Review maps anti-VEGF therapy evolution, pharmacology, and clinical use for retinal vascular diseases in India

Anti-vascular endothelial growth factor (anti-VEGF) therapy has revolutionized the management of retinal vascular diseases, including diabetic retinopathy and age-related macular degeneration, which are leading causes of vision loss. Despite significant advancements, challenges persist globally, particularly in regions like India, where unique economic and epidemiological factors impact treatment accessibility and delivery. Understanding the historical development, pharmacology, and clinical application of anti-VEGF agents, especially within specific healthcare contexts, is crucial for optimizing patient outcomes and ensuring equitable access to high-quality retinal care.

This comprehensive review article systematically examines the landscape of anti-vascular endothelial growth factor (anti-VEGF) therapy, specifically within the Indian context. The authors delineate the historical trajectory of anti-VEGF agents, from the initial identification of VEGF as a key driver of ocular neovascularization to the development of current potent molecules. The scope encompasses detailed pharmacology, regulatory milestones, and critical safety considerations associated with these therapies. A significant focus is placed on the unique epidemiological and economic factors prevalent in India, such as the substantial burden of diabetic retinopathy and age-related macular degeneration, the challenges of limited healthcare reimbursement, and the pivotal role of biosimilar ranibizumab products in expanding patient access to treatment. The review aims to synthesize existing knowledge to inform strategies for delivering equitable and high-quality retinal care across India's diverse population.

The review meticulously traces the evolution of anti-VEGF therapy, highlighting its transformative impact on managing retinal vascular diseases over the past two decades. It details the progression from early agents like pegaptanib and bevacizumab to the current generation of more potent molecules, including ranibizumab, aflibercept, brolucizumab, and faricimab. The authors underscore the foundational role of VEGF identification in driving ocular neovascularization as the basis for these therapeutic advancements. A key finding is the significant influence of India's unique healthcare environment, characterized by a high burden of diabetic retinopathy and age-related macular degeneration, on the adoption and accessibility of anti-VEGF treatments. The article emphasizes how limited healthcare reimbursement and the widespread availability of biosimilar ranibizumab products have been crucial in shaping the treatment landscape and expanding access to care.

The review concludes by outlining essential strategies to ensure the delivery of equitable, high-quality retinal care, tailored to the specific needs and challenges of a diverse Indian population, integrating economic and epidemiological insights into practical clinical approaches.