Evolving research is starting to change approaches to retinopathy, macular edema, and other ocular complications of diabetes. Blocking vascular endothelial growth factor (VEGF) remains the mainstay of treatment, but newer, longer-lasting and more effective agents are on the horizon.

“VEGF plays a major role in the development of diabetic eye disease, but sustained suppression of VEGF is still beyond the current generation of anti-VEGF injections. But there are new approaches in development,” said Peter A. Campochiaro, MD, the George S. and Delores Dore Eccles Professor of Ophthalmology and Neuroscience at The Johns Hopkins University.

Dr. Campochiaro will discuss some of those new approaches during Monday’s symposium Beyond Anti-VEGF Therapy—New Approaches in Diabetic Retinopathy Clinical Trials, which will begin at 4:30 p.m. in S-303 (South, Level 3).

New treatments in development focus on more recently defined molecular pathways. Some of these new pathways may have useful clinical effects in the kidneys and perhaps other organs, Dr. Campochiaro said.

One of the most promising ocular biologics in development is a bi-specific antibody that activates Tie-2, an endothelial cell-specific tyrosine kinase receptor that blocks both VEGF and angiopoietin 2. Blocking both pathways appears to be more effective than blocking VEGF alone, Dr. Campochiaro said, particularly in patients with diabetic macular edema.

There’s also a small molecule in development for diabetic retinopathy that, when combined with VEGF suppression, provides greater benefit than VEGF suppression alone in diabetic macular edema and also reduces albuminuria in patients with diabetes. The agent, which is delivered by subcutaneous injection, inhibits VE-PTP (vascular endothelial-protein tyrosine phosphatase) and activates Tie-2.

“This demonstrates that activating Tie-2 may provide some benefit in diabetic nephropathy, but there will not be a renal-specific product any time soon because the manufacturer is mostly interested in the eye,” Dr. Campochiaro said. “They can’t take another indication forward without a partner, but progress in diabetic retinopathy is promising.”

The symposium’s other presenters are Emily Y. Chew, MD, Director of the Division of Epidemiology and Clinical Applications at the National Eye Institute; Maria B. Grant, MD, the Eivor and Alston Callahan MD Endowed Chair and Professor of Ophthalmology at the University of Alabama Birmingham; and Jennifer I. Lim, MD, Professor of Ophthalmology and the Marion H. Schenk Esq. Chair in Ophthalmology for Research in the Aging Eye at the University of Illinois College of Medicine.