Dr. Mali’s Top 5 Predictions in Ophthalmology for 2021

Dr. Mali’s Top 5 Predictions in Ophthalmology for 2021

Dr. Joshua Mali:
Welcome everyone to another episode of the Eye Care Insider. I'm your host, Dr. Joshua Mali. And this is a very special episode, and we know we're at the finish line here of 2020, so finally made it through the year. Almost done. It's been a crazy year, to say the least, but a lot of excitement and hope on the horizon for 2021. So, this is my annual predictions for ophthalmology and the 2021 edition. And I'm so excited and so honored to have co-hosts guest host for this episode, Dr. Yasmin Mali, Dr. Yasmin Mali is a board-certified ophthalmologist and fellowship-trained pediatric ophthalmologist. She is currently faculty at Lake Erie, College of Osteopathic Medicine in Bradenton, Florida, and probably most importantly to me, she's my beautiful and lovely wife. So, Yasmine, welcome to the show.

Dr. Yasmin Mali:
Thank you. Thank you for the invitation to co-host this special podcast.

Dr. Joshua Mali:
Well, this will be fun. I always like to do these predictions on annual basis and 2021 certainly will be a very exciting year. And I like to run through my top five predictions for 2021 in ophthalmology and to have your feedback and what you think about my predictions. So here we go.

Number one on my prediction list is while COVID-19 will dominate the headlines in 2021, the human spirit and innovation will ultimately achieve victory and prevail. So, it's obvious that COVID-19 will likely continue to be the dominant story in 2021. This virus has impacted every part of our society and fabric of civilization. However, I strongly believe in humanity's ability to defeat this challenge through our unity and spirit, incredible ingenuity, and innovation. It has been amazing to see just the absolute speed, efficiency, and potency of the worldwide efforts in clinical research and the pharmaceutical industry to fight and crush this virus.

It really wasn't an industry-wide team effort with companies both big and small joining the battle. You know, for example, as of this writing pharmaceutical giant Pfizer is preparing to distribute their COVID-19 vaccine with a massive distribution plan unseen in our country's history while possibly equally as impressive small biotech company Sorrento Therapeutics has rapidly developed a tremendous pipeline of promising COVID-19 antibiotic treatments, vaccine candidates, and diagnostic tests that could hold the key to next generational management and potential cure of this disease. So, our unity as a society with our unshakeable will and determination is really what will win the battle against COVID-19. And this certainly will take the top spot in my predictions for 2021. So, he Yasmin, what do you think about my prediction? I think we're going to really crush this virus. There's a lot of hope so far on the horizon with vaccine distribution and new treatments coming out fairly soon on the horizon. What are your thoughts on this top prediction of mine?

Dr. Yasmin Mali:
Well, I definitely agree that the COVID-19 pandemic will dominate the headlines in 2021. However, the recent reports of the first healthcare workers receiving vaccinations really was such a touching moment after such a challenging year for so many all across the world to see the first round of vaccines being given was the glimmer of hope for what is to come. So hopefully we can turn the corner and as a community and as a society move towards a "new normal."

Dr. Joshua Mali:
Yeah, absolutely. I agree with you. I think that it was really important that healthcare workers have a chance to receive the vaccine, have an opportunity to get that early on because we're on the frontlines, right? We're taking care of patients, especially in ophthalmology. You know, we're very close up to patients at the slit lamp and our clinical exam is so it's just really an important aspect to have that safety from the vaccine for these frontline workers who really put their lives on the line for patients to help treat them. So, I absolutely agree with you. And I think it is going to be the top story for next year.

Okay. So, number two, on my list of Dr. Malley's top five predictions for 2021, number two is the competition battle lines will be drawn in 2021 for ocular therapeutics in the most common eye disease markets.

Okay. So, we know while COVID-19 did impact the vast majority of our society, surprisingly though clinical research is in ophthalmology did not stop. In fact, it continues to grow at a record pace with incredible amounts of data, to analyze, interpret for clinical application and ophthalmology. With this as kind of a backdrop for 2021, we're going to see product launches and regulatory approvals for ocular treatments in all the major disease states in ophthalmology. So, like dry eye, glaucoma, cataract, intraocular lens implants, and macular degeneration. We have never seen such innovation in multiple common ocular disease states simultaneously until now, and a few potential impactful players and 2021 to keep your eye on. In my opinion, are Genentech and Kala Pharmaceuticals. For Genentech is delivering a lot of significant optimism with two exciting products in the retina space. The first one is the port delivery system with Lucentis or the PDS system for wet AMD, which is really basically a revolutionary sustained drug delivery system to help treat wet AMD and Faricimab, which is the first bispecific antibody designed for intraocular use that can simultaneously bind and neutralize Ang-2 and VEGF-A., which appears to be very effective in diseases like wet AMD and diabetic macular edema.

Now, both these products are likely going to be game-changers in the retina therapeutic space. So really you want to keep your eye on Genentech and these products 2021. Kala Pharmaceuticals has a recent FDA approved product called EYSUVIS, which is loteprednol 0.2, 5% for the short-term treatment of the signs and symptoms of dry eye disease. So that also be a certainly a major player in the dry market and 2020 ones I could go on, on the list of different products that have been either recently approved or potentially could be approved in 2021 and the different spaces, but Yasmin would you like to hop in here. Do you have any thoughts on this or is there anything in the pediatric ophthalmology space that's new and exciting as well?

Dr. Yasmin Mali:
Yeah, I'd love to speak about the pediatric ophthalmology realm. And if I was doing this top five, I probably would include an increase in incidence and progression of myopia, especially now with the implementation of virtual school and the time children are spending online and with activities with screen time. I think we'll definitely see an increase in myopia across the board. So that's my prediction. As far as new technologies and new therapeutics, there are quite a number of research studies looking at treatments to decrease myopia progression, for example, multifocal contact lenses orthokeratology as well as pharmaceutics, like low dose atrophying in children. So, there are a lot of promising therapeutics. Yeah.

Dr. Joshua Mali:
I agree with you. I think that I've seen myopia all over the news, you know, recently a lot of headlines about treatment of myopia. And certainly, I think it's a hot topic currently in pediatric ophthalmology. And it's just crazy to see that in all the different major subspecialties we're seeing innovation really all the same time. Sometimes it takes years for certain subspecialties that bring in different medications and things like that, but it just seems like it's all happening at once. And it's really exciting to see it, it's great to be in an ophthalmology and great to be a part of it and be able to utilize these medications in our patients to bring the best possible outcomes. So certainly, it's just a very, very exciting time. And again, for the pharmaceutical industry, a very competitive time. So, they're going to be all kinds of fighting for market share.

So that's going to be kind of a critical, critical juncture this, this 2021 year, where you have multiple medications just really fighting for market share. So really, it's going to be like the last person standing here to decide who kind of wins the day on the market share. So, keep a lookout for the different products in these major disease states, because it's going to be surely a battle. Okay. Now moving on to number three on my list is artificial intelligence or AI will continue its rise and application in clinical ophthalmology. So, I've been writing about this for years about AI and its great potential, and rightfully so. I mean, this technology has really been designed to improve efficiency and data analysis, and it's now been strategically and successfully implemented into ophthalmology and actually frankly, all of medicine. And one particular device I may want to keep your eye on is in the retina space is Notal Visions home OCT system.

This is a new platform for monitoring patients with wet AMD and its pioneering patient operated design and utilizes it to identify any fluid in the retina and helps to help diagnose patients with wet AMD. So allows patients to complete the test at home with the machine learning algorithm and this performs that automate analysis and generates a report and transmits that information to the physician. So really this innovation represents a symbiotic relationship between artificial intelligence and telemedicine and certainly could revolutionize the way we monitor and determine treatment intervals for patients receiving intravitreal anti-VEGF medications. So certainly the home OCT system is a very exciting system and it could be inevitably the new standard of care and wet AMD management, you know, really fine-tuning what we do in retina and how we schedule patients for injections, bringing them into the clinic to examine them for injections and really change and revolutionize the way we do things currently. So, I think AI is just kind of slowly been implemented in our current systems and hopefully helping to be a helpful adjunct, uh, to, to us as physicians and managing patients better and delivering better outcomes. Yasmin, are there any AI, either devices or systems or platforms in pediatric ophthalmology?

Dr. Yasmin Mali:
You know, that's a very interesting question. And most recently there have been some wearable devices that can record various parameters. For example, reading distance, time spent reading, ambient light, and these parameters are reported back to the where the patients so that they can modify their behavior in the hopes of decreasing myopia progression. And one of the wearable devices that comes to mind is the Clue Clip, which has been in recent studies. So, I hope that in the future, we'll see more artificial intelligence in the pediatric ophthalmology space, not only in myopia prevention but also decreasing its progression as well as in other aspects of ophthalmology.

Dr. Joshua Mali:
Great. Yeah, I mean, AI has certainly been implemented in multiple facets in ophthalmology and all our specialties. So, I think that its ability to help us efficiently see patients and provide that extra layer of care, I think is going to be a nice advantage to have in clinical ophthalmology and medicine overall. Okay. We're winding down to number four on my list of Dr. Malley's Top Five Predictions for Ophthalmology in 2021. Number four is telemedicine platforms will still play a role in ophthalmology with COVID 19 and 2020. We saw in around the mid-March time to April time period ophthalmology practices basically shut down. It was a very historic unfortunate time where from the direction of our professional organizations and state and local and federal governments, it was advised to halt. Most things that are at the time and ophthalmology practices were one of the things that needed to be shut down at that time to help for the public health crisis at that time.

And telemedicine really exploded during that time. The business and utilizations really spiked during that kind of mid-March to April time period, due to these restrictions and temporary shutdowns. But in my opinion, it was really only acceleration of an earlier trend that I was kind of seeing that has been gaining traction over the past several years. Telemedicine is starting to kind of become more easier to use and more accessible to physicians and then also to patients and its ability to help clinics and ophthalmology practices is starting to become more and more evident. And obviously, while telemedicine will never replace a physical exam, especially in ophthalmology, we still have to examine the eye. And I think telemedicine has its limitations there. I still believe telemedicine can be a helpful adjunct and a service that ophthalmology practices can provide to benefit patients. And frankly, patients will start to expect to have that as an available option and certain circumstances going forward.

So certainly, patients that have certain types of follow-ups, maybe it's a quick dry follow-up or quick little check during the postoperative period, things like that. I think that's kind of where its sweet spot is. Certainly, I don't think it's going to take the place of a full, comprehensive eye exam, but I think it can be really helpful adjuncting patients that live far away or have difficulty coming to the clinic or that just want a brief visit. I think it could provide a great value to them. And I think it's a nice service to have in your practice. And I think certainly ophthalmologists in the community will be continually utilizing it. Obviously, I think it was a pretty high utilization earlier this year, but I think we're starting to go back to somewhat normal office visits, but I think it's nice to still have that telemedicine option for patients. And I think they'll certainly appreciate that as well. And Yasmine, what's your thoughts on telemedicine? How do you feel about this? I mean, I can't imagine doing a pediatric exam through telemedicine. I mean, what's your sense through the pediatric ophthalmologic community? Is that, were they able to complete telemedicine visits with kids? How did that go? I was really curious about that. I'm sure our listeners are.

Dr. Yasmin Mali:
Yeah, absolutely. The pediatric ophthalmology community did pivot to incorporating telemedicine into their processes, especially when the pandemic hit in late March and early April. So, I think there are many benefits to incorporating telemedicine, as you said, it's not going to replace the complete pediatric ophthalmology exam. However, um, it can be an adjunctive tool that many patients and providers will expect to see in the future. It will help decrease the chair time. If you can gather history information as well as preliminary screening tests that you can do via telemedicine, it decreases the patient's time in your office. And I think even after the patient visit, it allows for opportunities for patients and families to connect with their doctor questions arise, or just follow up test results that wouldn't necessarily require an in-person visit to discuss those. So, I do think that telemedicine's here to stay in one form or another. And as you said, it would not completely replace children's eyes exams or business evaluation, but it is definitely an adjunctive tool that is here to stay.

Dr. Joshua Mali:
Yeah, well said, well said, and to now go drum roll. What's the final prediction on my list? Number five prediction for 2021 is virtual ophthalmology conference options will be present for the majority of 2021. We're all used to the live meetings, the great live meetings that are put on in ophthalmology. That's just great places to see old friends, to gain a lot of knowledge through the informative sessions, as well as interact with industry and, and develop those relationships. And we had to really adapt and pivot this year for sure with the social distancing guidelines and large crowds. So certainly, the adaptability of ophthalmology conferences and professional organizations in 2020 has been absolutely incredible. I've been so impressed by organizations such as the American Academy of Ophthalmology and the American Society of Retina Specialists, which put together very successful and informative virtual annual meetings in really such a short amount of time.

It's been nothing short of amazing. The strong leadership of these organizations should be applauded for their ability to adapt and pivot during this challenging time to deliver stellar meetings. Do the success. My prediction is that these major meetings not homology in 2021 and beyond we'll continue to have a virtual option to allow flexibility and more widespread participation for future meetings. In addition, I think meetings that take place during the end of 2021 will likely have some sort of hybrid model or you'll see kind of a live in-person meeting with a limited number of registered participants, as well as a simultaneously broadcast virtual meeting platform for those that are unable to attend the live event. So, I think this constant exchange and flow of ideas and knowledge is really the lifeblood of our profession and we'll need these forms to continue to thrive successfully in our field. So, this is kind of, I think it's going to happen for 2021 Yasmin, were you able to attend any meetings this year virtually and what were your thoughts on those?

Dr. Yasmin Mali:
Yes, I did attend the American Academy of Ophthalmology virtual meeting as well as the Pediatric Ophthalmology Subspecialty day. And I thought it was a very interesting experience, very well put together and quite impressive, the format of the whole conference, the whole virtual conference. And I hope that we can continue to see virtual options available to ophthalmologists going forward, especially for the Academy, but also for other some specialty conferences. I know that the APOS organization is hosting a virtual conference coming up in the springtime, which will be wonderful, and as far as the Woman In Ophthalmology conference, they had a virtual meeting this past summer, and hopefully, we'll continue to have virtual options available going forward. This will enable ophthalmologists who cannot travel for whatever reason to participate and to be engaged in the new research and studies that are going on as well as collaborating with other colleagues and experts in their respective specialties.

Dr. Joshua Mali:
Yeah. Very exciting to see that. And I think this is going to be a very exciting year with a lot of great potential and a lot of hope. And a lot of innovation really is, is the keyword for 2021. And that's my top five predictions and we have a little bonus one here, a little surprise announcement on my podcast today. I like to announce that it's probably the first time this has happened on a podcast, but I like to announce that Yasmin and I will be expecting our second child in March of 2021. So, we're very excited about that and want to announce to everybody on our podcast here today. So, thank you very much, Yasmin any final words?

Dr. Yasmin Mali:
Well, thank you for the invitation to co-host this very special episode with you. It was an honor and I look forward to hosting other episodes with you in the future. And I wish everyone a very safe and happy holiday season and a prosperous 2021.

Dr. Joshua Mali:
Thank you so much for being my guest host for this special episode. And thank you for listening to The Eye Care Insider, where we get the insight of every story. Be sure to read the latest news and commentary on helaio.com. If you love the show, follow us on Twitter and feel free to email [email protected]