There are unmistakeable parallels in a retina and a coral reef. Both comprise complex, highly sensitive ecosystems that rely on light as their primary source of energy. And both can be damaged by chronic inflammation, oxidative stress, and the collapse of delicate mutualistic or cellular networks.
It was, therefore, appropriate that this year’s Asia-Pacific Vitreoretina Society (APVRS) congress, held on the spectacular Gold Coast, was themed ‘Where Retina Meets the Reef’.
The 19th annual APVRS congress, convened by Dr Anil Sharma (New South Wales) and Dr Mali Okada (Victoria), was memorable and a resounding success. Held in conjunction with the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) Queensland state branch meeting, the congress attracted 2,000 delegates from 46 countries, who came to discuss the complex interconnected structure of the retina, visit trade exhibitors, and engage in a program spanning public health, clinical trials, and surgical innovation.
In his welcome address, congress President and APVRS Secretary-General, Professor Andrew Chang AM (New South Wales), told delegates the event had grown well beyond its regional roots “into a global platform to share knowledge”.
While networking takes place in many different ways, he observed that many of the connections occurring on the exhibition floor, and in the wet labs and presentation rooms, would lead to collaborations, whether in practice, research, or industry.
Prof Chang described the congress as an event with “industry meeting clinicians, young students meeting masters, surgeons meeting medical retinal ophthalmologists, and all ophthalmic subspecialities uniting paths under one roof”. Ophthalmologists from across the world he had spoken with had been enthusiastic about visiting Australia.
Professor Tien Yin Wong (Singapore), President of APVRS, traced APVRS’ origins back to its first congress in 2006, founded by a small group of Asia-Pacific retinal specialists including the late Professor Yasuo Tano (Japan), as well as Professor Ian Constable (Western Australia), who was in attendance. Since then, he said, APVRS has grown “in strength, size, impact, and influence”.
Scale of Regional Blindness
A dedicated public health session brought together speakers from countries and regions including Indonesia, Bangladesh, and the Pacific, each addressing the practicalities of delivering eye care in vastly different health systems.
Professor Muhammad Bayu Sasongko outlined the scale of the challenge in Indonesia, a country whose geography – thousands of islands spread across a vast archipelago – makes conventional eye care delivery models unworkable. Indonesia’s response to the rising incidence of diabetic retinopathy is a four-region screening and referral network built around primary health facilities for screening, as well as district and tertiary hospitals, linked by a shared electronic health record so a patient’s screening and treatment history follows them between facilities. The aim is to eventually cover more than six million Indonesians living with diabetes. Prof Sasongko was candid about the obstacles, citing changes to the insurance system, limited financial capacity, and “a potential political situation that most likely will slow down the work”.
Professor Sabrina Rahmatullah presented on Bangladesh’s experience, noting the country’s success in reducing cataract blindness is now being tested by a much harder adversary. “Unlike cataract, diabetic retinopathy needs lifelong monitoring and repeated treatment, a far harder problem for healthcare systems like ours,” she said. More than 13 million adults live with diabetes in Bangladesh, and around 30% of them are expected to develop diabetic retinopathy. The Diabetic Association of Bangladesh’s hospital network, mobile diagnostic buses that take retinal imaging and even laser treatment directly to underserved districts, organisations like Orbis International and the Fred Hollows Foundation, and public-private partnerships offering subsidised anti-VEGF treatment are “a genuine step forward” but demand far outweighs supply. Artificial intelligence (AI) is already “in motion, not just a proposal”. An AI platform, deployed across 18 primary vision centres since 2025, has seen monthly screening volumes grow from 17 patients in its first month to 300 by mid-2026, with between 23% and 53% of screened patients in any given month found to have referable disease. Prof Rahmatullah proposed a multi-tier pathway, with AI-assisted grading, hospitals for laser treatment, tertiary centres for advanced disease, and a follow-up system. She argued that an “AI-assisted screening system could significantly improve screening coverage in resource-limited settings”.
Prof Sasongko was candid about the obstacles, citing changes to the insurance system, limited financial capacity, and “a potential political situation that most likely will slow down the work”.
The Pacific: A Plan for the Future
Dr Duke Mataka, representing the Pacific Eye Care Society from Tonga, set out the challenges of managing vision impairment and blindness in his region, where around 50 ophthalmologists serve a population of 12 to 13 million people. Some Pacific nations have no ophthalmologist at all, relying instead on trained eye nurses. Only two vitreoretinal units exist across the entire region, in Fiji and Papua New Guinea.
In Tonga, where Dr Mataka lives, the prevalence of diabetes is “way out of proportion”, at about four in 10 people aged over 50. Despite this, he said 85% of people living with diabetes in Tonga had never had retinal screening. Efforts to improve care include a van that collects people and transports them to an eye care clinic for screening. Treatment for patients with diabetic retinopathy is limited in Tonga and some other islands of the Pacific that have not included anti-VEGF on their “essential drug list”.
Professor Nitin Verma (Tasmania) followed with what he termed a plan for the future – a model built on work by RANZCO that aims to match the delivery of support to what Pacific nations actually request, rather than what is donated to them. “You can’t design a program for the Pacific without knowing what the Pacific wants,” he said. The five core components of his plan are workforce, equipment, screening, treatment pathways, and governance. On equipment, he was blunt about the failures of ad hoc donation: “Very often when it gets to where it’s supposed to get to it doesn’t work, it can’t be supported, and basically goes from one room to another”. Prof Verma described governance, not funding, as the more persistent obstacle. “Funding always comes as a problem, but I don’t think funding is the problem. Governance is usually the problem,” he said, describing the Pacific as “a family” that must design and direct its own solutions in partnership with outside support.
Prof Verma returned later in the program with a companion presentation on equipment sustainability, proposing a formalised, demand-led model for redistributing retired equipment from Australian and New Zealand hospitals – typically replaced on a 10-year cycle while still carrying five to 10 years of useful life – into under-resourced settings.
He recommended the following five rules for equipment donation: transfers only proceed on request; equipment must meet the same standard used at home; manufacturers must commit to years of ongoing service support; training extends to biomedical technicians as well as clinicians; and running costs are disclosed upfront. When governments take ownership of equipment supplied, it is more likely to be optimally maintained and used. Alcon Constellation Vision Systems, recently supplied to Papua New Guinea, Fiji, and Laos, he said, were formally handed over to health ministries – in one case prompting one country’s prime minister to personally inspect the equipment.
Quantifying the Carbon Cost of Injections
In a fascinating presentation, Dr Scott McClintic (United States), a member of the American Society of Retina Specialists’ sustainability committee, presented data on the environmental footprint of intravitreal injections, of which an estimated 35 million are administered worldwide each year. Citing convergent published studies from Ireland and New Zealand, he put the figure at roughly 14 kilograms of CO2 equivalent per injection – approaching 500,000 tonnes annually worldwide.1,2 His committee’s life-cycle analysis identified concrete opportunities to reduce this footprint:
- A modest redesign of medication packaging could cut associated waste and emissions by more than 70%.
- Switching from single-use polystyrene shipping coolers to reusable containers, some rated for 76 uses before disposal, could reduce shipping-related emissions by more than half.
- A forthcoming committee brochure will set out which materials associated with injection procedures are genuinely necessary, and which recyclable packaging is being rendered non-recyclable by additive chemicals.
Finally, Dr McClintic observed that longer-acting anti-VEGF agents are not straightforwardly greener, noting their higher cost is a reasonable proxy for a heavier manufacturing footprint.
Dr McClintic observed that longer-acting anti-VEGF agents are not straightforwardly greener
The Tano Lecture: Professor Gemmy Cheung
The congress’s keynote Tano Lecture, established in 2009 in memory of APVRS Founding President Prof Tano and awarded annually to a senior figure judged to have made outstanding contributions to vitreoretinal disease, went this year to Professor Gemmy Cheung (Singapore). She holds the Arthur Lim Professorship of Ophthalmology at Duke-NUS Medical School, National University of Singapore, and is Director of Translational Clinical Research at the Singapore Eye Research Institute. Her citation noted more than 400 peer-reviewed publications, an h-index of 81, and a career spent establishing polypoidal choroidal vasculopathy (PCV) as a distinct, Asian-prevalent phenotype of age-related macular degeneration (AMD), with work that has shaped global diagnostic and treatment guidelines.
Delivering the lecture, titled ‘Phenotyping Asian AMD’, Prof Cheung traced her research back to the transition from photodynamic therapy to anti-VEGF treatment two decades ago, when it became apparent that first-generation anti-VEGF agents performed differently in the polypoidal lesions common in Asian populations than in typical Western neovascular AMD (nAMD). She noted that even now, “at most about 20% of registration trial populations were described as Asian” – a gap her Translational Asian Patient AMD program has worked to close. Using optical coherence tomography angiography (OCT-A) and 3D reconstruction, her group has shown polypoidal lesions to be more structurally complex than earlier imaging suggested, and has established non-invasive, OCT-based diagnostic criteria that no longer depend on indocyanine green angiography. She also presented comparative data showing Asian patients with PCV have fewer drusen and thicker choroids than Western patients with AMD regardless of where they live – evidence, she said, that genetics rather than environment principally drives the phenotype.
AI in the Retina Clinic
During a wide-ranging session on the use of AI in ophthalmology, Dr Rishi Singh, from the United States, delved into the tangible advantages of using this technology at Massachusetts Eye and Ear, Massachusetts General Hospital, Brigham and Women’s Hospital, and affiliated sites. He described ambient documentation tools – his group trialled a variety of platforms before adopting DAX Copilot – as transformative, citing internal data showing 74% of clinicians spent less time on the computer and 52% reported a better patient experience. Autonomous diabetic retinopathy screening in primary care clinics, he said, had identified a 21% positivity rate among diabetes patients receiving routine care. The benefits have been twofold: some patients with diabetes, who might otherwise go years without a retinal exam, are being screened and referred only when necessary, and secondly, retinal specialists are only seeing patients who require specialist assessment. Dr Singh spoke about using AI to rapidly identify clinical trial candidates from tens of thousands of electronic records, as well as the use of large language models to synthesise complex multi-institution patient histories and review industry contracts, in one case helping recover close to a million dollars in denied insurance claims. “It has become very useful to the way we transform our practice,” he said, and has “made decisions faster and better for patients”.
The Velodrome study, run in Australia, is testing whether refilling the PDS with ranibizumab every 36 weeks is as safe and effective as every 24 weeks for people with nAMD
Roche’s Port Delivery System
A Roche industry symposium explored the treatment burden of frequent anti-VEGF injections and the case for continuous drug delivery via its port delivery system (PDS) for patients with nAMD. The refillable implant, roughly the size of a grain of rice, is surgically placed via the pars plana and capable of sustained ranibizumab delivery over months. Data presented from the Phase 2 Ladder and Phase 3 Archway trials supported a 100 mg/mL dose delivered on a 24-week refill interval, compared with monthly injections in the comparator arm.3,4 The Velodrome study, run in Australia, is testing whether refilling the PDS with ranibizumab every 36 weeks is as safe and effective as every 24 weeks for people with nAMD.5
During the session, a patient of Dr I-Van Ho (New South Wales), a high-end hairdresser who is enrolled in the PDS clinical trial, described the shift from three-weekly injections in his other eye to six-monthly refills. “The port delivery system outweighs having injections,” he said, explaining the disruption of frequent treatment on his working life: “My work’s there, and [when I need an injection] I’ve got to then go in and cancel everybody… if I need to go and do something, if I need to go and stay or go overseas, it’s all got to be coordinated.”
Advancing Excellence: Collaborating in the Wet Lab
By Professor Andrew Chang AM
One of the most anticipated highlights of APVRS 2026 was the wet lab program, pictured above, which provided delegates with a rare opportunity to refine advanced vitreoretinal surgical techniques in a hands-on learning environment. Participants gained practical experience in specialised procedures, such as intraocular lens suturing and macular buckling for high myopia, guided by an international faculty of expert instructors led by Professor Lawrence Lee (Queensland), Professor Wai-Ching Lam (Canada), and Dr Carlo Nasol (Philippines). The program was made possible through the generous support of industry partners, who donated state-of-the-art surgical microscopes, machines, instruments, and equipment. Using highly realistic Oculus model eyes, delegates were able to practise complex procedures in a controlled setting, reinforcing APVRS’ commitment to surgical education and excellence in patient care.
World Retina Spotlight and Speakers’ Corner
A signature feature of APVRS 2026, the World Retina Spotlight, brought together representatives from APVRS’ 18 member societies to share insights, innovations, and experiences from around the world. Overseen by Professor Adrian Fung (New South Wales), the program fostered international dialogue and collaboration through presentations centred on six key themes: Public Health Initiatives, Machinery and Medicines, Digital Innovations, Sustainability, Asia Meets the World, and Education. These timely discussions highlighted how different regions are addressing common challenges and opportunities in retinal care, while showcasing emerging technologies, innovative treatment approaches, educational initiatives, and sustainable healthcare strategies.
In addition to the World Retina Spotlight, APVRS 2026 provided a dedicated Speakers’ Corner, offering our member societies a valuable platform to showcase local achievements, research, and clinical experiences. This initiative was particularly meaningful for some smaller or developing countries or territories, where opportunities to present on the international stage may be limited. The Speakers’ Corner enabled societies to nominate emerging retinal specialists and younger ophthalmologists to share their work with a global audience, fostering the next generation of leaders in retinal care. By amplifying diverse voices and perspectives from across the region and beyond, these initiatives reinforced APVRS’ commitment to inclusivity, education, and international collaboration, while strengthening connections among vitreoretinal specialists worldwide.
Charting the Future of Retinal Innovation
Designed as a platform to bridge innovation and clinical practice, the Future of Retinal Innovation Forum explored the complete journey of bringing new technologies and therapies from concept to patient care. Discussions covered the pathway from scientific discovery and early-stage innovation to clinical trials, commercialisation, and real-world implementation. Experts also examined critical topics including startup funding, global regulatory requirements, investment strategies, and government initiatives that support innovation through research grants and tax incentives. By bringing together innovators, clinicians, investors, industry leaders, and policymakers, this forum provided a forward-looking perspective on the future of retinal medicine and established a strong foundation for future editions of this exciting new APVRS initiative.
Building on Success
We are deeply grateful for the overwhelmingly positive response to this year’s program and for the enthusiastic participation of our member societies and delegates. As APVRS continues to grow and strengthen its international network, the Society looks forward to welcoming delegates to the APVRS 2027 Congress in Kuala Lumpur, Malaysia, 3–5 December 2027, where the exchange of knowledge, innovation, and collaboration will continue to advance retinal care across the region and beyond.
Professor Andrew Chang AM is a vitreoretinal surgeon and ophthalmologist. He is the Medical Director of Sydney Retina, Head of Ophthalmology at Sydney Eye Hospital, and APVRS congress President and Secretary-General.
References
- Power B, Brady R, Connell P. Analyzing the carbon footprint of an intravitreal injection. J Ophthalmic Vis Res. 2021 Jul 29;16(3):367-376. doi: 10.18502/jovr.v16i3.9433.
- Chandra P, Welch S, Oliver GF, Gale J. The carbon footprint of intravitreal injections. Clin Exp Ophthalmol. 2022 Apr;50(3):347-349. doi: 10.1111/ceo.14055.
- Holekamp NM, Campochiaro PA, Regillo C, et al; all Archway Investigators. Archway randomized phase 3 trial of the port delivery system with ranibizumab for neovascular age-related macular degeneration. Ophthalmology. 2022 Mar;129(3):295-307. doi: 10.1016/j.ophtha.2021.09.016.
- Khanani AM, Callanan D, Gune S, et al; for the Ladder Investigators. End-of-study results for the Ladder phase 2 trial of the port delivery system with ranibizumab for neovascular age-related macular degeneration. Ophthalmol Retina. 2021 Aug;5(8):775-787. doi: 10.1016/j.oret.2020.11.004.
- A study of the efficacy, safety, and pharmacokinetics of a 36-week refill regimen for the port delivery system with ranibizumab in patients with neovascular age-related macular degeneration (Velodrome). Available at: clinicaltrials.gov/study/NCT04657289 [accessed Sept 2026].
