Treatment best practice

The Vision Academy seeks to provide guidance on best clinical practice through collective expertise in areas with insufficient conclusive evidence (such as from large clinical trials). Read more about guidance from the Vision Academy on the following topics:

  • Optimal application of anti-VEGF therapy
  • Management of subfoveal hemorrhage
  • Use of topical antibiotics with intravitreal injections
  • Principles for the management of DME
  • The optimal management of patients with RPE tear

Optimal application of anti-VEGF therapy 

There is a lack of clarity on the optimal treatment regimen for anti-vascular endothelial growth factor (VEGF)-treated retinal conditions and how regimens can be administered in the clinic. As therapy has evolved, so too have the regimens used in clinical practice. However, visual outcomes in the real world have generally not reflected those in clinical trials. One reason for this could be a lack of consensus on how best to administer anti-VEGF therapy.

Hear from Professor Paolo Lanzetta on the need for Vision Academy guidance on the optimal use of anti-VEGF therapy.


Hear recommendations from Professor Paul Mitchell and Dr. Andrew Chang on the optimal anti-VEGF therapy regimen.

Man's eye

Management of subfoveal hemorrhage

Subfoveal hemorrhage results in progressive visual decline. However, there are a variety of treatments targeted at the removal or displacement of the hemorrhage. The Vision Academy aims to understand and communicate the latest evidence on best practice for treating subfoveal hemorrhage.

Read more about the management of subfoveal hemorrhage in the Vision Academy Viewpoint

Download the management of subfoveal hemorrhage slide kit

Use of topical antibiotics with intravitreal injections 

Topical antibiotics are commonly used alongside intravitreal injections, as they are expected to minimize the risk of serious complications such as endophthalmitis. However, evidence-based guidelines are lacking in terms of the use of antibiotics during intravitreal injection procedures. Based on an extensive review of the evidence literature, the Vision Academy does not recommend the use of topical antibiotics alongside intravitreal injections. There is no evidence for the prevention of infection and a reduction in infection-related morbidity. Repeated use is proven to increase the risk of antibiotic resistance and there is an additional cost and burden to patients, physicians, and healthcare systems.

Hear from Associate Professor Alex Hunyor on the development of the Vision Academy Viewpoint on this topic.

Principles for the management of DME

A recently published Vision Academy Clinical Challenge article in JAMA Ophthalmology examined a case study of a patient presenting with center-involved diabetic macular edema (CI-DME) and proliferative diabetic retinopathy (PDR). It provides expert interpretation of real-world treatment decisions alongside current treatment guidelines. This publication is a significant part of the Vision Academy’s goal to set out the key principles for the prevention and treatment of DME, a common complication in patients with poorly controlled diabetes mellitus.

Read the Vision Academy abstract on CI-DME and PDR

The role of OCT-A in retinal disease management
Additional measures of visual function beyond acuity

The optimal management of patients with RPE tear

Retinal pigment epithelium (RPE) tears are a relatively frequent occurrence in patients with neovascular age-related macular degeneration (nAMD), and may develop spontaneously or following laser photocoagulation, photodynamic therapy, or intravitreal injection. Visual acuity is frequently poor for these patients in the long term. As the number of patients with nAMD and associated anti-VEGF injections increase, addressing the challenges of preventing and treating RPE tear formation have become increasingly important in order to help preserve visual function in these patients.

The Vision Academy has provided expert recommendations for the management of RPE tear during anti-VEGF therapy in a recently published article. Guidance on the diagnosis and monitoring of RPE tears, as well as the treatment of nAMD in patients with RPE tears, is provided. Risk factors for the development of RPE tear during anti-VEGF therapy have also been identified.

Read the Vision Academy publication on the management of patients with RPE tear

Read the Vision Academy Viewpoint on the management of patients with RPE tear