Patients with serious eye diseases experienced worsening conditions after losing access to copay assistance and switching from branded anti-VEGF drugs to bevacizumab, according to two studies presented at the American Society of Retina Specialists annual meeting in Montreal.
The results demonstrate the impact of funding cuts to programs like Good Days, a nonprofit that provided financial help for retina and macular disease treatments for over twenty years. When its support ended in January 2025, many patients had to use the cheaper, off-label alternative.
Switching drugs led to worse outcomes
Cleveland Clinic researchers tracked 89 eyes from 69 patients with wet age-related macular degeneration, diabetic macular edema, or retinal vein occlusion. All had been stable on branded anti-VEGF therapies before losing copay support.
After switching to bevacizumab—sold as Avastin for cancer but repackaged by compounding pharmacies for eye injections—patients faced measurable declines. Central subfield thickness, a key measure of retinal swelling, increased on average by 28.5 µm. The median time between injections dropped from 8.6 weeks to 7.5 weeks, requiring more frequent treatments to maintain stability.
Even with additional dosing, 15.7% of eyes still had poor outcomes, defined as losing at least 15 letters on a standard eye chart or worsening retinal thickness. Nearly 17% of patients returned to branded therapies after the decline.
Danny Mammo, M.D., of the Cole Eye Institute at Cleveland Clinic, stated that the change was linked to anatomic worsening and shorter injection intervals. He added that shorter preswitch intervals and early detection of fluid could help identify patients at risk.
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Medicare patients hit hardest
A study from the Retina Group of Washington examined 355 eyes from 240 Medicare and Medicare Advantage patients with wet AMD. Before the Good Days funding cut, only three eyes in 2024 had received bevacizumab. By 2025, that number rose to 28.
The shift altered treatment patterns. While nine eyes needed shorter intervals between injections, the total number of injections per patient fell in 2025. Visual acuity declined at the first visit after the switch but partially improved by year’s end—though not to earlier levels.
Researchers from the Retina Group of Washington found that the funding loss was tied to significantly worse visual outcomes among Medicare patients with neovascular AMD.
Bevacizumab’s affordability makes it appealing for patients with limited funds, but its off-label use for eye conditions involves trade-offs. Unlike branded anti-VEGF drugs, which have FDA approval for retinal diseases, bevacizumab requires repackaging into smaller doses by compounding pharmacies. This process can introduce variability in quality and sterility.
For patients managing chronic conditions, the change adds uncertainty. The studies show that even brief treatment disruptions can have lasting effects—effects that might have been prevented with continued access to their previous medications.
