The Future of Bevacizumab | Plus John Miller, MD, on the Mass Eye and Ear Vitrectomy Course | Encelto for MacTel2

Guests: John B. Miller, MD – Associate Professor of Ophthalmology, Harvard Medical School; Director of Retinal Imaging; Associate Fellowship Director, Vitreoretinal Surgery, Mass Eye and EarShow SummaryJohn Kitchens, MD, opens with a recap of the inaugural Kiawah Eye Retina meeting, which used a case-based, panel-driven format and drew 80 retina specialists. It left him hoping for an invitation back next year.John and Scott then turn to two news stories. First: Outlook Therapeutics won its formal dispute resolution appeal with the FDA and resubmitted its BLA for ONS-5010 in June. John and Scott unpack what an FDA-approved ophthalmic bevacizumab would mean for practices, patients, and the future of compounded bevacizumab — and why everything hinges on how Outlook chooses to price it.John B. Miller, MD, joins to preview the 16th Annual Mass Eye and Ear Vitrectomy Course (July 10-11, 2026), a boot camp-style introduction to vitreoretinal surgery for first-year fellows that takes place in the actual Mass Eye and Ear ORs.The Vitreoretinal View closes with a deep dive into Encelto (Neurotech Pharmaceuticals), the first FDA-approved treatment for MacTel2, covering patient selection, the reimbursement landscape, how AI may help identify disease earlier, and why 200 implants in the first year of launch represents a genuine milestone for a rare disease therapy.Hosts: John Kitchens, MD; Scott KrzywonosTopics CoveredKiawah Eye Retina Meeting RecapFirst-ever retina track at Kiawah Eye; co-chaired by John Kitchens, MD, and LejlaVajzovic, MD; organized by Rishi Singh, MDEntirely case-based format with panels, audience participation, and fellow/resident presentations~80 attendees, strong industry presence; John anticipates the meeting doubles in size next yearOutlook Therapeutics Outlook won its formal dispute resolution appeal May 26, 2026; FDA concluded substantial evidence of effectiveness for nAMD; BLA resubmitted June 1, 2026 as a Class 1 review (60-day PDUFA decision window)If approved, ONS-5010 would be the first FDA-approved ophthalmic formulation of bevacizumab The double-edged sword: approval validates the need for a reliably manufactured, ocular-grade bevacizumab; published data documents significant variability in compounded Avastin concentrationRisk to access: once an approved drug exists, FDA may restrict compounding; if priced too high, patients without insurance could lose access to their most affordable optionMass Eye and Ear Vitrectomy Course with John B. Miller, MD16th annual course; July 10-11, 2026; free of charge; held at Mass Eye and EarDesigned for first-year retina fellows; ~60 first-year fellows typically attend out of ~85 nationwide — effectively the entire incoming classDay 1: lectures and case panels featuring faculty including Harry Flynn, MD; Stanley Chang, MD; and Steve Charles, MDDay 2: wet lab in the actual Mass Eye and Ear ORs; fellows rotate through three one-hour stations covering scleral buckling, vitrectomy, and membrane peeling; near 1:1 faculty-to-fellow ratio; injection technique stations also incorporatedRegistration: course page hosted by MCPI; late registrations acceptedRegister at this link: https://mcpi.cventevents.com/event/mee2026/summaryVitreoretinal View: Encelto for MacTel2MacTel2: now understood as a neurodegenerative, not primarily vascular, condition; bilateral; often presents in the 30s-50s; affects reading speed and juxtafoveal vision even when distance acuity is preservedEncelto (Neurotech Pharmaceuticals): CNTF-producing cell implant sutured inferotemporally via pars plana; FDA-approved March 2025; potentially lifelong — viable CNTF-producing cells confirmed 14 years post-implantation200 implants in first year of launch: hosts characterize this as a strong result given the $250,000 price, limited patient population, and modest per-procedure margin for surgeonsReimbursement pathways: buy-and-bill (high risk of clawback) vs. specialty pharmacy route (no drug margin, but surgical fee intact); insurance approvals still maturingPatient selection: John identifies two groups — those stable and needing reassurance vs. those with meaningful functional decline who are the most motivated candidatesAI and early detection: John describes uploading de-identified OCTs that appeared normal to Claude AI, which flagged subtle early MacTel characteristics — raising the possibility that AI-assisted screening could identify subclinical disease earlier and improve treatment timingKey TakeawaysThe path to approval for ONS-1050 is now clearer than ever — but its impact on patients will be determined by pricing, not the science.The Mass Eye and Ear Vitrectomy Course remains one of the most hands-on, surgically focused fellowships boot camps in the country; first-year fellows should register early.Encelto's first year in the real world reflects genuine surgeon commitment to a therapy that offers modest financial incentive but meaningful patient benefit.AI-assisted OCT interpretation may play a future role in identifying subclinical MacTel earlier — improving the window for intervention.Sponsor NotesWatch the Purple Chair series at Vabysmo-HCP.comCredits Production & Marketing: Laura Brown | Business Operations: Liz Hogan Listen at RetinUp.com | Apple Podcasts | Spotify | YouTube