Previous episodes
Clorinda Walley of Good Days joins John Kitchens, MD, and Scott Krzywonos to explain how the patient assistance organization works, who qualifies, and how retina specialists can help sustain its funding. Prof. Paulo Stanga then presents the inaugural Image of the Month: a papillophlebitis case showing how pre-visit Optos Silverstone RGB imaging can redirect a diagnosis before the physician enters the room.
In this episode of RetinUp, Clorinda Walley of Good Days joins hosts John Kitchens, MD, and Scott Krzywonos to explain how the patient assistance organization works, who qualifies, and how retina specialists can help sustain its funding.
The episode also introduces the inaugural Image of the Month, with Prof. Paulo Stanga presenting a papillophlebitis case that demonstrates how pre-visit ultra-widefield RGB imaging with the Optos Silverstone RGB can redirect a diagnosis before the physician enters the room.
Hosts: John Kitchens, MD, and Scott Krzywonos
Topics Covered
Good Days in 2026 (Clorinda Walley)
What is Good Days?
Types of assistance (copay, premium, and travel support across multiple disease categories) and who is eligible for support
Funding sources for Good Days
How retinal vascular disease assistance operates separately from GA assistance
What happens when a program is funded—and when funding runs out
Good Days' advocacy in DC and beyond
Getting your patients enrolled in Good Days
Image of the Month: Papillophlebitis (Prof. Paulo Stanga)
Case presentation: patient referred for a clinical trial with presumed branch retinal vein occlusion
Ultra-widefield RGB imaging with the Optos Silverstone upon referral
Final diagnosis: papillophlebitis
Clinical workflow advantages of pre-visit imaging
Key Takeaways
Good Days is a critical safety net for Medicare patients who cannot afford their retinal treatments, but its programs depend entirely on ongoing donations — funding can close without warning. Retina specialists can directly support Good Days by getting on the notification list, posting donation signage, and advocating with pharma partners for continued funding. Retina practice as we know it is supported by Good Days—but Good Days itself is only around as long as their donation base shows up.
Ultra-widefield imaging captured early in an appointment changes clinical workflow: Prof. Stanga's case demonstrates that RGB imaging can redirect a diagnosis before the physician enters the room. True-color RGB ultra-widefield imaging with swept-source OCT provides a more complete picture of the retina than two-channel systems, particularly at the vitreoretinal interface and in patients with media opacity.
Sponsors
RetinUp is an editorially independent podcast supported with advertising.
This episode is sponsored by Ocular Therapeutix. Learn more at OCUTX.com. This episode is sponsored by Genentech, maker of Vabysmo (faricimab-svoa). Watch the Purple Chair series at Vabysmo-HCP.com.
The images featured in this episode were captured using the Optos Silverstone RGB. Learn more about Silverstone RGB at Optos.com/products/silverstone.
Proposed Medicare and Medicaid cuts, heads-up 3D surgical visualization, and the SOL-1 Phase 3 superiority trial all take center stage as Stanford's Darius Moshfeghi, MD, joins John Kitchens, MD, and Scott Krzywonos to unpack what Axpaxli's superiority outcome over aflibercept means for retina practice — and what comes next with SOL-R.
This episode of RetinUp opens with a policy discussion on proposed Medicare and Medicaid funding cuts and what they could mean for retina practices and vulnerable patients.
John Kitchens, MD, then shares a decade of experience with heads-up 3D visualization in the Vitreoretinal View segment, covering its advantages for surgical training and outcomes, and why adoption has remained slower than expected.
In the main interview, Stanford's Darius Moshfeghi, MD, joins Scott and John to break down the SOL-1 Phase 3 superiority study on Axpaxli (OTX-TKI), Ocular Therapeutix's investigational bioresorbable intravitreal hydrogel incorporating axitinib. He explains his role as an independent rescue monitor, unpacks what the superiority outcome over aflibercept means for clinical practice, and previews what the SOL-R study may show next.
Hosts: John Kitchens, MD, and Scott Krzywonos
Topics Covered
SOL-1 Study: Design, Findings & Context (Darius Moshfeghi, MD)
The independent rescue monitor role: what it is, how it worked, and why it was created for SOL-1
SOL-1's study design, superiority outcome, and floaters data (and why they were not clinically concerning)
Superiority vs. non-inferiority: implications for labeling, step therapy avoidance, and physician adoption
How retina specialists could integrate Axpaxli into their practice protocols
How SOL-R differs from SOL-1, and what SOL-R might show us
Vitreoretinal View: Heads-Up 3D Visualization
Origins of heads-up 3D: TruVision and Alcon NGenuity
Zeiss and Heidelberg heads-up visualization systems
Why John adopted NGenuity early and continues to use it
Key benefits: surgical video quality, fellow training, and real-time coaching
Cost considerations and other reasons why adoption has remained low
The anterior segment opportunity: how cataract surgery economics may drive broader uptake
Medicare & Managed Care Policy Concerns
Proposed $200 billion in federal budget cuts and the potential impact on Medicare and Medicaid
Risk of increased step therapy, Avastin-first policies, and tiered drug coverage
Access-to-care concerns for Medicaid patients, particularly at academic medical centers
The difference between traditional Medicare and managed Medicare (Medicare Advantage)
Historical context: past Congressional threats to Medicare reimbursement and how they've played out
Key Takeaways
The independent rescue monitor role pioneered in SOL-1 reflects a novel, collaborative approach to adjudicating vision-threatening events in clinical trials. Physicians will likely adapt Axpaxli into existing treat-and-extend protocols; SOL-R's more traditional design may generate data that resonates more directly with clinical practice. SOL-1 is the first superiority study in retina/ophthalmology, demonstrating that a single injection of Axpaxli (Ocular Therapeutix) outperforms aflibercept 2mg (Regeneron) on vision maintenance — with durability extending well beyond current approved dosing intervals. Heads-up 3D visualization offers meaningful advantages for surgical training and video quality, but high costs for integrated systems and declining surgery center reimbursements continue to limit adoption. Proposed federal budget cuts to Medicare and Medicaid represent a real threat to retina practices and patient access, particularly for drug coverage and underserved populations.
Marci English and Erin Kimbrel, PhD, of Astellas discuss Phase 1b interim results for ASP7317, an investigational RPE cell therapy showing functional vision gains in advanced GA — plus two pipeline programs for Stargardt disease and glaucoma. Murtaza Adam, MD, then makes the case for IV-free vitreoretinal surgery, and the hosts discuss what office-based surgery will take to become a reality.
Recorded on the final day of ARVO 2026 in Denver, John Kitchens, MD, invites Marci English and Erin Kimbrel, PhD, from Astellas to review some of the most significant cell therapy data to emerge in retina in recent years: the Phase 1b interim results for ASP7317, an investigational RPE cell therapy that showed functional visual acuity gains in patients with advanced GA. The conversation covers what made earlier cell therapies fail, what's different now, the path to a registrational trial, and two additional pipeline programs: ASP2767 (a gene therapy for glaucoma) and ASP2020 (an immune-evasive RPE cell therapy for Stargardt disease).
The Vitreoretinal View segment features Murtaza Adam, MD, who has been performing IV-free vitreoretinal surgery since 2018, now accounting for roughly 70% of his cases. He breaks down patient selection, practical logistics, and why the approach could serve as a bridge to office-based surgery.
John and Scott then cover the realities of office-based surgery and speculate on what needs to change for retina surgeons to embrace it.
Hosts: John Kitchens, MD, Scott Krzywonos
Topics Covered
ASP7317 Phase 1b Interim Results
ASP7317: investigational RPE cell therapy derived from human embryonic stem cells, delivered via subretinal transplantation in advanced GA secondary to AMD
Three dose cohorts with severity stratification; BCVA improvements observed in multiple patients, including gains of 2 lines
GA lesion area stabilized in treated eyes; only 1 month of immunosuppression required
Mechanism: likely a combination of cell replacement, phagocytic debris clearance, and trophic factor secretion
Why earlier RPE transplantation attempts failed: engraftment and immune rejection; advances in differentiation technique and surgical delivery have changed the picture
Pipeline & Path Forward
Astellas plans to engage regulators in the coming months with the goal of moving directly to Phase 3; functional BCVA endpoints expected to be central to the registrational design
Complement inhibitors and ASP7317 seen as complementary across the GA spectrum: slowing progression in early disease, potentially restoring function in advanced disease
ASP2020: iPS-derived RPE cell therapy for Stargardt disease; Phase 1 expected in 2026; EVOLVE natural history study ongoing
ASP2767: AAV gene therapy for neuroprotection of retinal ganglion cells in glaucoma; IND filing anticipated shortly
Vitreoretinal View: IV-Free Surgery (Murtaza Adam, MD)
Oral sedation plus sub-Tenon's block replaces IV anesthesia in approximately 70% of Dr. Adam's cases; in practice since 2018 with published safety data
Patient benefits: no fasting, no anesthesiologist copay, no GLP-1 or anticoagulation concerns; appropriate patients can drive themselves home
Patient selection is key, and active patient communication during surgery is essential
Office-Based Surgery in 2026
The financial model isn't there yet: no facility fee reimbursement in the office setting, and organized ophthalmology advocacy has stalled
Key Takeaways
ASP7317 Phase 1b data showed cell-based therapy led to functional BCVA gains in advanced GA.
Astellas views complement inhibitors and ASP7317 as complementary tools, not competitors, across the GA disease spectrum.
IV-free vitreoretinal surgery is practical, patient-friendly, and already in routine use — but the path to office-based surgery still requires a reimbursement solution.
Credits Production & Marketing: Laura Brown | Business Operations: Liz Hogan
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