Pipeline Check-In | Plus Carl Danzig, MD, on His Mid-Career Practice Switch

Guest: Carl J. Danzig, MD – Vitreoretinal Surgeon, Fort Lauderdale Eye Institute; and Advanced Retina Institute, Bonita Springs, Florida Show Summary John Kitchens, MD, and Scott Krzywonos take stock of the three biggest retina news stories of 2026 — the SOL-1 superiority data for Axpaxli (Ocular Therapeutix), the FDA approval of Lytenava (Outlook Therapeutics), and the LUGANO Phase 3 near-miss for Duravyu (EyePoint Pharmaceuticals) — and look ahead to three imminent late-phase readouts: DAYBREAK for Zenkuda (Kodiak), BRUNELLO for Restoret (Merck/EyeBio), and ARCHER 2 for vanoprument (Annexon). Carl J. Danzig, MD, then joins for a candid conversation about leaving a solo retina practice after 14 years, navigating a non-compete, commuting across Alligator Alley, and what it actually costs — personally and professionally — to make a major mid-career transition. He recently joined Fort Lauderdale Eye Institute as one of four retina specialists, beginning to see patients there on August 24, 2026. Hosts: John Kitchens, MD, Scott Krzywonos Topics Covered 2026 Pipeline Check-In: Catching Our Breath Axpaxli / SOL-1: first superiority study in retina; at week 36, 74% of Axpaxli patients maintained vision vs. 56% on a single aflibercept injection; at 1 year, 66% had not lost 10 letters; NDA filing planned for 2026. Lytenava: FDA-approved July 2026 for wet AMD — first FDA-approved ophthalmic formulation of bevacizumab; full commercialization early 2027. Key unresolved question: impact on compounded bevacizumab access for DME, CRVO, BRVO, and myopic CNV. Duravyu / LUGANO: primary non-inferiority endpoint missed; attributed to nine outlier patients with vision loss unrelated to wet AMD; ad hoc analysis excluding those patients showed non-inferiority; LUCIA companion study data expected Q4 2026. 2026 Pipeline Check-In: What's Coming Kodiak — DAYBREAK (Zenkuda / KSI-501): Phase 3 for wet AMD vs. aflibercept; topline data expected September 2026. Merck — BRUNELLO (Restoret / MK-3000): Wnt pathway agonist antibody for DME; data expected within 4–6 weeks. A second Merck program — an ang-1 upregulator and VEGF inhibitor designed to activate the Tie2 receptor rather than merely inhibiting ang-2 — follows behind. Annexon — ARCHER 2 (vanoprument): C1q complement inhibitor for GA; Phase 2 showed a VA benefit without slowing lesion growth; Phase 3 primary endpoint is vision preservation, not lesion growth. Carl J. Danzig, MD, on Switching Practices at Mid-Career Background: Temple, Wills Eye, SUNY Downstate, UT Southwestern fellowship; joined Rand Eye Institute in 2012 as the practice's first and only retina specialist. Solo practice realities: PI on 59 clinical trials in an anterior segment practice; elected to Retina Society. Why he left: felt like "salmon swimming against the current"; outgrowing his role; needed partners, shared call, and a research-aligned culture. The transition: geographic restriction meant commuting Fort Lauderdale to Bonita Springs — across Alligator Alley — Tuesday through Thursday; often away five to six nights at a time. Income went to zero; non-compete anxiety; the mental and emotional load on his family was real. "Phil Rosenfeld, MD, told me I jumped out of an airplane holding my family's hand and no one had a parachute." Fort Lauderdale Eye Institute: one of four retina specialists; seven minutes from home; active clinical trial program; first patient day August 24, 2026. Advice: know your worth, move sooner if the fit is wrong, and build your network before you need it. Key Takeaways The three biggest retina stories of 2026 set up a fall season with multiple Phase 3 readouts that could further reshape the treatment landscape. Annexon's ARCHER 2 is the most mechanistically distinct GA program in Phase 3 — a C1q inhibitor targeting photoreceptors upstream of RPE loss. Leaving a practice at mid-career is a financial, legal, logistical, and deeply personal decision — Carl Danzig's transition is a useful blueprint. Network-building early in training is the single most durable investment a retina specialist can make. Sponsors This episode is made possible by Genentech, maker of Vabysmo (faricimab-svoa). Hear peer perspectives and case studies in the Purple Chair series at Vabysmo-HCP.com. This episode is brought to you by Ocular Therapeutix. Learn more at OCUTX.com.