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How Vabysmo Works in the Eye

Vabysmo Injections for Retinal Disease

Conditions Vabysmo Is Approved to Treat

Vabysmo is FDA-approved for three specific retinal conditions. Each of these conditions involves abnormal fluid or blood vessel changes in the retina that can threaten vision without treatment.

In wet AMD (age-related macular degeneration), abnormal blood vessels grow beneath the retina and leak fluid or blood. This damages the macula, the central portion of the retina responsible for sharp, detailed vision. Without treatment, wet AMD can cause rapid and significant central vision loss. Vabysmo reduces this leakage and can slow or improve vision loss, particularly when treatment begins early.

Diabetic macular edema (DME) develops when diabetes causes fluid to accumulate in the macula, blurring central vision and making everyday tasks like reading and driving more difficult. DME can occur at any stage of diabetic retinopathy and is one of the most common causes of vision loss in people with diabetes. Vabysmo reduces fluid buildup in the macula and can improve visual clarity over time. Managing blood sugar levels alongside injection treatment supports the best possible outcomes.

Retinal vein occlusion (RVO) occurs when a vein carrying blood away from the retina becomes blocked, causing swelling and fluid leakage in the macula. Vabysmo is approved to treat macular edema that develops as a result of RVO, reducing the swelling and protecting vision.

What Clinical Evidence Shows

Vabysmo was studied extensively in large clinical trials before approval, and real-world experience since its introduction has confirmed those results. This body of evidence gives our team confidence in how to use it effectively for each patient.

Two large clinical trials, TENAYA and LUCERNE, compared Vabysmo to aflibercept (Eylea) in patients with wet AMD. Results showed that Vabysmo was noninferior to Eylea in improving vision. Importantly, nearly 80 percent of wet AMD patients treated with Vabysmo were able to extend to at least 12-week injection intervals, and approximately 60 percent reached 16-week intervals after the initial loading phase.

The YOSEMITE and RHINE trials enrolled over 1,800 patients with DME. Patients treated with Vabysmo gained an average of 11 letters on a standardized eye chart over one year, comparable to results seen with Eylea. Studies also showed that a higher proportion of Vabysmo patients had complete clearance of retinal fluid at 12 weeks compared to those receiving aflibercept alone, suggesting a stronger drying effect in some patients.

Since Vabysmo became available, dozens of published real-world studies have confirmed that the results seen in clinical trials hold up in everyday clinical practice. These studies show that many patients can maintain their vision gains while receiving fewer injections per year compared to older anti-VEGF treatments.

What to Expect During Treatment

Knowing what the treatment schedule looks like from the start can help you plan and stay consistent with your care. The process is individualized, and your Retina Specialist will guide each step based on how your eye responds.

Treatment with Vabysmo begins with a loading phase of four monthly injections. These initial doses build up the medication in the eye and begin stabilizing the retina. During this period, you will visit your Retina Specialist once every four weeks.

After the loading phase, your Retina Specialist will use imaging tests and vision checks to determine whether injection intervals can be extended. Some patients can go as long as 16 weeks between doses. This personalized approach, often called treat-and-extend, adjusts your schedule based on how your retina is responding rather than following a fixed calendar.

Plan to spend approximately one to two hours at the office for each injection visit. Most of that time is spent on check-in, eye drops for dilation and numbing, and a brief monitoring period after the injection. The injection itself takes only seconds.

  • Numbing drops are applied before the injection to minimize discomfort
  • An antiseptic rinse is applied to reduce infection risk
  • A brief sensation of pressure during the injection is common
  • Mild redness or irritation after the visit typically resolves within a day or two
  • Arrange for someone to drive you home, as your vision may be mildly blurred for several hours

Even as intervals extend, regular monitoring remains essential. At each visit, your Retina Specialist will check your vision and perform an OCT scan (optical coherence tomography, a painless imaging test that creates a detailed cross-section of the retina) to look for any remaining or returning fluid. These scans guide decisions about whether to maintain, extend, or shorten the time between injections.

Who May Benefit from Vabysmo

Vabysmo is not the right choice for every patient, but it is a strong option for several groups. Your Retina Specialist will evaluate your full history before recommending it.

Patients who have not yet received any anti-VEGF injections may be excellent candidates for Vabysmo. Clinical trials included a large proportion of treatment-naive patients and showed strong vision outcomes in this group. Starting with Vabysmo may allow patients to benefit from extended dosing intervals from the very beginning of their treatment.

Frequent injection appointments can be a real challenge, especially for patients who rely on others for transportation or who live a significant distance from a retinal practice. For patients who respond well, Vabysmo may meaningfully reduce the number of office visits per year, making it easier to stay consistent with care.

Patients already receiving anti-VEGF injections such as Avastin (bevacizumab), Lucentis (ranibizumab), or Eylea (aflibercept) may consider switching to Vabysmo. Common reasons include persistent retinal fluid despite regular injections or a goal of extending treatment intervals. Your Retina Specialist can assess whether switching is appropriate based on your specific condition and imaging findings.

How Vabysmo Compares to Other Anti-VEGF Medications

Several anti-VEGF medications are available for retinal conditions, and each has its own profile. Understanding the differences can help you have a more informed conversation with your Retina Specialist.

Eylea (aflibercept) and Lucentis (ranibizumab) are well-established anti-VEGF medications that target only VEGF-A. Both have strong long-term safety records built over more than a decade of clinical use. These medications typically require injections every four to eight weeks in most patients. Vabysmo's dual-target design allows many patients to extend intervals further while achieving comparable vision outcomes.

Avastin (bevacizumab) is used off-label for retinal conditions and was originally FDA-approved for cancer treatment. Large clinical studies have shown it to be effective for many patients, and it is considerably less expensive than other options. However, it generally requires more frequent dosing than newer agents. Vabysmo's ability to extend intervals may reduce the total number of visits per year for patients who are good candidates for it.

There is no single best anti-VEGF medication for every patient. Your Retina Specialist will consider your specific diagnosis, disease severity, treatment history, and personal preferences when recommending the right approach. Switching between medications when the initial treatment does not achieve the desired response is common and appropriate.

Safety Profile and Side Effects

Like all injectable retinal treatments, Vabysmo carries a small risk of side effects. Understanding these risks helps you recognize when to contact your care team promptly.

The most frequently reported side effects in clinical trials included cataract development and conjunctival hemorrhage (a small area of bleeding on the white of the eye). These side effects were generally mild and occurred at rates comparable to those seen with other anti-VEGF injections. Most injection-related side effects resolve on their own within a few days.

As with any intravitreal injection, there is a small risk of more serious complications. These include endophthalmitis (infection inside the eye), increased eye pressure, retinal detachment, and vitreous hemorrhage (bleeding inside the eye). Retinal vasculitis, which is inflammation of the blood vessels in the retina, has been reported rarely with Vabysmo. The overall rate of serious complications remains low, and strict sterile technique during every injection is used to minimize these risks.

After any injection, contact your Retina Specialist right away or go to an emergency room if you experience sudden vision loss, increasing eye pain, worsening redness, or a significant increase in floaters. These symptoms can be signs of a serious complication that requires prompt evaluation and treatment.

Frequently Asked Questions

These answers address common questions that go beyond the general information covered above, including practical guidance to help you navigate your treatment confidently.

Interval extension is evaluated after the four-injection loading phase is complete. At that point, your Retina Specialist reviews your OCT images and visual acuity results to determine whether your retina is stable enough to space out treatments. Some patients move to 8-week intervals initially, while others progress more quickly to 12 or 16 weeks. The pace is always guided by your individual response rather than a set schedule.

Vabysmo has shown strong results in both wet AMD and DME, though the conditions involve different disease processes. For DME specifically, managing systemic diabetes control alongside injections plays an important role in outcomes. Your Retina Specialist will factor in your underlying health status, not just the retinal findings, when setting expectations for your treatment.

Vision improvement is possible for many patients, especially when treatment begins early before significant retinal damage has occurred. However, results vary from person to person. Some patients regain meaningful visual function, while others experience stabilization that prevents further loss. Vision lost due to long-standing or advanced retinal damage may not be fully recoverable, which is why beginning treatment promptly after diagnosis is so important.

Contact your Retina Specialist's office as soon as possible to reschedule. Missing or delaying an injection, especially during the loading phase or during a period of active disease, can allow retinal fluid to return and vision to decline. Do not wait until your next regularly scheduled appointment if you have missed a visit; earlier rescheduling helps protect the progress you have made.

Intravitreal injections are generally considered safe for patients on anticoagulants (blood thinners), but it is important to share a complete list of your medications with your Retina Specialist before treatment begins. Certain systemic health conditions may affect your overall care plan. Your Retina Specialist and your other physicians can work together to ensure that your retinal treatment is coordinated safely with your broader health management.

For conditions like wet AMD, ongoing treatment is typically necessary to maintain vision, though intervals may lengthen over time as your eye stabilizes. For DME, treatment may eventually be paused if the condition fully resolves, but continued monitoring remains important to detect any recurrence early. Your Retina Specialist will reassess your long-term plan at every visit based on current imaging and vision data.

Start Your Retinal Care at Atlantic Retina Center

At Atlantic Retina Center, our fellowship-trained, board-certified team specializes exclusively in the retina, vitreous, and macula, bringing focused expertise to every patient we care for across the Eastern Shore of Maryland and central and southern Delaware. If you have been diagnosed with wet AMD, diabetic macular edema, or retinal vein occlusion, or if you have concerns about your retinal health, we are here to help you understand your options and create a personalized treatment plan. Our team uses advanced retinal imaging at every visit to track your progress with precision and make informed decisions about your care. We look forward to partnering with you to protect and preserve your vision.

What Our Patients Say

  • “Visit was calm and enjoyable. Staff professional and friendly. Impressed with high-tech equipment. Wait minimal. Never felt rushed with the doctor.”

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    Milford, Delaware

  • “Excellent staff and doctors. Treatment plans detailed and effective. I chose this office as second opinion, should have been first choice.”

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    Dover, Delaware

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    Dover, Delaware

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    Milford, Delaware

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    Easton, Maryland

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    Milford, Delaware

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    Jon Lipka

    Salisbury, Maryland

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    Salisbury, Maryland

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    Salisbury, Maryland

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    Dover, Delaware

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    Salisbury, Maryland

  • “I’ve been a patient at Atlantic Retina for years, referred by my optometrist after a retinal detachment. Dr. Rial and his team have been exceptional in monitoring and preserving my vision.”

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    Salisbury, Maryland

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    Salisbury, Maryland

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    Salisbury, Maryland

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    Easton, Maryland

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    Paul Shultz

    Salisbury, Maryland

  • “After frequent prescription changes and vision loss, Dr. Rial diagnosed macular pucker and prescribed drops. After 6 weeks, the bulge reduced by half. Excellent care and treatment.”

    Jeffrey Williamson

    Easton, Maryland

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    Ocean Pines, Maryland

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    Dover, Delaware

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    Milford, Delaware

  • “Doctor Paul and the entire staff were absolutely over the top with concern and care. We need more doctors in any branch of medical care to take lessons from the Staff and Doctor Paul!”

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    Easton, Maryland

  • “Dr. was very thorough in explaining my glaucoma condition and treatments. Much more than 2 ophthalmologists I saw in NY for 8 years. He's a 10-star doctor!”

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    Milford, Delaware

  • “Long-time patient, impressed with Atlantic Retina Center and Dr. Rial’s professional, courteous care. Grateful for wonderful care.”

    K R

    Dover, Delaware

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    Mary Jo Vasil haines

    Dover, Delaware

  • “I want to say thank you to the Drs and team for getting me in on short notice for an emergency appointment and a shout out to Laura for keeping me updated on my appointment and calling me back in a timely manner thank you all.”

    Sharon Price

    Milford, Delaware

  • “Dr. Rial is a great Doctor. He takes care of his patients and even though he is very busy he is friendly and takes his time with each of us to help us with our eye problems.”

    Janet Otto

    Easton, Maryland

  • “All staff members were very pleasant. Dr. Paul is a God sent. I feel very comfortable with him. I trust his judgement of my treatment to my eye.”

    Mildred M

    Salisbury, Maryland

  • “Very nice assistant at the desk. Nurse practitioners were so nice and friendly. Dr. was a very nice doctor too and friendly. Very good Eye Specialists.”

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    Milford, Delaware

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    Dover, Delaware

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    Milford, Delaware

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    Easton, Maryland

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    Milford, Delaware

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    Milford, Delaware

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    Easton, Maryland

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    J M

    Dover, Delaware

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    Milford, Delaware

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    Paul S

    Dover, Delaware

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    Salisbury, Maryland

  • “If it weren’t for Dr. Schwartz and his staff, I would’ve lost my most precious gift. Thank you a billion times over for your incredible care!”

    Darrell

    Easton, Maryland

  • “Dr. Paul is a busy and compassionate doctor. He knows my husband's history of M. D. Now he has my own M. D. To deal with. As promised, the black dot disappeared by morning. I am very appreciative that Dr. P. Comes to Easton. Thank you.”

    Tom Knight

    Easton, Maryland

  • “Dr. Paul Lagonigro and staff gave me confidence and kept me informed. Forever grateful to Dr. Joseph Schwartz who performed my surgery and the entire Atlantic Retina Center team for excellent care.”

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    Salisbury, Maryland

  • “I’ve seen Dr. Rial for 8–9 years. I appreciate his professionalism, respect, and thorough care. I have full confidence in his diagnoses and guidance.”

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    Easton, Maryland

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    Salisbury, Maryland

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    Milford, Delaware

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    Dover, Delaware

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    Dover, Delaware

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    Easton, Maryland

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    William Doran

    Salisbury, Maryland

  • “Everything went well with new format for signing in. Thrilled to be back with Dr. Thanks.”

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    Milford, Delaware

  • “Preferred by my eye doctor and never disappointed. Customer service amazing. The Doctor listens and cares. Friendly people, blessed to find them.”

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    Dover, Delaware

  • “Atlantic Retina, Dover and Salisbury staff caring and professional. Dr. Schwartz is superior in his profession.”

    shirley M S

    Dover, Delaware

  • “I visited Atlantic Retina Center for macular degeneration. Dr. Schwartz and staff were professional and skilled, with excellent equipment and care. Highly recommend their services.”

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    Easton, Maryland

  • “So good to know Dr. is back in Milford. Office is beautiful and relaxing. Staff, especially Nicole, is amazing.”

    Bishop Marion L. Hendricks

    Milford, Delaware

  • “A long time patient, Always been impressed with Atlantic Retina Center and Dr. Rial’s care. Professional, courteous, and Dr. Rial always addresses any concerns. Grateful to have such wonderful care.”

    Kelley Rouse

    Salisbury, Maryland

  • “All staff very pleasant. Dr. Paul is a God sent. I feel comfortable with him and trust his judgment of my eye treatment.”

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    Dover, Delaware

  • “Extremely satisfied from check-in to check-out. Nurses were pleasant and thorough. Dr. Rial clearly explained my MRI results and next steps. Very grateful for the excellent care.”

    Wayne Robinson

    Easton, Maryland

  • “Great practice with nice staff and professional service. Dr. Paul Lagonigro listens to you and helps you understand what is going on. I'd recommend them to anyone”

    Vicky Heeger

    Salisbury, Maryland

  • “Everyone is polite and friendly. They make you feel like you’ve known them for years. Really comfortable.”

    anthony scalia

    Dover, Delaware

  • “Love the Dr. He always treated me with respect, was personable, listened to my complaints, never just rushed me through a visit and assured me that the problem would be resolved. Great doctor and bedside manner as it is called, is "5 stars" WORTHY!”

    Virginia Evans

    Milford, Delaware

  • “Dr. Paul Lagonigra is very knowledgeable, extremely competent and person centered. Even though he knows I am also a health professional and have been treated for macular degeneration for several years, he always makes sure that I am comfortable with my treatment.”

    Regina Cusson

    Salisbury, Maryland

  • “My wife had retinal detachment. Dr. did initial evaluation, Dr. performed surgery, skills impeccable, thorough and considerate. Staff top notch. Grateful!”

    Rich Durbin

    Milford, Delaware

  • “Thank you. We had an exceptional experience and our concerns were addressed with compassion and understanding.”

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    Dover, Delaware

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    Salisbury, Maryland

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    Dover, Delaware

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    Ocean Pines, Maryland

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    Easton, Maryland

  • “Everyone professional, took time to explain. Nicole did a great job and was patient helping me understand. I really appreciate the overall experience.”

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    Milford, Delaware

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    John Elko

    Salisbury, Maryland

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    Joseph Gordon

    Milford, Delaware

  • “The staff is very nice at the desk and Dr. was nice, knowledgeable, and punctual!”

    Holley Porter

    Milford, Delaware

  • “Staff is always friendly. Dr. Schwartz is very professional and informative. I was legally blind in one eye and can see now.”

    Bonnie Hillwig

    Dover, Delaware

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    Janet Moore

    Easton, Maryland

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    Matt

    Ocean Pines, Maryland

  • “My first visit, all staff were very polite and informative.”

    Nancy Graves

    Dover, Delaware

  • “I like everyone at the surgery office. Everyone was attentive and explained in detail. Doctor was experienced and made me aware of everything. Thanks 😊.”

    William Morrow

    Milford, Delaware

  • “Highly recommend Dr. Schwartz and team. I called with an eye emergency and was seen within an hour. Anytime I’ve had an emergency, I’m seen same day. He’s professional and very knowledgeable.”

    Livn “Liv” Lyfe

    Salisbury, Maryland

  • “Dr James Rial is always very friendly and professional. He spends whatever time it takes to carefully explain his diagnosis. Staff also very friendly and make me feel confident that they are the best.”

    Steve Trowbridge

    Salisbury, Maryland

  • “My 92-year-old mom with dementia needed an eye injection for macular degeneration. The staff and doctor were kind, professional, and made the procedure quick, gentle, and comfortable.”

    Donna Spitz

    Easton, Maryland

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    Michele Finn

    Milford, Delaware

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    Barbara Bigelow

    Dover, Delaware

  • “Dr. Schwarz is always thorough and professional, and his technicians provide excellent, skilled support. Highly recommend this practice.”

    Sheega Beemom

    Easton, Maryland

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    Lisa Parsons

    Milford, Delaware

  • “Appointment was kept on time and Dr. was attentive to my needs and cared about my health.”

    Tony Dagostino

    Milford, Delaware

  • “I’ve been a patient for 3+ years. Dr. Rial and his staff are excellent; pleasant, competent, and thorough. His injections are nearly painless, and my sight remains normal thanks to him.”

    Marilyn Mann

    Easton, Maryland

  • “It may have taken a little but worth the wait. Beautiful office, friendly efficient staff. ”

    Linda Foskey

    Milford, Delaware

  • “A routine eye exam found a problem. My optometrist referred me to ARC, and they scheduled me the next day. Dr. Rial and staff were exemplary; professional, skilled, and caring.”

    Lee Karrh

    Easton, Maryland

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    Kathleen Calvert

    Easton, Maryland

  • “I had an emergency visit to Atlantic Retina Center before a Europe trip. Dr. Lagonigro and staff were efficient and caring, thoroughly examining my eyes and clearing me for travel.”

    Deborah Reilly

    Easton, Maryland

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    Nancy White

    Salisbury, Maryland

  • “Professional courteous staff, listens to my feedback. Dr. Paul is thorough, understanding and patient.”

    Howard Winfree

    Easton, Maryland

  • “Excellent staff and doctors, professionalism paramount. Treatment detailed, very effective. I chose them for a second opinion and they should have been first.”

    Bernard B

    Salisbury, Maryland

  • “We went to Azar Eye Institute for an emergency due to my husband’s sudden floaters. They were prompt, caring, and fit us in immediately. Grateful for their excellent, attentive care!”

    Kirsten Krogen

    Ocean Pines, Maryland

  • “My husband was diagnosed with wet AMD. Thanks to a quick referral, he began treatment promptly. Dr. Lagonigro was professional, knowledgeable, and concise. We are so grateful. 5⭐️⭐️⭐️⭐️⭐️”

    JKC Maine

    Salisbury, Maryland

  • “First visit nerves went away because of kind services. Laser part was my concern but there wasn’t any problem. Pleasant experience.”

    Jean Jamison

    Dover, Delaware

  • “Love new place the girls were great and the doctor was fast no complaints about the new location a lot better”

    K H

    Salisbury, Maryland

  • “Very efficient and courteous staff. Dr. is thorough, helpful, explained clearly, answered questions. Appointment soon as new patient. Will see him annually.”

    Adrian Morris

    Milford, Delaware

  • “First cataract eye was cloudy 24 hrs after surgery. Second eye surgery was a completely different experience! Super clear vision! Thank you Dr.!!!”

    Cindi Chaimowitz

    Milford, Delaware

  • “Dr. Paul Lagonigro and team gave me confidence. Grateful to Dr. Joseph Schwartz for surgery and Atlantic Retina team for excellent care.”

    Jean Dowding

    Dover, Delaware

  • “My visit at Atlantic Retina was good as usual. Shorter wait time, overall very good.”

    William Wooters

    Dover, Delaware

  • “Friendly staff. Dr. Schwartz explains things very well. Very clean facility.”

    Ray T

    Dover, Delaware

  • “Dr Schwartz and his team provide first rate care. I have wet AMD in both eyes and I depend on these folks to protect my eyesight -- and they do!!”

    Len Smith

    Salisbury, Maryland

  • “Nichole H. was patient, nice and thorough. Then Dr. came in, wonderful doctor. One of the best eye exams I have had. Highly recommend the Milford location.”

    Jackie H.

    Milford, Delaware

  • “The staff are friendly. Dr. Schwartz is nice and kind.”

    Karen Cassese

    Dover, Delaware

  • “I’ve been treated for macular degeneration 7+ years. This was the first painless treatment as assistant used generous numbing drops. I plan to request extra numbing in the future.”

    teri gray

    Dover, Delaware

  • “I was a little scared about my eye injury, and they explained everything, and helped me to not be as worried.”

    Jomol Mo

    Salisbury, Maryland

  • “The staff was courteous and professional and I didn't have a long wait before I was seen. Dr. Rial was thorough with his tests and explained the results clearly.”

    Susan Griffith

    Salisbury, Maryland

  • “Well organized office. Great staff. First visit involved emergency repair of torn retina by Dr. Schwartz for which I was very appreciative. He and the staff continue with follow up care. Many thanks.”

    Diane Malone

    Salisbury, Maryland

  • “The doctors and staff at Atlantic Retina Center are excellent. Dr Rial is thorough and tells you about the real deal in a way you can understand it. I couldn't ask for better treatment.”

    Andrew Schneider

    Easton, Maryland

  • “Dr. Paul is the best. The office is responsive and care is the reason for my eyesight being the best it can be.”

    Susan W

    Dover, Delaware

  • “Very fast and efficient with a great staff. I truly enjoyed my appointment and received excellent care. Highly recommend!”

    Robin Gleason

    Ocean Pines, Maryland

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