The Discover Change Retina Conference in Korea had some great discussions about the use of the new bispecific intravitreal injection Faricimab (Vabysmo).

“Bispecific” means it has two targets – not only the VEGF we are all very familiar with but now Ang-2. Angiopoietin 2 levels are elevated in patients with diabetic retinopathy. Ang-2 binds to a receptor called Tie2 on the surface of endothelial cells. This binding leads to destabilization of pericytes, the cells which wrap about capillaries to help regulate blood flow. Destabilization of pericytes can cause blood vessels to become leaky and fragile, leading to further damage to the retina. Vabysmo blocks Ang-2 as well as VEGF, helping to stabilise capillaries and reduce leakage.

The other exciting topic at the conference was “Personalised medicine”. We are going to be hearing a lot more about personalised medicine over the coming years, not only in ophthalmology but in many other fields, especially cancer. Personalised medicine is a rapidly growing field and aims to provide tailored medical treatment to individual patients based on their unique genetic, environmental, and lifestyle factors. It is well known to those who treat a lot of diabetic retinopathy patients that they are not all the same and this is where “Personalized medicine” comes in with several new approaches being developed.

There is increasing evidence that identifying OCT biomarkers may predict not only how a patient will respond to intravitreal injections, but which particular injection may be the best. Hyper-reflective foci are commonly noted in patients with diabetic retinopathy. One theory is that these represent clumps of activated glial cells.

Artificial intelligence (AI) is also being used in personalized medicine for diabetic retinopathy. AI algorithms are already analyzing OCT scans at some large hospitals overseas and this will very soon identify patterns and predict which treatments are most likely to be effective for individual patients.
Analysis of the metabolome can identify which of many hundreds of potential growth factors or proteins are abnormal, allowing selection of a particular injection most likely to help that patient.
Overall, personalized medicine holds great promise for the treatment of diabetic retinopathy. The approval of Faricimab (Vabysmo) on to the PBS is an exciting advance that will help many patients. By tailoring treatments to individual patients based on their unique characteristics, it will be possible provide more effective and efficient care.