Written by: Ceegi Mullis, Thomas Moran, Josh Hill
The 2025 American Society of Retina Specialists (ASRS)® conference showcased groundbreaking research and insightful discussions, underscoring critical challenges and opportunities in retina care. Several compelling presentations highlighted the importance of physician autonomy, the societal costs of administrative hurdles, and evolving treatment trends in anti-VEGF therapies. Here are the key takeaways:
1. Physician Autonomy in Treatment Selection is Crucial for Optimal Care
Dr. Prithvi Bomdica from The Retina Institute® presented compelling evidence demonstrating that, for neovascular age-related macular degeneration (nAMD), retina specialists’ treatment selections significantly outperform treatments mandated by step therapy protocols. Patients under physician-directed care were less likely to need medication switches, indicating a more effective initial treatment choice. This finding stresses the importance of maintaining physician autonomy in medication selection to ensure the highest quality of individualized care.
2. Prior Authorizations Impose Significant Societal Costs Despite Limited Savings
Dr. Ella Leung of Georgia Retina® shared results from a theoretical cost model analyzing the societal impact of prior authorization (PA) processes for anti-VEGF treatments. While insurers save an average of $28.90 per injection by requiring PA, the broader societal costs are substantial—exceeding $10,000 per patient over a lifetime. These costs stem primarily from lost workplace productivity ($491.86), patient burden ($292.71), and provider overhead ($27.35). PA is far less efficient than outcomes-based models such as OMI’s Shared Savings approach, which yields net savings of over $300 per injection while minimizing administrative burdens.
Conclusion
The 2025 ASRS® conference highlighted the complex balance between delivering high-quality retina care and managing costs at both the patient and societal levels. The evidence emphasizes:
- The critical role of physician autonomy in treatment decisions for better patient outcomes.
- The need to reconsider administrative policies like prior authorizations that may save insurers modest sums but impose heavy costs on patients, providers, and society.
- The financial pressures on Medicare driven by evolving prescribing behaviors and the emergence of new, costly therapies.
As retina specialists and policymakers navigate these challenges, embracing evidence-based approaches that prioritize patient-centered care and streamline administrative processes will be key to advancing both clinical outcomes and healthcare sustainability.