The following transcript has been edited for clarity. 

I'm SriniVas Sadda, MD, FARVO, and I am professor of Ophthalmology at UCLA at the Doheny Eye Institute, and I had the great pleasure of presenting at ARVO 2026, a paper on subretinal hyperreflective material (SHRM) and its relevance to vision and how it performed in the TENAYA and LUCERNE studies. Now, this was a topic of great personal interest to me because my group was one of the first to identify—back in the time domain OCT era almost 2 decades ago—the importance of this material. And in fact, in those days, we called it subretinal tissue, and we found it to be the most important predictor in terms of visual outcomes, which kind of makes sense because it is material that is located between the photoreceptors and the RPE. And since that time, it's been renamed. We know there are a number of different potential sources for subretinal hyperreflective material, but importantly, type 2 neovascularization is located in the subretinal space as is subretinal hemorrhage, and these kinds of materials can ultimately lead to the development of fibrosis.

The TENAYA and LUCERNE trials of faricimab (Vabysmo; Genentech) presented an opportunity to actually study this further. One of the important observations that I presented was that we do see a differential in terms of the reduction of subretinal hyperreflective material or SHRM between faricimab and aflibercept that's evident right during the loading phase of the therapies with a greater reduction in area as well as volume of this SHRM with faricimab.

In addition, we showed that the amount of SHRM that's present at 12 weeks in fact does predict vision over time, which confirms some of our previous findings from our older studies. I think that was also an important takeaway. Because SHRM is of visual significance, I think it really highlights the importance of trying to eliminate SHRM as completely and as early as possible to get the best vision outcomes for patients.

And that is actually one of the arguments for using second-generation agents like faricimab for treating these patients, I believe, because you have this superior resolution of this material. RP