Lessons through the lens: Device Development

A decade ago, I walked into my first Ophthalmology role at Roche . It was a time when Apple had released the first smartwatch, Taylor Swift’s album hit #1 and patients only had the option of anti-VEGF therapy to treat retinal conditions. Today, Taylor Swift is still dominating the charts, but the ophthalmology landscape has transformed with options that go beyond anti-VEGF now available, along with the rise of innovative therapies, including approaches like dissolvable and fixed implanted devices. Now feels like the perfect time to sit down with my colleague, Mercè Morral , Global Development Lead for the Surgery and Device Development Team, Ophthalmology, to reflect on the technological advancements of ocular devices, their challenges and the opportunities for the future.

Nilesh: Firstly, I’m interested to learn about what attracted you to work in Roche Ophthalmology, Mercè?

Mercè: I’ve always been attracted to developing solutions that protect what matters most to people with vision loss, whether that’s their ability to drive, read a book or see their grandchild’s face clearly.

I was also attracted to technology. When I was a medical student, I would always invest in the coolest tech, such as the latest iPod, so specialising as an ophthalmologic surgeon felt right because of the exciting potential of technology for diagnostics and treatments in this area.

Nilesh: Absolutely, the opportunity to make a meaningful impact for patients was key too. In Ophthalmology there was so much unmet need, including improving efficacy outcomes and? reducing the treatment burden, so I’m excited to help find solutions that solve these, no matter how challenging.

Early diagnosis and treatment are essential to preserving vision, and evolving technology has a big role in this. At Roche and within the clinic, you must have seen many groundbreaking technological advancements over the years?

Mercè: Yes, from lenses to lasers and more recently novel delivery systems that either dissolve in the eye or stay to deliver the drug. I still remember the ‘wow moment’ when I saw the optic nerve with a lens for the first time. For me, one of the most beautiful aspects of ophthalmology is that we can directly access the eye, unlike other organs in the body.

Nilesh: You’re right,? with tools such as optical coherence tomography (OCT), retinal specialists can capture detailed images? of the retina, in a non-invasive manner, which has improved our understanding of disease. However, delivering sufficient treatment to the back of the eye requires intravitreal injections, and for many people the thought of having an injection in the eye is initially a cause of anxiety and fear.

Mercè: Exactly, it’s difficult for people with retinal conditions to stick to receiving frequent eye injections. It’s also difficult for healthcare systems to provide enough capacity for everyone who needs to be treated. Together this creates a perfect storm for low treatment adherence and poorer visual outcomes.

For me, that’s why certain eye devices have been revolutionary. There are now fixed and dissolvable implanted devices available for certain retinal conditions enabling treatment to reach the back of the eye, where the tissue really needs it. But developing and deploying these kinds of devices comes with its own unique set of challenges.

Nilesh: It’s so true! And these challenges are mulit-faceted, requiring multiple aspects to work in tandem, the mechanism of action needs to be relevant, the molecule needs to be potent and safe and the delivery needs to be effective.

One key challenge is building a device small and robust enough to deliver a drug directly to the eye’s delicate and intricate tissues, and then manufacturing this consistently. What are your thoughts from a surgical perspective?

Mercè: Device implantation requires precision, so continuous optimisation of novel surgical techniques and training is essential.

It’s important to combine forces with surgical talent to help shape efforts, as well as support surgeons in the operating room.

Nilesh: ?In your opinion, does ensuring consistency when it comes to surgical techniques require a lot of dedication and resilience?

Mercè: Definitely, the mindset of continuous improvement comes naturally to us. In our everyday lives, continuous improvement of technology is the norm, after all, we’re on the iPhone 15 now! It’s no different with medical devices and surgical techniques.

Like any disruptive technology, there are early adopters and the later majority, who will be motivated to use a new medical device once witnessing more real-world data and experiences.

Nilesh: I agree, the technology can take us so far, but we need close partnerships with physicians to bring these devices to people with retinal conditions who really need them, especially following the enthusiasm from participants in clinical trials. From a patient perspective, a continuous delivery approach is very compelling as it can help to reduce the treatment burden of frequent eye injections.

Mercè: Precisely! That’s why partnering with patients and physicians is so important, not only for insights but to ensure we translate the patient experience from trials into practice. There are many partnerships happening behind the scenes.

Nilesh: Yes, we’re already working with surgeons to upskill and share techniques, but we also need to continue to work with health authorities. To get a device across the finish line, conversations must take place between device and drug divisions, meaning not only that current devices can be approved for people who need them, but that these new regulatory pathways can pave the way for future innovations too!

Looking ahead, what are you most excited about in this space?

Mercè: There are some interesting modalities up and coming, such as gene and cell therapies that require cells to grow outside of the body and then be implanted. But I’m most excited about the possibility of devices with the potential to deliver a host of different treatments, helping even more patients. What about you?

Nilesh: I'm excited about building on the progress that we’ve already made, as there’s so much more that we can do with devices to create a brighter future for people living with vision loss.

Final thought – what are you most proud of during your time working at Roche?

Mercè: I’m most proud of our persistence and resilience as a team throughout all aspects of the technology journey and our perseverance, despite the complexities, to help people with eye conditions live their lives to the fullest. And you?

Nilesh: Our unwavering commitment to listening and collaborating with the community stands out for me. After all, no pharma company is an island - it takes strong partnerships to make a real difference to patients.