A new generation of retinal drugs is fundamentally changing how eye diseases are treated, with some requiring just one injection every six months instead of the grueling monthly schedule that millions of patients currently endure. The first to market is Susvimo, made by Genentech, which uses a tiny refillable port implanted in the eye to continuously release medication over six months. In clinical trials, over 98 percent of patients went the full six months before needing a refill, and visual outcomes matched those of patients receiving monthly injections.
For the estimated 20 million Americans living with age-related macular degeneration and diabetic eye disease, many of whom are older adults already managing cognitive decline or dementia, reducing the frequency of eye injections from 12 times a year to just two is not a minor convenience. It can mean fewer clinic visits, less caregiver burden, and better treatment adherence for people who might otherwise skip appointments due to transportation challenges, memory difficulties, or simple exhaustion. This article covers the three leading drugs in this space, their clinical evidence, safety concerns worth knowing about, and what the pipeline looks like heading into 2026 and beyond.
Table of Contents
- How Does a Retinal Drug Work With Just One Injection Every Six Months?
- Susvimo’s Rocky Road From Approval to Real-World Use
- Axpaxli and the Next Wave of Long-Lasting Retinal Implants
- How Duravyu Could Further Reduce Treatment Burden
- Safety Risks and Limitations Caregivers Should Understand
- The Brain-Eye Connection and Why Retinal Treatment Matters for Dementia
- What the Retinal Drug Pipeline Means for the Next Five Years
- Conclusion
- Frequently Asked Questions
How Does a Retinal Drug Work With Just One Injection Every Six Months?
The traditional approach to treating wet age-related macular degeneration and diabetic macular edema involves injecting anti-VEGF drugs directly into the eye, typically every four to eight weeks. These drugs block vascular endothelial growth factor, a protein that drives the abnormal blood vessel growth responsible for vision loss. The problem is obvious: patients need to show up at a retina specialist’s office roughly once a month, receive a needle in the eye, and repeat this indefinitely. Many patients, particularly those with cognitive impairment or limited mobility, fall off their treatment schedules, and their vision deteriorates as a result. Susvimo takes a different approach entirely. Rather than repeated individual injections, a surgeon implants a small device called the Port Delivery System into the wall of the eye during a one-time outpatient procedure.
This reservoir continuously releases ranibizumab, the same active drug found in the widely used Lucentis, directly into the vitreous cavity. When the reservoir runs low, roughly every six months, a clinician refills it through the port in an office visit that takes minutes. The Phase III Archway study confirmed that this continuous delivery maintained visual gains equivalent to monthly injections, with only 1.6 percent of patients needing any supplemental treatment before their first scheduled refill. What makes this particularly relevant for brain health is the well-documented connection between vision loss and cognitive decline. Multiple studies have linked untreated macular degeneration to increased dementia risk, likely because sensory deprivation accelerates neurodegeneration. Any treatment that keeps patients on their medication schedule more reliably has downstream implications for brain health, not just eyesight.
Susvimo’s Rocky Road From Approval to Real-World Use
Susvimo initially received FDA approval in October 2021, making it the first and only retinal treatment offering as few as two treatments per year. However, the path to widespread adoption hit a significant bump. In 2022, Genentech issued a voluntary recall related to manufacturing concerns with the device, pulling it from the market temporarily. Updated versions of Susvimo became available again to U.S. retina specialists in 2024, and the drug regained its footing. Then came a major expansion. In February 2025, the FDA broadened Susvimo’s approval to include diabetic macular edema and diabetic retinopathy, not just wet AMD. For diabetic retinopathy specifically, the approved refill interval is every nine months, meaning some patients may need the port refilled fewer than twice a year.
This expansion matters enormously given that diabetes affects roughly 37 million Americans, and diabetic eye disease is one of the leading causes of blindness in working-age adults. However, Susvimo is not without real safety concerns that patients and caregivers should weigh carefully. The Archway trial data showed a three-times-higher rate of endophthalmitis, a serious and potentially sight-threatening eye infection, compared to standard monthly injections. Specifically, 1.7 percent of Susvimo patients developed endophthalmitis versus 0.5 percent with conventional intravitreal injections. While those numbers are still relatively low in absolute terms, endophthalmitis can cause permanent vision loss if not caught and treated quickly. For patients with dementia who may have difficulty communicating new symptoms like sudden eye pain or vision changes, this elevated infection risk deserves a frank conversation between caregivers and the treating ophthalmologist.
Axpaxli and the Next Wave of Long-Lasting Retinal Implants
Susvimo may have been first, but it will not be alone for long. Ocular Therapeutix is advancing Axpaxli, a bioresorbable hydrogel implant that delivers axitinib, a tyrosine kinase inhibitor, continuously for nine to twelve months. Unlike Susvimo’s permanent port, the Axpaxli implant dissolves on its own over time, meaning patients would need just one to two injections per year with no surgical implantation of a device. The company has announced plans to submit its New Drug Application in the first quarter of 2026, using the 505(b)(2) regulatory pathway, which allows for a potentially faster review since axitinib is already FDA-approved for use in kidney cancer. The pivotal Phase 3 SOL-1 trial enrolled 344 treatment-naïve wet AMD patients across more than 100 sites in the United States and Argentina.
A separate Phase 2 trial, SOL-R, reached its target enrollment of 555 patients, providing a substantial safety and efficacy database. What distinguishes Axpaxli from Susvimo conceptually is the mechanism. While Susvimo delivers ranibizumab, the same anti-VEGF molecule used in monthly injections, Axpaxli uses a tyrosine kinase inhibitor that blocks VEGF signaling through a different pathway. This could matter for the estimated 15 to 20 percent of patients who respond inadequately to standard anti-VEGF therapy. If Axpaxli earns approval, clinicians would have a meaningfully different treatment option, not just the same drug in a longer-lasting package. For elderly patients and their caregivers already overwhelmed by medical appointments, the prospect of a single injection lasting up to a year could be transformative.
How Duravyu Could Further Reduce Treatment Burden
EyePoint Pharmaceuticals is developing Duravyu, a sustained-release intravitreal insert that delivers vorolanib, a multi-mechanism tyrosine kinase inhibitor targeting not just VEGF but also PDGF and IL-6/JAK1 signaling pathways. By hitting multiple drivers of retinal disease simultaneously, the theory is that Duravyu could provide more comprehensive disease control than drugs targeting VEGF alone. The Phase 2 DAVIO 2 trial produced encouraging results: an 88 percent reduction in treatment burden at six months, with more than 80 percent of patients either supplement-free or requiring only one additional anti-VEGF injection. Two identical Phase 3 trials, named LUGANO and LUCIA, have completed enrollment with over 900 total patients. Topline data from LUGANO is expected by mid-2026, with LUCIA results following shortly after. EyePoint also dosed its first patients in Phase 3 diabetic macular edema trials as of March 2, 2026, expanding the potential reach of this technology.
The tradeoff worth noting is timing. Susvimo is available now. Axpaxli could reach the market in late 2026 or 2027 if its NDA review goes smoothly. Duravyu is further behind, with pivotal data still pending. For patients currently struggling with monthly injections, Susvimo represents an immediate option, while Axpaxli and Duravyu represent potentially better future options with different safety profiles and mechanisms. The practical calculus for patients and their families involves weighing current suffering against the possibility that waiting a year or two might yield a treatment that is less invasive, longer-lasting, or more effective.
Safety Risks and Limitations Caregivers Should Understand
No discussion of these drugs is complete without an honest look at their downsides. The surgical implantation required for Susvimo’s Port Delivery System is more involved than a standard intravitreal injection. It requires a trained vitreoretinal surgeon, takes longer, and carries the risks inherent in any eye surgery, including the elevated endophthalmitis rate mentioned earlier. Not every retina practice is equipped or trained to offer Susvimo, which can create access barriers, particularly in rural areas or underserved communities. For patients with dementia or significant cognitive impairment, any eye procedure raises unique concerns. Informed consent becomes more complex. Post-operative care instructions may not be followed reliably.
Warning signs of complications, such as increased redness, pain, or sudden vision changes, may go unreported if the patient cannot articulate them. Caregivers need to be actively involved in monitoring and should discuss these scenarios with the retina specialist beforehand. There is also a broader limitation that applies to all three drugs discussed here: they treat the symptoms of retinal disease, not the underlying cause. Patients with wet AMD will still have AMD. Those with diabetic retinopathy still have diabetes. These drugs slow or halt vision loss driven by abnormal blood vessel growth, but they do not reverse existing damage, and they require ongoing treatment indefinitely. If a patient discontinues therapy, whether due to progressing dementia, caregiver burnout, or other factors, the disease will resume its course. This is a reality that families should plan for early rather than confronting in a crisis.
The Brain-Eye Connection and Why Retinal Treatment Matters for Dementia
Research increasingly points to the retina as a window into brain health. The retina is embryologically part of the central nervous system, and studies have found that retinal thinning, detectable through routine eye imaging, correlates with higher dementia risk. More directly, severe vision loss from untreated eye disease is associated with social isolation, reduced physical activity, depression, and accelerated cognitive decline, all of which are independent risk factors for dementia. Keeping an older adult’s vision stable is therefore not just an ophthalmological goal.
It is a cognitive preservation strategy. Treatments that reduce barriers to adherence, whether by cutting injection frequency from 12 times a year to two or by eliminating the need for monthly clinic visits, can help maintain the sensory engagement that protects brain function. For caregivers managing a loved one’s dementia alongside other chronic conditions, fewer medical appointments is not a luxury. It is a practical necessity that frees up time and energy for the daily work of dementia care.
What the Retinal Drug Pipeline Means for the Next Five Years
The retinal drug landscape is entering a period of genuine transformation. Within the next two to three years, patients could have access to at least three distinct long-duration treatment options, each with a different mechanism of action, delivery system, and dosing interval. Competition among Genentech, Ocular Therapeutix, and EyePoint Pharmaceuticals will likely drive improvements in safety, convenience, and possibly cost.
Looking further ahead, the sustained-release technology being developed for retinal drugs could eventually be applied to other eye conditions and potentially to drug delivery in other parts of the body. An independent Data Safety Monitoring Committee has already recommended continuation of the Duravyu trials without protocol changes, which is a quietly encouraging signal about tolerability. For families navigating dementia care today, the immediate takeaway is more practical: if monthly eye injections have become unsustainable for your loved one, a conversation with their retina specialist about Susvimo is worth having now, and better options may arrive within the next couple of years.
Conclusion
The shift from monthly retinal injections to treatments lasting six months or longer represents one of the most meaningful quality-of-life improvements in ophthalmology in years. Susvimo is already available and FDA-approved for wet AMD, diabetic macular edema, and diabetic retinopathy. Axpaxli and Duravyu are advancing through late-stage clinical trials with promising data, offering the potential for even longer intervals and different therapeutic mechanisms.
For the millions of older adults managing both vision loss and cognitive decline, these treatments address a real and pressing need. Caregivers and family members should discuss these options with their loved one’s retina specialist, particularly if adherence to monthly injections has become a struggle. Ask about Susvimo eligibility, inquire about clinical trial enrollment for newer agents, and make sure the care team understands the full picture of your loved one’s health, including any cognitive challenges that might affect treatment monitoring. Reducing the burden of eye care is one concrete step toward preserving both vision and quality of life in the years ahead.
Frequently Asked Questions
Is Susvimo available right now?
Yes. After a voluntary recall in 2022 and subsequent updates, Susvimo became available again to U.S. retina specialists in 2024. In February 2025, the FDA expanded its approval to include diabetic macular edema and diabetic retinopathy in addition to wet AMD.
Does Susvimo require surgery?
Yes. The Port Delivery System must be surgically implanted in the eye during a one-time outpatient procedure performed by a vitreoretinal surgeon. Subsequent refills every six months are done in-office and are much simpler.
What is the main safety concern with Susvimo?
Clinical trials showed a 1.7 percent rate of endophthalmitis, a serious eye infection, compared to 0.5 percent with standard monthly injections. While still relatively uncommon, this three-fold increase is something patients and caregivers should discuss with their doctor.
When might Axpaxli become available?
Ocular Therapeutix plans to submit its New Drug Application in the first quarter of 2026. If the review proceeds on a typical timeline, approval could come in late 2026 or 2027, though this is not guaranteed.
Are these treatments a cure for macular degeneration?
No. These drugs manage the symptoms of wet AMD and diabetic eye disease by blocking abnormal blood vessel growth. They do not cure the underlying condition, and treatment must continue indefinitely to maintain visual gains.
Can someone with dementia safely receive these treatments?
Generally yes, but it requires careful coordination. Caregivers should be involved in post-procedure monitoring since patients with cognitive impairment may not report warning signs of complications. Discuss the specific risks and monitoring plan with the retina specialist before proceeding.
