RetinUp Podcast

Show Summary

This episode of RetinUp opens with a timely policy discussion between the hosts about proposed Medicare and Medicaid funding cuts, exploring what they could mean for retina practices and their most vulnerable patients.

The Vitreoretinal View segment features John Kitchens, MD, sharing his decade-long experience with heads-up 3D visualization. He reviews what makes it transformative for training and surgical outcomes, why widespread adoption has been slower than expected, and what might finally tip the scales.

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 discusses his unique role as an independent rescue monitor, explains the study's novel design, unpacks what the superiority outcome over aflibercept actually means for clinical practice, and previews what the SOL-R study may tell us next.

Hosts: John Kitchens, MD, Scott Krzywonos

Guests: Darius Moshfeghi, MD – Chief, Retina Division; Professor, Byers Eye Institute, Stanford University School of Medicine

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.

Credits Production & Marketing: Laura Brown | Business Operations: Liz Hogan

This episode of RetinUp is a special deep dive into the Vit-Buckle Society (VBS), tracing its origins and previewing what’s ahead for the 2026 meeting.

In the first segment, Ross Lakhanpal, MD, shares the founding story of VBS — from informal dinner discussions among fellows to one of the most distinctive and influential meetings in retina. What began as an effort to preserve surgical retina education has evolved into a meeting known for its creativity, honesty, and strong sense of community.

The episode then shifts to Aleksandra Ratchitskaya, MD, who outlines the agenda and structure of the 2026 VBS meeting, including expanded programming for trainees, new educational tracks, and the continued emphasis on open discussion and real-world clinical challenges.

Across both conversations, a consistent theme emerges: VBS succeeds because it prioritizes authenticity, collaboration, and the full experience of being a retina specialist — not just the science.

Hosts:

John Kitchens, MD

Scott Krzywonos

Guests:

Ross Lakhanpal, MD, FACS – Founding Member, Vit-Buckle Society (VBS); Retina Care Center (Maryland)

Aleksandra Ratchitskaya, MD, – President, Vit-Buckle Society (VBS)

• Origins in 2004–2006 among fellows seeking more surgical retina focus
• Early dinner meetings piggybacking on major conferences (ASRS, AAO)
• Initial industry support from Bausch + Lomb and later Alcon
• The role of key mentors including Timothy Murray, MD, and Harry Flynn, MD,
• Transition from informal gatherings to a standalone national meeting
• Early challenges with organization, funding, and defining a clear vision

• Introduction of debates, live surgery, and unconventional formats
• The importance of creativity, energy, and peer-driven programming
• Balancing innovation with professionalism as the meeting grew
• The role of medical conference planners (MCPI) in scaling the event
• How VBS differentiated itself from traditional, science-heavy meetings

• Decision to hand leadership to the next generation
• Evolution of programming under new leadership
• Increased focus on year-round education, social media, and engagement
• Current leadership structure and succession planning
• Why maintaining a strong culture and relationships is critical to continuity

• Expanded Thursday programming for fellows, trainees, and early-career specialists
• “VBS Silver” sessions for more experienced physicians
• Fellows Forum-style competitions, including surgical video presentations
• Awards, including Lifetime Achievement and Mentorship recognition
• Dedicated sessions on practice management, advocacy, and wellness

• Surgical case discussions focused on complications and real-world challenges
• Debates on controversial clinical and professional topics
• A strong emphasis on honesty and open dialogue
• Social programming built around the Alice in Wonderland theme
• Networking that reflects the collaborative, peer-driven culture of VBS

• VBS was founded to address a gap in surgical retina education and has grown into a broader platform for professional development.
• The meeting’s success is rooted in its culture of openness, creativity, and peer collaboration.
• Leadership transition to younger physicians has strengthened the organization and expanded its reach.
• VBS continues to stand out by addressing the full scope of retina practice, including clinical, personal, and professional challenges.

Production & Marketing: Laura Brown

Business Operations: Liz Hogan

Listen at RetinUp.com | Apple Podcasts | Spotify | YouTube

In this breaking news episode, John Kitchens, MD, and Scott Krzywonos react to the announcement that Biogen will acquire Apellis Pharmaceuticals for $5.6 billion, an approximately 8x revenue multiple driven largely by Syfovre (pegcetacoplan), which accounts for the majority of Apellis’ srevenue.

The discussion focuses on what this acquisition could mean for the future of geographic atrophy (GA) treatment, including concerns around strategic priorities, industry support programs, and whether Biogen will maintain Apellis’ current momentum in retina.

This acquisition has the potential to reshape the geographic atrophy landscape — but its success will depend on whether Biogen maintains Apellis’ clinical focus, physician relationships, and commitment to innovation in retina.

Hosts:

John Kitchens, MD

Scott Krzywonos

Listen now at RetinUp.com or wherever you get your podcasts.

This episode of RetinUp combines clinical innovation and device engineering, starting with a discussion on photobiomodulation (PBM) in age-related macular degeneration (AMD), followed by a deep dive into the future of ophthalmic laser technology.

First, Marion Munk, MD, shares her extensive real-world experience using the Valeda Light Delivery System (Alcon) for PBM, including patient selection, treatment protocols, and functional outcomes. With over 300 patients treated, she provides one of the most comprehensive perspectives currently available on how PBM is being implemented in clinical practice.

The episode then shifts to Oliver Hvidt, co-founder and CEO of Norlase, who explains how his training in economics led him to develop a next-generation, portable laser systems. The conversation explores how engineering, economics, and workflow design intersect to improve efficiency in retina practices.

The episode opens with a brief discussion on optometric scope expansion in Kansas, where John explains that fears surrounding scope changes may be overblown.

Hosts:

John Kitchens, MD

Scott Krzywonos

Guests:

Marion Munk, MD – Medical Retina & Uveitis Specialist, Gutblick Group (Switzerland)

Oliver Hvidt – Co-Founder & CEO, Norlase

1. Kansas legislation expanding optometric procedural scope
2. Real-world experience from Kentucky following similar changes
3. Why expanded scope has had limited impact on retina practice
4. The evolving role of optometry as general ophthalmology declines

1. Differences between general “red light therapy” and medical PBM
2. The Valeda Light Delivery System and evidence from LIGHTSITE trials
3. Real-world outcomes from 300+ treated patients
4. Ideal patient profiles (drusen-predominant AMD, non–center-involving GA)
5. Reported benefits: improved dark adaptation, contrast, and daily function
6. ~50–60% of patients reporting subjective improvement
7. Challenges in correlating functional gains with OCT or structural changes
8. Implementation strategies: standardized imaging, AI-assisted analysis, and patient tracking
9. When to continue vs. discontinue treatment in non-responders

1. Founding story: from engineering collaboration to ophthalmic application
2. Redesigning laser architecture using semiconductor technology
3. Miniaturization and portability (headset-based indirect laser systems)
4. MEMS-based pattern scanning vs. traditional galvanometer systems
5. Designing equipment around workflow efficiency, not just performance
6. Addressing increasing patient volume with limited clinical resources
7. Funding challenges in a post-COVID, AI-dominated investment landscape
8. Future roadmap: software-driven upgrades and multi-specialty applications

1. Photobiomodulation is gaining traction, but patient selection and expectation-setting are critical.
2. Functional improvements in AMD may not always correlate with structural imaging.
3. Device innovation in retina is increasingly focused on efficiency, portability, and workflow integration.
4. The future of ophthalmic technology will depend as much on practice economics as clinical performance.

This episode includes a segment made possible with support from Alcon, featuring technologies like UNITY VCS designed to enhance surgical performance and efficiency.

Credits:

Production & Marketing: Laura Brown

Business Operations: Liz Hogan

Listen at RetinUp.com | Apple Podcasts | Spotify | YouTube

Hosts:

John Kitchens, MD

Scott Krzywonos

In this special RetinUp Mailbag episode, John Kitchens and Scott Krzywonos answer listener questions from retina specialists around the country about three issues: cash-pay diversification, the future of emerging therapies in light of payer realities, and how practices can realistically adopt expensive new technology as reimbursements decline.

The conversation explores whether concierge retina models could emerge in certain markets, how insurers may respond to high-cost innovations like gene therapy and tyrosine kinase inhibitors, and what practical frameworks practices use when deciding whether to invest in new surgical or imaging equipment.

Throughout the episode, a central theme emerges: innovation in retina continues to accelerate, but reimbursement pressure is forcing practices to rethink business models, technology adoption, and long-term sustainability.

Topics Covered

Listener question from Jed Assam, MD (VRA Vision, Sioux Falls, South Dakota)

1. Whether concierge retina could work, and whether VIP-style care models might translate to retina practices
2. Potential cash-pay services such as photobiomodulation (PBM) therapy
3. Operational considerations for scheduling concierge visits separately from standard clinic flow
4. Geographic limitations for cash-pay models in smaller markets

Listener question from Deepak Sambhara, MD (Eye Clinic of Wisconsin, Wausau, Wisconsin)

1. How payers may respond to upcoming therapies such as tyrosine kinase inhibitors and gene therapy
2. The likelihood of step therapy policies changing
3. Pricing challenges for long-duration treatments
4. Economic implications of one-time gene therapy approaches

Listener question from Priya Vakharia, MD (Retina Vitreous Associates of Florida, Tampa, Florida)

1. How practices decide when to adopt new surgical technology
2. Cost pressures from declining surgical reimbursement
3. Evaluating investments in surgical and imaging equipment
4. The potential role of AI-driven analysis in improving efficiency and clinical decision-making

1. Concierge-style retina care may be viable in affluent metropolitan markets but remains niche.
2. Insurance economics will strongly influence how quickly new therapies reach patients.
3. Practices increasingly rely on ROI analysis and efficiency gains when deciding whether to adopt new technologies.
4. Artificial intelligence may help practices manage growing data complexity, though its financial model remains uncertain.

RetinUp listeners can submit questions by sending a voice memo to [email protected], leaving a comment on YouTube, or connecting with John and Scott on LinkedIn.

Sign up for our newsletter at RetinUp.com.

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