Short prior authorization delays for drug therapy did not cause vision loss in most patients newly diagnosed with age-related macular degeneration (AMD). However, a small number of people — especially those with subretinal hemorrhage — experienced loss of visual acuity while waiting and failed to recover after 6 months.

The research, presented at the American Society of Retina Specialists (ASRS) 2026 Annual Meeting in Montreal, found the average wait for prior authorization between diagnosis and first treatment was 12.2 days. Nearly 5% of eyes showed long-term vision decline past 6 months.

“Prior authorization treatment delays were not associated with short-term vision changes in neovascular AMD,” said J. Mingyi Huang, MD, retina specialist and vitreoretinal surgeon at The Retina Group of Washington in Fredericksburg, Virginia.

The retrospective cohort study included 249 eyes from 225 patients who were diagnosed with neovascular AMD and scheduled for a first intravitreal injection between November 2024 and October 2025 at The Retina Group of Washington. Patients who had previous treatments or missed an appointment were excluded. Patients with diabetic macular edema or retinal vein occlusion were also excluded.

Huang and colleagues found mean visual acuity for the total cohort did not change significantly from baseline to the first treatment visit, from 20/84 to 20/88.

However, 12 eyes in the cohort lost three or more lines of vision during their waiting period for prior authorization. Their cumulative vision worsened from 20/152 at diagnosis to 20/575 at their first injection visit. Six months later, the average vision was 20/168 in these participants compared with 20/77 in those who had not experienced loss during the wait (P = .039). The average waiting time between groups was not significantly different.

Overall, 6 of the 12 eyes had an initial subretinal hemorrhage at intake and one had a large pigment epithelial detachment, but none had any significant changes in pathology between the initial diagnosis and injection visit, Huang said.

Stop Gaps

The study is meaningful, if small, because waiting for prior authorization for intravitreal drugs is universal among retina practices, said Manju Subramanian, MD, associate professor at Boston University Chobanian & Avedisian School of Medicine in Boston, who moderated the study panel.

Subramanian took an impromptu poll of the audience, finding about 20% indicated they give samples of drugs while patients await prior authorization. She treats patients initially with bevacizumab while awaiting prior authorization.

“The risk you run with delaying care is that patients can get worsening retinal bleeding during that time while you’re waiting for prior authorization,” she said. “There are a lot of clinicians out there who have to wait on prior authorizations, and maybe they don’t have access to samples from companies,” including her own, she said.

Huang said if a patient has a subretinal image at the initial visit, “I will try to fight more to get same-day authorization.”

The use of bevacizumab as a stopgap can vary among retina specialists because the drug needs to be formulated for ophthalmic use by compounding pharmacies.

“If you’re in a practice setting that doesn’t have access to a good compounding pharmacy, then you’re probably not going to use it as much,” Subramanian said. “It’s a great drug for how much it costs.”

Huang reported no relevant financial relationships. Subramanian reported being a consultant to Regeneron.

Richard Mark Kirkner is a medical journalist based in the Philadelphia area.