Optimizing Treatment Transitions and Reducing Steroid Use with Second-Generation Anti-VEGF Therapies in Retinal Vascular Diseases

In this segment, Dr. Harit Bhatt and Dr. Deepak Sambhara explore practical strategies for switching and reloading patients when transitioning from aflibercept 2 mg to 8 mg or between faricimab and aflibercept 8 mg. Dr. Sambhara shares that he typically reloads patients during the switch to ensure long-term durability, explaining to patients that the short-term increase in visit frequency leads to extended intervals later. Dr. Bhatt echoes this approach, noting that reloading gives “recalcitrant” or suboptimal responders a renewed opportunity for visual improvement and more consistent outcomes. Both clinicians emphasize the importance of personalized treatment plans, especially for patients struggling with adherence or severe disease. The conversation then shifts to steroid use in diabetic macular edema (DME)—both physicians report a significant decline in corticosteroid reliance, crediting the dual-pathway and durable efficacy of second-generation anti-VEGF agents for reducing treatment burden and inflammation-related adjunctive therapy needs.