Retina Summit 2026: DR referrals and genetic testing for ODs

We’re picking up on our recap from the American Academy of Optometry’s (AAO’s) 2026 Retina Summit from earlier this month (see here for the first installment).

Up next: Our rundown on two areas of retinal care that optometrists (ODs) should be paying attention to in clinical practice: diabetic retinopathy (DR) management and genetic testing for inherited retinal diseases (IRDs).

But before we get into those, we want to tell you about the event’s premier sponsor: Apellis Pharmaceuticals.

How did attendees hear from Apellis?

The pharmaceutical company was front and center during the meeting’s sponsored lunch symposium, in which Aunkur M. Shah, MD, FASRS, of the Midwest Eye Institute, presented clinical findings on SYFOVRE (pegcetacoplan injection).

What to know about it: This therapeutic received FDA approval in early 2023 as the first and only treatment for patients with geographic atrophy (GA) secondary to age-related macular degeneration (AMD).

• See here for a look at the most recent long-term (5-year) clinical data supporting its use in providing an extended delay of GA progression.

Let’s look at DR; How should ODs approach their management protocol?

Keep in mind: DR is the leading cause of preventable blindness among working-age adults.

Dr. Attar emphasized two things: DR is a chronic disease, and lifestyle management makes a difference in outcome(even more so than AMD, in fact). “There’s no other disease that we see so many systemic influences as DR,” she said.

And among the latest treatments to manage this disease:

• Glucagon-like peptide-1 receptor agonists (GLP-1 RAs)—though research has linked use to both protective and adverse effects (see 2025 findings from the American Optometric Association [AOA]) over the last few years:
• LKC Technologies’ RETeval device, a handheld and portable electroretinogram (ERG) system for measuring retinal function and diagnosing eye diseases (including DR).
• Advanced imaging, including looking beyond the posterior pole to evaluate the periphery
  • Examples: Ultra-wild imaging (Optos), fluorescein angiography (FA), optical coherence tomography (OCT)

So where do ODs come in?

ODs may be the first eye doctor a diabetic patient sees—meaning they play a critical role in detecting and managing patients.

• “We have much more control over the future of this disease,” Dr. Rafieetary said. “There is no reason for any patients to go blind from diabetes because we have effective ways to diagnose, manage, and treat."

And as Dr. Attar told attendees: “You should have a strong relationship—and be in communication with—a retinal specialist.”

And what should they know?

Our top three takeaways:

1. Don’t rely just on patients’ symptoms—be proactive in screening
   1. What to do in practice:
      1. Regularly dilate diabetic patients—even if their vision appears fine
      2. Use widefield imaging (if available)
      3. And if unsure of next steps … always refer
2. Systemic changes may worsen the retina (temporarily), particularly with new diabetic medications like GLP-1 drugs.
   1. What to do in practice:
      1. Ask patients about medication changes or major drops in A1C
      2. If yes, shorten any follow-up intervals or refer to an MD sooner
      3. Maintain communication with the patients’ primary care provider or endocrinologist if disease progression is observed
3. Know when to refer—sooner rather than later. ODs don’t necessarily need to manage DR, so recognizing when the disease needs a referral is critical.
   1. As such, over-referring rather than under-referring is advised.
   2. When to refer in practice:
      1. Urgently: With any neovascularization, vitreous or preretinal hemorrhage, or suspected macular edema
      2. Soon: With moderate-to-severe nonproliferative DR (NPDR), if uncertain of findings or a poor imaging view, and if patient is noncompliant or lost to follow-up

Next up: Genetic testing … should ODs really be utilizing this?

Instead of asking What does a disease look like? ODs should be asking: What is the genetic cause?

Genetic testing comes in when an OD has exhausted their imaging options as a way to confirm or rule out a diagnosis, and “gives you an advantage to more precisely know what a disease is,” Dr. Rafieetary said.

• For example: Such testing is critical for diagnosing, managing, and identifying clinical trials for orphan diseases such as retinitis pigmentosa (RP) and Stargardt disease
  • See here for a look at the latest FDA-designated investigational candidates targeting these diseases in the clinical pipeline.

They emphasized the need for ODs to recognize genetic causes of retinal disease—particularly inherited retinal disease (IRD)—as well as how to:

• Avoid diagnostic pitfalls
• Integrate genetic testing into clinical decision-making

So how can ODs be offering genetic testing?

One option: The nonprofit Foundation Fighting Blindness provides free genetic tests for ODs to offer in their practices via the My Retina Tracker Genetic Testing Program for patients with a clinical diagnosis of an IRD.

• And take note: The American Academy of Ophthalmology guidelines now recognize and recommend genetic testing for IRDs as standard care.
• In fact: The AOA has also necessitated that ODs get familiar with (and add) genetic testing for qualifying patients.

Let’s get those key takeaways.

While ODs don’t need to diagnose every rare retinal disease, they should recognize red flags, avoid premature labeling, and refer (at the right time).

1. Retinal diseases can mimic each other—even genetic diseases—so don’t just rely on appearances (imaging) alone.
   1. What to do in practice:
      1. If a patient’s imaging isn’t fully fitting the standard pattern (or the disease progression / history appears off), refer or investigate further rather than labeling (and potentially misdiagnosing) early.
2. Genetic testing is becoming part of standard retinal care. While an OD may not necessarily need to order testing themselves, they should know when it can make a difference.
   1. Advantages for practice use:
      1. Can change the diagnosis and affect disease management
      2. Identifying patients eligible for new treatments or clinical trials
      3. Important for family counseling and prognosis
      4. Now recommended for various IRDs
3. Consider beyond the eye, as some retinal findings may indicate systemic disease such as hearing loss, kidney disease, or neurologic issues. These patients may present for the first time in an OD’s chair.
   1. Case in point: Vision and hearing loss may actually be Usher syndrome.
   2. What to do in clinical practice? Ask patients screening questions—and if they answer “yes,” coordinate care or refer, as needed:
      1. Any hearing problems?
      2. Any family members with vision loss?
      3. Any other health issues?

Finally, let’s get a big-picture takeaway on this.

As Dr. Attar noted, the time when ODs could just perform vision exams—and no other form of care—is long past due.

“As primary eyecare providers, the OD is fundamental in patients’ continuum of care. And with the retina—we have limitations,” she said. “So it’s critical that we offer solutions to those limitations and set patients up to prevent further vision loss.”

... and can we expect more meetings such as this?

Indeed. We can. AAO is actually gearing up to host its second regional event on June 27.

• The topic: myopia
  • COPE-accrediated CE available: 6.5 hours
• The presenters:
  • Erin Tomiyama, OD, PhD
  • Ashley Wallace-Tucker, OD, FAAO
• The location: St. Louis, Missouri

See here for a rundown on what attendees can expect (including the cost).