03/09/2026
Who gets represented by clinical evidence, and who gets left behind?
As retinal care continues to advance, clinical trials are increasingly designed to identify and enrol patients most likely to benefit from a particular treatment. While these approaches can help demonstrate treatment effectiveness, they also raise an important question: what happens to the patients who don't fit the profile?
A new editorial, “Enriched trial designs and the patients left behind,” by Gregor S. Reiter and Anat Loewenstein, explores this challenge and the need to ensure that advances in retinal care translate into meaningful options for all patients.
Two messages stand out:
1. Evidence needs to come earlier and be better planned. Patients who are well suited to enriched trials should also be able to understand how effective a treatment is in the context of their specific condition and circumstances.
2. Research must continue for those who cannot benefit from currently approved approaches. We need to identify alternative targets, outcomes and measures of treatment benefit before irreversible vision loss and its impact on quality of life become even greater.
Ophthalmology and retinal care have come a long way, from observing vision loss to actively working to preserve and improve vision. But important gaps remain, including generalisability of evidence, restrictive reimbursement and advanced indications that remain outside current treatment pathways.
Bridging these gaps will require academia, industry, regulators and patient organisations to work together, with patients at the centre of how we define meaningful evidence and treatment benefit.
There is much to celebrate in how far retinal care has come, but there is still a long road ahead to ensure that no patient is left behind.
Read the editorial: https://link.springer.com/article/10.1007/s00417-026-07452-5
Authors: Gregor S. Reiter, Department of Ophthalmology and Optometry, Medical University of Vienna; and Anat Loewenstein, Ophthalmology Division, Tel Aviv Medical Center, affiliated with Tel Aviv University.
[ID: Graphic promoting a new editorial on enriched clinical trials, highlighting the need for more inclusive, patient-centred research in retinal care, with a QR code to read the editorial.]
