Hosts:

John Kitchens, MD

Scott Krzywonos

Guests:

Thomas Stone, MD – Program Committee Chair, ASRS Business of Retina Meeting

Maria Berrocal, MD – CEO, Drs. Berrocal & Associates; Associate Professor, University of Puerto Rico

David Mandell, JD, MBA – Co-Founder & Partner, OJM Group

RetinUp brings together three distinct but interconnected conversations focused on the business, surgical innovation, and financial realities of retina practice.

First, Tom Stone joins the show to preview the upcoming ASRS Business of Retina Meeting in Houston (March 20–22). He outlines this year’s agenda, which covers staffing strategies, AI in practice operations, drug inventory management, coding updates, and a new full-day clinical trials workshop designed to help practices launch research programs from the ground up.

Next, in the Vitreoretinal View segment, Maria Berrocal discusses her experience using the Alcon UNITY VCS system, focusing on flow-based vitrectomy, 30,000 cpm performance, and the evolution of 27-gauge surgery. She also shares early observations comparing case times and complication rates versus legacy systems.

For the long-form interview, David Mandell of the OJM Group offers a structured framework for physician wealth management across career stages—covering early-career planning, mid-career tax strategy and asset protection, and retirement-phase portfolio positioning.

ASRS Business of Retina Meeting

1. The 2026 meeting agenda: staffing, AI implementation, and drug inventory strategy
2. Coding updates and compliance (including Modifier -25)
3. Launch of the Clinical Trials Workshop (capped at 80 participants, so register soon!)
4. Dedicated business curriculum for fellows

Vitreoretinal View – Surgical Innovation

1. Transition from vacuum-based to flow-based vitrectomy on Alcon UNITY VCS
2. 27-gauge adoption and surface vitrectomy precision
3. Reduced instrument frustrations

Physician Wealth Strategy

1. Why retina specialists are unique when it comes to wealth strategy
2. Early-career debt balancing, disability protection, and lifestyle creep
3. Mid-career tax optimization and liability protection
4. Retirement red-zone portfolio repositioning
5. Assessing private equity offers

1. The Business of Retina Meeting is will be in Houston March 20-22. Registration link below.
2. Flow-based vitrectomy may meaningfully refine 27-gauge surgery.
3. Financial discipline—not peak income—is what ultimately determines long-term security.

1. ASRS Business of Retina Meeting – Register Here
2. OJM Group – ojmgroup.com
3. Use the code RetinUp26 to get a free copy of the book Wealth Planning for the Modern Physician: Residency to Retirement at the OJM Bookstore.

Hosts:

John Kitchens, MD

Scott Krzywonos

Show Summary:

In this emergency episode of RetinUp, John and Scott break down the newly announced SOL-1 study data evaluating Axpaxli (Ocular Therapeutix) for the treatment of wet AMD.

The superiority trial compared a single Axpaxli injection to a single Eylea injection (after all eyes received a pair of monthly Eylea doses) in patients with wet AMD. The primary endpoint was the proportion of patients maintaining vision at 36 weeks (defined as losing fewer than 15 ETDRS letters).

Key findings include:

1. 74% of Axpaxli patients maintained vision at 36 weeks vs. 59% in the Eylea arm
2. Approximately 75% of Axpaxli patients required no rescue treatment through 36 weeks
3. Durable disease control extending 24–36 weeks, with some patients reaching 52 weeks

John and Scott discuss:

1. How the SOL-1 study design (FDA-aligned superiority endpoint) shaped the results
2. What this means for durability beyond traditional anti-VEGF therapies
3. Why the market reaction diverged from clinical enthusiasm
4. How to talk to your patients who hear about study data
5. What to expect next from the SOL-R study and a potential FDA submission

Why It Matters:

For the first time in years, retina specialists may be looking at a new mechanism of action — a tyrosine kinase inhibitor — with the potential to significantly extend treatment intervals after a single injection.

More detailed analysis and expert commentary coming soon on RetinUp.

Listen & Subscribe:

RetinUp.com | Apple Podcasts | Spotify | YouTube

Credits:

Production & Marketing: Laura Brown

Business Operations: Liz Hogan

Hosts:

John Kitchens, MD

Scott Krzywonos

Guest:

Thomas Albini, MD

Professor of Clinical Ophthalmology, Bascom Palmer Eye Institute

Course Co-Organizer, Angiogenesis, Exudation, and Degeneration Meeting

Show Summary:

In this episode, RetinUp offers pre-meeting coverage of the 2026 Angiogenesis, Exudation, and Degeneration meeting with one of its long-time course co-leaders, Thomas Albini, MD. John and Scott sit down with Tom to help listeners navigate what can be an overwhelming, marathon agenda—and to highlight the sessions most likely to shape retina care and research in the year ahead.

The conversation spans the rapid expansion of artificial intelligence in retina, early-phase geographic atrophy studies, durability strategies in wet AMD, and a packed slate of gene therapy and inherited retinal disease (IRD) updates. Tom also explains why the meeting remains fully virtual, how talks are selected, and why Angiogenesis continues to serve as a global preview of where retina research is heading.

Topics Covered:

1. Why the Angiogenesis meeting remains virtual—and how attendance has doubled
2. How to prepare for a one-day, 80+-talk retina marathon
3. The growing role of AI and machine learning in imaging and clinical trials
4. When AI may realistically impact everyday clinical practice
5. Early-phase geographic atrophy data and emerging systemic therapies
6. Oral and non-intravitreal treatment strategies—and their safety tradeoffs
7. Complement vs. non-complement targets in GA
8. Advances in wet AMD durability
9. What to watch in gene therapy, including delivery routes and inflammation risk
10. Inherited retinal disease sessions, including optogenetics and gene-agnostic approaches
11. Home OCT, imaging innovation, and AI-inferred fluorescein angiography
12. Landmark trials reaching their final chapters—and why they matter
13. How Angiogenesis fits alongside meetings like ASRS, AAO, and the Vit-Buckle Society

Key Quotes:

1. “You could say this is a lot of [AI] talks, but I think it's the tip of the iceberg. I would imagine it's going to be grow exponentially over the years.” — Thomas Albini, MD
2. “If there's any hour to not miss in this meeting, I've bookmarked that 2:45 to 3:45 hour because you literally get every single gene therapy talk in a single hour.” — John Kitchens, MD

Hosts:

John Kitchens, MD

Scott Krzywonos

Guest:

Elizabeth Cifers

Founder & Principal Consultant, Elizabeth Cifers Consulting

Show Summary:

In this episode, RetinUp introduces a new recurring segment, Vitreoretinal View, focused on surgical innovation and next-generation vitrectomy platforms. John breaks down where vitreoretinal surgery is headed, and comments on Alcon’s UNITY VCS system, flow-based vitrectomy, and his expectations for the next wave of surgical innovation.

But first, the conversation kicks off with a discussion of drug access and policy, as John and Scott revisit Outlook Therapeutics’ unsuccessful attempt to secure FDA approval for ONS-5010, an ophthalmic formulation of bevacizumab. They explain why continued access to compounded bevacizumab remains critical for affordability and patient choice.

In the second half, the hosts sit down with Elizabeth Cifers, one of the country’s leading ophthalmic coding and compliance experts. Elizabeth offers a clear-eyed assessment of Modifier -25 and Modifier -59, why enforcement has intensified, and how CMS’s shift from post-pay recovery to pre-pay, AI-driven audits is fundamentally changing compliance risk for retina practices heading into 2026. (Do you think your practice’s billing and coding staff would find this episode helpful? If so, share it with them—and tell them to send us feedback by emailing us at [email protected].)

Topics Covered:

Why Outlook Therapeutics’ FDA rejection preserves access to compounded bevacizumab

Economic and regulatory risks of an FDA-approved bevacizumab alternative

Launch of the Vitreoretinal View surgical segment

Next-generation vitrectomy platforms and workflow efficiency

Alcon UNITY VCS vs. the legacy Constellation systems

Flow-based vs. Venturi-based vitrectomy

Surgical innovation amid declining reimbursement

What Modifier -25 actually requires — and common misconceptions

Proper and improper use of Modifier -59

Documentation gaps that trigger audits

CMS’s shift to AI-based anomaly detection

Pre-pay vs. post-pay audits and what practices should expect

How retina practices can prepare for changes in coding enforcement without overcorrecting

Key Quotes:

“The medicine is usually good. It’s the documentation that doesn’t support what’s being billed.” — Elizabeth Cifers

“With the algorithms CMS has now, [the question of whether you’ll be hit with an audit] is not an if — it’s a when.” — Elizabeth Cifers

“Compounded bevacizumab remains one of the most important access tools we have in retina.” — John Kitchens, MD

Guest Info:

Visit elizabethcconsulting.com to learn about how Elizabeth Cifers.

Sign up for her newsletter here, where Elizabeth shares actionable tips and strategies to help you run a more efficient, compliant, and profitable retina practice.

Hosts:

John Kitchens, MD

Scott Krzywonos

Guest:

Rishi P. Singh, MD

Chair, Department of Ophthalmology, Harvard Medical School

Chair, Department of Ophthalmology, Mass General Brigham

Show Summary:

In this episode, John and Scott break down two major developments affecting retina practices nationwide before welcoming one of the field’s most influential leaders. The discussion opens with the newly announced CMS GLOBE Model, a Medicare Part B demonstration project designed to lower drug prices through most-favored-nation pricing, and what it could mean for buy-and-bill retina practices. They then turn to the FDA’s expanded label for EYLEA HD, which now includes retinal vein occlusion and allows monthly dosing for certain patients.

In the second half, the hosts are joined by Rishi P. Singh, MD, newly appointed Chair of Ophthalmology at Harvard Medical School. Rishi reflects on stepping into leadership at one of the most storied institutions in medicine, his path from retina specialist to hospital CEO and back to academia, and how academic centers must adapt amid policy shifts, private equity pressure, and rapid technological change.

Topics Covered:

1. The CMS GLOBE Model and most-favored-nation drug pricing
2. Potential administrative and financial impact on practices in affected regions
3. The FDA’s expanded EYLEA HD label for RVO and monthly dosing
4. How label flexibility may change first-line treatment decisions
5. Insurance lag and real-world adoption challenges after label changes
6. Leadership transition at Mass Eye and Ear and Mass General Brigham
7. Balancing clinical care, research, and training in academic medicine
8. The role of academic centers in advocacy, innovation, and policy influence
9. Physician recruitment, culture, and servant leadership
10. Private equity’s role in modern ophthalmology
11. Industry collaboration, integrity, and long-term impact on patient care
12. The future of ophthalmology drug access under Part B and Part D reform

Key Quotes:

1. “The biggest issue for any of us is if buy-and-bill medicine disappears from our practices.” — Rishi P. Singh, MD
2. “We’ve been too focused on reactionary medicine and not enough on prevention.” — Rishi P. Singh, MD
3. “Anything that substantially disrupts drug pricing is going to have downstream consequences for practices.” — John Kitchens, MD

Credits:

Production & Marketing: Laura Brown

Business Operations: Liz Hogan

Listen and Subscribe:

🎧 RetinUp.com | Available on Apple Podcasts, Spotify, and YouTube

Hosts:

John Kitchens, MD

Scott Krzywonos

Guest:

Shane Dixon, Vice President of Vision, Strategic Advancement & Business Development, Cencora Specialty GPO

Show Summary:

In this episode, John and Scott continue their coverage of the Cencora Vision Exchange meeting with an in-depth conversation about the economic, policy, and operational forces reshaping retina practices. The discussion opens with key takeaways from the meeting’s opening sessions, including a deep dive into drug pricing policy, the downstream impact of federal legislation on how retina practices are reimbursed for care, and the coding and billing changes showcased at the Cencora Vision Exchange meeting.

John then sits down with Shane Dixon, VP at Cencora Specialty GPO, to unpack what a Group Purchasing Organization actually does—and why its role has become increasingly critical. Drawing on his experience as a physician assistant, former Regeneron launch leader for Eylea, practice executive, private equity operator, and now GPO executive, Shane offers a rare, 360-degree view of how drugs move from manufacturer to patient, how contracts are structured, and how practices can survive tightening margins.

Topics Covered:

1. Key takeaways from the Cencora Vision Exchange meeting
2. Federal drug pricing policy and “Most Favored Nation” pricing
3. How government policy is reshaping retina drug economics
4. Coding and billing risk, including increased scrutiny of Modifier 25
5. CMS’s use of AI for claim detection, audits, and recovery
6. Declining surgical reimbursement and its impact on access to care
7. The collapse of the Good Days patient assistance fund and what replaces it
8. What a Group Purchasing Organization (GPO) is and how it works
9. How Cencora’s GPO leverages scale, segmentation, and contracts
10. Differences between private practice and large aggregators

Key Quotes:

1. “The way we get paid for drugs is going to fundamentally change—and it’s going to change fast.” — John Kitchens, MD
2. “We’re not just doing contracts. We’re helping practices think strategically about how they operate.” — Shane Dixon
3. “Documentation isn’t optional anymore. ‘I didn’t know’ is not going to cut it.” — John Kitchens, MD

Credits:

Production & Marketing: Laura Brown

Business Operations: Liz Hogan

Listen and Subscribe:

RetinUp.com | Available on Apple Podcasts, Spotify, and YouTube

Hosts:

John Kitchens, MD; Scott Krzywonos

Guest:

Eric Besse, Vice President & General Manager, Besse Medical (a Cencora company)

Show Summary:

In this episode, Scott and John return from the Cencora Vision Exchange meeting in Dallas and sit down with Eric Besse, VP and General Manager of Besse Medical, to unpack the unseen infrastructure that keeps retina practices running. Eric shares how his family’s corner pharmacy grew into one of the most influential specialty distributors in the country and explains why drug distribution is far more than logistics — it’s practice support, financial stewardship, technology integration, and practice-level partnership.

The conversation spans everything from cold-chain handling and inventory management to sustainability and the future of practice support. For retina specialists, this is a rare, behind-the-curtain look at the systems that make allow retina practices to operate smoothly. 

Topics Covered:

• What the Cencora Vision Exchange meeting is and who attends
• The family origins of Besse Medical and its growth into a national distributor
• How Cencora and Besse Medical fit together
• Why distributors manage more than just shipping 
• Technology platforms such as CubixxMD and PODIS
• How drug distributors support retina workflows, billing, and compliance
• The importance of stable, long-tenured support teams for practices
• Cencora’s new recyclable, corrugated cold-chain packaging initiative

Key Quotes:

• “We don’t want to be viewed as a distributor that picks, packs, and ships product. We want to be more than that, and we push ourselves to be more than that.” — Eric Besse
• “If the soda fountain down the street puts two cherries on top, you put three. If they put three, you put four.” — Eric Besse, on his family’s philosophy of service
• “If I were starting a practice today, [Cencora] would be the first place I would turn to partner.” — John Kitchens, MD

Hosts:

John Kitchens, MD

Scott Krzywonos

Guest:

Alexander Gaffney, VP of Regulatory Policy & Intelligence, Agency IQ / POLITICO

Show Summary:

In this episode, Scott calls in from the Outer Banks to discuss two major clinical headlines before turning to federal policy. First up is the PRIMA retinal prosthesis, a wireless subretinal chip that helped patients with geographic atrophy regain partial reading vision. Then, Scott and John analyze the rapidly expanding — and often contradictory — body of research on GLP-1 receptor agonists and their links to retinal disease.

In the second half, they welcome Alexander Gaffney from POLITICO’s Agency IQ for a deep dive into how the ongoing government shutdown and widespread staff reductions are affecting the FDA’s ability to review and approve ophthalmic therapies. From PDUFA carry-over funds to workforce attrition, Alec explains why the true impact may not be the shutdown itself, but the backlog that follows.

Topics Covered:

• PRIMA retinal implant: wireless innovation and its surgical challenges
• The trade-off between functional vision gains and expanded atrophy area
• GLP-1 receptor agonists: mixed data on AMD, DR, and DME risk
• FDA shutdown implications for ophthalmic trials and approvals
• The reduction in force across FDA divisions and its effect on review capacity
• How new leadership and the National Priority Voucher Program aim to modernize the agency
• Why backlogs could extend into 2026 for gene therapy and TKI programs

Key Quotes:

• “I’m less worried about the shutdown itself — I’m worried about what happens afterward.” — Alexander Gaffney
• “You might not be able to read or drive, but that peripheral vision is what lets you move through the world. Losing more of that matters.” — John Kitchens, MD
• “We don’t always know what we’ve lost — how much faster certain drugs might have reached patients.” — Scott Krzywonos

Credits:

Production & Marketing: Laura Brown

Business Operations: Liz Hogan

Listen and Subscribe:

 RetinUp.com | Available on Apple Podcasts, Spotify, and YouTube

Hosts:

Scott Krzywonos

John Kitchens, MD

Show Summary:

In this episode, Scott and John pick up where they left off — talking about the American Academy of Ophthalmology (AAO) meeting and how innovation is reshaping the field. They explore their favorite AAO host cities, the atmosphere of this year’s meeting, and the under-the-radar conversations shaping the future of retina.

Scott shares insights from iCelerator, his favorite ophthalmology meeting, which highlights how technology, AI, and macroeconomic forces are influencing eye care. The two discuss “oculomics” — using retinal data to understand systemic diseases — and the potential of multimodal AI systems that combine imaging, genetics, and longitudinal data.

John then breaks down the next wave of therapies: gene therapy, tyrosine kinase inhibitors (TKIs), and how FDA study design changes could reshape how new drugs are approved. The discussion dives into superiority studies, the logic of targeting diabetic retinopathy (DR) instead of diabetic macular edema (DME), and what these shifts mean for patients and clinicians.

They wrap with a preview of the Cencora (formerly AmerisourceBergen) meeting — a behind-the-scenes look at the often-overlooked but crucial role drug distributors play in retina care.

Credits:

Production & Marketing: Laura Brown

Business Operations: Liz Hogan

Listen and Subscribe:

🎧 RetinUp.com | Available on Apple Podcasts, Spotify, and YouTube

In the debut episode of RetinUp, Drs. Scott Krzywonos and John Kitchens introduce their vision for the show—unfiltered conversations between retina specialists that capture the hallway and after-hours discussions rarely heard on stage.

They kick off by recapping highlights from the AAO Annual Meeting, including the first-ever full eye transplant, updates on Alcon’s Unity vitrectomy system, the LumiThera photobiomodulation platform, and the coming wave of AREDS 3 vitamins.

The episode then turns to a one-on-one interview with Cedric Francois, founder and CEO of Apellis Pharmaceuticals, whose journey from surgeon to biotech innovator led to the creation of Syfovre, the first approved treatment for geographic atrophy. Francois shares how a chance encounter at the Macula Society set his career in motion, the origins of complement inhibition research, and what it means to lead a mission-driven biotech as both a scientist and physician.

• AAO 2024 highlights:
• The world’s first whole-eye transplant — and what it could mean for future nerve regeneration research.
• Alcon’s new Unity vitreoretinal platform — first major system since Constellation.
• The promise and controversy of photobiomodulation in dry AMD care.
• Previewing AREDS 3 — a reformulated vitamin blend with added B vitamins and lower zinc.
• Inside the Apellis Story:
• How a Belgian surgeon became a biotech CEO in Kentucky.
• The early experiments that led to complement inhibition research.
• The role of serendipity at the Macula Society—and how a single conversation led to Apellis’s first investment.
• Lessons learned from Potentia’s first molecule (POT-4/APL-1) to Syfovre (pegcetacoplan)
• The transition from Louisville to Boston’s biotech hub.
• Why physician-founders bring unique empathy—and accountability—to innovation.

From the first eye transplant to the first therapy for geographic atrophy, Episode 1 sets the tone for RetinUp— candid, curious, and clinically relevant. Drs. Krzywonos and Kitchens explore how preparation meets luck, and how visionaries like Cedric Francois turn bold ideas into breakthroughs for patients.

Hosts: Scott Krzywonos and John Kitchens, MD

Guest: Cedric Francois, MD, PhD (Apellis Pharmaceuticals)

Business Operations: Liz Hogan

Production & Marketing: Laura Brown

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