A vision like no other: Why personalised healthcare (PHC) is the future of ophthalmology

In the healthcare space, we’re used to seeing trends come and go, but I believe that PHC is one that will stick around and ultimately transform the way we treat people with vision loss. PHC is a multidisciplinary approach that offers the promise, via recent and future innovations, to improve vision outcomes for individuals. As the healthcare landscape evolves, there is growing awareness that the current treatment approach doesn’t work for all people experiencing vision loss. Interventions known to work for ‘most people’ are not enough. We want to replace a one-size-fits-all method with one that reflects a more precise understanding of individual needs, targeting therapy and care to meet those needs.?

Thinking beyond medicines

True PHC involves more than just medicines; it uses a combination of treatments, data services, devices, at-home-monitoring and new technologies and wearables. In ophthalmology, the potential impact of PHC is huge for people with conditions such as neovascular or ‘wet’ age-related macular degeneration (nAMD) and diabetic macular edema (DME), which result in some of the highest rates of vision loss globally. Over the last decade, these conditions have been managed with treatments that target a protein called vascular endothelial growth factor (VEGF), as the VEGF pathway is key to the development and progression of retinal conditions. These ‘anti-VEGFs’ are a great example of targeted treatments that have had a real impact on improving vision outcomes. Additionally, the dosing schedule and frequency of anti-VEGF injections can be adapted (within certain limitations) based on how people receiving the treatment respond – so there is a small element of personalisation currently possible. However, for a variety of reasons, in the real-world setting and despite the best efforts of ophthalmologists, people with these conditions still continue to lose their vision.

More needs to be done to meet the needs of people living with ophthalmic conditions. For me, the solution is PHC. We need to look beyond medicines that target a single pathway and continue innovating to be able to accurately identify the right treatments for the right people, and then continuously monitor response and disease progression. This will allow us to provide a personalised approach at every step of the patient journey.

A vision for the future

So, what could PHC in ophthalmology look like? Precise diagnostic testing could allow ophthalmologists to analyse the disease-related pathways active in an individual’s condition and select a treatment approach tailored to these specific pathways. This may include treatments that combine different biomarker targets; for example, VEGF alongside a second, or even third pathway. My hope is that in the future there will be a broader choice of treatments available for retinal conditions, and that this, coupled with more specific diagnostic testing, would allow us to match the right person to exactly the right treatment.

The next step, continuous monitoring, could allow for a feedback loop ensuring optimisation of care for people living with low vision. By understanding and tracking how an individual’s condition is responding to treatment and progressing (or not!) over time, ophthalmologists would be able to adjust the treatment regimen to maximise impact and outcomes. Imaging systems like optical coherence tomography now enable us to see disease activity and predict disease progression in a way we couldn’t before, and I expect future innovations will be even more impactful. Additionally, at-home monitoring systems, including wearable monitors, will be able to detect changes in vision and disease progression in real-time, alerting individuals and ophthalmologists of key changes hopefully before any symptoms develop. These innovations are possible thanks to artificial intelligence and machine learning and will increase the speed and accuracy at which we can review clinical data, in a way that is impossible to replicate via manual review1.

PHC has been a priority for Roche for the last decade and we have already seen some amazing leaps forward in other disease areas; Oncology has seen huge success in diagnostic testing, whilst at-home monitoring has proved effective in Neuroscience, particularly in multiple sclerosis. We are working hard, alongside our partners in the ophthalmology community, to bring this approach to people living with vision loss. The future of ophthalmology is bright, with innovations set to reduce vision loss around the world, with lower treatment burden, fewer side effects, better outcomes and increased patient satisfaction. It is my hope and belief that in the future, PHC will mean that we not only prevent vision loss, but perhaps even enable vision gains.

References

[1] Kapoor, R et.al. Artificial Intelligence and Optical Coherence Tomography Imaging. Asia-Pacific Journal of Ophthalmology: March 2019 - Volume 8 - Issue 2 - p 187-194; 10.22608/APO.201904.