSAR, PHOTON, and YOSEMITE/RHINE have reshaped clinicians’ comfort with longer intervals. He also highlights insights from DRCR Retina Networks Protocol AO, which explores home OCT-guided dosing with faricimab, revealing new understandings of daily fluid dynamics and individualized response patterns. Both physicians emphasize a nuanced, patient-specific approach—accepting minimal, stable subretinal fluid in exchange for fewer visits and sustained vision. Together, they illustrate how advanced imaging and real-world confidence are redefining disease monitoring and extending treatment durability in retinal vascular disease management.

Experts discuss evolving strategies in treat-and-extend protocols for retinal diseases, emphasizing OCT's role in optimizing patient care and outcomes.

Reinforcing Safety and Patient Confidence with Second-Generation Anti-VEGF Therapies

In this segment, Dr. Harit Bhatt and Dr. Deepak Sambhara address patient and physician concerns regarding the safety profiles of second-generation anti-VEGF agents—aflibercept 8 mg and faricimab. Dr. Sambhara notes that while isolated cases of intraocular inflammation (IOI) or retinal vasculitis have been reported, the incidence is extremely rare, often resolving spontaneously or with short-term topical steroids. He emphasizes that these events occur so infrequently that they are not a routine part of informed consent discussions. Dr. Bhatt echoes this sentiment, describing his similarly minimal experience with mild, self-limiting inflammation and no severe complications. Both physicians reflect on the public perception shaped by pharmaceutical advertisements, underscoring the importance of educating patients about the strong real-world safety and efficacy of these agents. These therapies remain dependable, durable, and safe, reinforcing clinician confidence and patient reassurance in long-term treatment planning. 

Experts discuss the safety of retinal treatments, addressing concerns about rare side effects and emphasizing the overall efficacy of these medications.

Deepak Sambhara, MD

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