The following transcript has been edited for clarity.

Gaurav K. Shah, MD: Hi, my name is Gaurav K. Shah, MD. I’m the president-elect of the American Society of Retina Specialists (ASRS), who will be starting his term for 2026 and 2027. I’m delighted to lead the organization that has been led previously by many other leaders, including the most recent, Geoffrey Emerson, MD.

Retinal Physician: As you prepare to begin your term as ASRS president, what are the key issues and opportunities you hope to focus on in the next year?

Dr. Shah: For retina, we are in a very different world right now. We have lots of products. We have lots of amazing innovations. But what our clinicians are having issues with is, number one, access to these medicines and innovations for all of their patients. We have issues with payers. We have issues with the Good Days program. We also have manufacturing and supply chain issues. But I would say every crisis can hopefully lead us to solutions. And as we all know, sometimes creative solutions can come out of crisis.

One of the biggest crises that we face is operating room (OR) access. We have retina specialists that are unable to do the procedure for retinal detachment repair. This is akin to a cardiologist with a patient who has an acute myocardial infarction and not having a treatment for that. Even though we have retina specialists who want to do surgery for these patients, they cannot get in the operating room for many reasons, including economic reasons. What’s happened is retina specialists are now unable to do cases at nights and weekends in many large American cities. And that really cannot happen because that can potentially lead to more vision loss.

We also have the issue of having fewer retina specialists in this country. We graduate about 110-115 retina specialists as fellowship physicians every year. Right now, the number of ophthalmologists that are going in the field is less and less in terms of the amount of graduates we can produce. And we hence have less people going into retina for all the reasons I mentioned. We have issues of sometimes slightly longer hours, compared to some of our other colleagues in ophthalmology, so residents are choosing not to go into retina.

So we have an FTE problem. That is going to be one of the biggest issues that we face because we can have the finest products, the finest machines, but we need to have people to do those things in places where they can perform all of those wonderful procedures.

Retinal Physician: Retina is entering an era of expanded treatment options, including gene therapies, TKIs, and sustained delivery. How can ASRS help members evaluate and integrate these innovations into clinical practice?

Dr. Shah: That’s a very good question. If we look back in time 20 years ago, the anti-VEGF era sort of came about. And at that time, our choices were really anti-VEGF and maybe just 1 anti-VEGF. Then we went to multiple different anti-VEGFs. Before that came photodynamic therapy (PDT), before anti-VEGFs. So we’ve seen this paradigm shift where anti-VEGFs have been one of the amazing things, at least in my lifetime, for retina.

And we are now entering an era where patients want more. They want better outcomes. They want less interventions to the eye. And I believe that with TKIs—again, all the data is not there yet, but there’s a potential use for those medicines, maybe in conjunction with anti-VEGF. Some of this is going to be driven, obviously, by what insurance companies allow us to do.

As we move on from, let’s say, injecting something into the eye, it’s injecting something into the eye or underneath the retina that makes the retina to be the gene factory. And that is the hope with gene therapy.

Now, there’s lots of unanswered questions: long-term outcomes, inflammation, cost. So we are going to be dictated with therapies, like many other things, by the insurance carriers. We’re going to have to have a stepwise approach that’s probably going to be given to us. The ASRS will do everything possible to make sure the access to drugs is determined by the physician and not by the insurance carrier.

So I think that is one of the things that’s been a fundamental virtue of our society, is to give our clinicians the ability to choose rather than somebody having to choose for them. Now, we’re not always successful, and we have to admit that, but we have to keep trying because there’s a lot of external pressures, both from Congress, from CMS, from insurance companies, consolidation of health care, that are going to be as important as the science itself.

So it’s a multifactorial approach as we get new therapies. But I can assure you, [ASRS chief executive officer] Jill Blim and her team, who do a lot of advocacy both on the government side and the insurance side and the corporate side, will do everything possible, along with our leadership, to make sure our members have the best access to medicines.

Retinal Physician: What excites you most about the future of retina? And what message would you like to share with ASRS members as you begin your term?

Dr. Shah: I think excitement in our field, of course, we can say comes from great technology, great medicine, new drugs, new approaches. I think for me personally, what excites me is all the young energy we see in our field. We need to have the exuberance of youth that leads us to new ideas, new innovations, and new thought processes.

If we can bottle all of that with medicines, with surgical devices, the youth is what’s going to carry our field. It is our job as a society to really uplift the youth and bring them to the forefront so all of us can kind of take a step back and make sure that they have the opportunity to lead our society. As I always say, all of us have an expiration date, and we have a date of “best used by.” We can’t stand in front of people who are going to do great things just because they’re young.

I believe that our job, to make it exciting for our society—because the ASRS has always been an inclusive society—is to include that and make sure we share that with the world, with all of our partners. So that is my hope, and I know that’s the hope of our leadership. And we have shown that with all of our programs for young doctors, for residents, for medical students, for the international group. We want to be all things retina. RP