Peppermint VenturePartners GmBH

Dr Sophia Pathai MD

As a proponent of social media to keep abreast of innovation and research I enjoyed a tweet in June 2022 by Michael Chiang, MD, Director of the National Eye Institute. He wished new residents a happy journey in ophthalmology, also sharing his perspective that 50% of what we learn will become obsolete in our career. His advice was to continuously learn how the standard of care evolves through research. This led me to reflect about innovation leaps in healthcare, with a focus on ophthalmology medtech.

Global health challenges remain but innovation leaps have moved the needle forward

The mountain of avoidable blindness remains one of the global health care challenges of our time, with more than 1.1 billion people living with vision loss.The aging population means that age-related conditions such as cataract and macular degeneration are the main stay of eye clinics, and despite an armamentarium of glaucoma therapeutics we still have many glaucoma patients who develop vision loss. At the same time, huge innovation leaps in ophthalmology have indelibly changed the way we practice. Optical Coherence Tomography, (OCT) an imaging modality used in several specialties, has truly come to prominence in ophthalmology. OCT machines are common place in eye clinics, to guide and inform treatment as ubiquitously as the chest x-ray is deployed on a thoracic ward. Yet, the prototype device was first used as late as 1993, and initially only 180 units were sold in a 3-year span. Similarly, until the beginning of the 21^st century,we were content to use argon laser to treat many retinal conditions, but the discovery of the angiogenesis pathway and subsequent development of anti-vascular-derived endothelial growth factor (VEGF) treatments delivered by intraocular injections entirely reshaped the way we treat these patients. This innovation leap in ophthalmic therapeutics stems from insights harnessed from system i can ti-VEGF use to treat tumours. A salient reminder that innovation comes not only from blue sky thinking, but from leveraging side glances into adjacent landscapes. Over the last 20 years, healthcare delivery and the patient journey have improved thanks to these innovation leaps, rather than incremental add-ons. How do we embrace disruption in medtech to keep moving the needle forwards to ensure better outcomes for patients and more efficient healthcare systems?

“Timely diagnosis will remain a cornerstone of the patient journey; if we can reach the patient early in a disease course, the outcome can be markedly improved”

Embracing the disruptive nature of MedTech as an enabler of patient care

Founders of truly disruptive technologies nearly always find their ideas spurned by the majority, happy to stay within the status quo. However, increasing pressures on healthcare systems globally, combined with society’s demand for increased accessibility and equality of care means that disruption is the critical path we must collectively forge to enable us to reach these goals. I will share some examples from ophthalmology - I believe these will be the disruptors - Diagnosis, Disruption and Delivery – to bring about the kind of change,that to Dr Chiang’s point, will lead to 50% of what we practice now transitioning to obsolescence in the next 10-15 years.

Timely diagnosis will remain a cornerstone of the patient journey; if we can reach the patient early in a disease course, the outcome can be markedly improved. Similarly, if we can monitor a patient and their condition at frequent intervals we can increase our knowledge of the disease, the effects of treatment, and gain a better understanding of the levers fortreatment uptake or changes in patient compliance. This is where remote monitoring for diagnosis and prognosis is already establishing itself as an important enabler within the patient journey. This includes modalities such as remote tests of visual acuity via smartphone apps that can detect a change in a patient’s vision, even sending a notification to the clinician to recall a patient. An internal monitor placed in the eye to measure intra-ocular pressure, where increases can be a key risk factor for glaucoma, is being assessed in clinical trials, under FDA Breakthrough Device designation, recognition of this monitoring innovation. OCT is also being transformed to a home-based handheld device, utilising AI algorithms to detect changes in the retina which could indicate the need for earlier treatment. Machine learning is also being employed to personalise treatment regimens for patients with retinal diseases, by virtue of software platforms with an excellent user experience (UX) to aid treating physicians. True disruption will occur when a therapeutic is prescribed with these kind of tech enablers, to bring about personalised medicine within the context of absolute precision.

Innovation leaps also need to place impact firmly in context. Democratization of access will be a key tenet as healthcare systems evolve. Exciting developments in allogenic cell therapy platforms for ocular and lung conditions, aim to disrupt the cell therapy ecosystem by creating products that are accessible and affordable for patients worldwide. Lasers might find their disruptive home in glaucoma, with a non-contact laser system in clinical trials, envisaged to be used as a first-line treatment for glaucoma, rather than eye drops. The technology can be deployed by all eye care professionals, not only ophthalmologists; this ease of use combined with the radical shift from a lifetime of continuous eyedrops to a few seconds of laser will introduce a new level of disruptive innovation.

Eye drops and their utility also brings me to my last area of disruption – delivery. Anyone who has tried to instil eye drops for themselves or to a child will recall how tricky this can be, with the cheek often receiving more of the product than the ocular surface. Technological advances in drug delivery include horizontal microjet dispensers that can deliver minimal amounts of medication to the eye, while maintaining similar efficacy to eyedropper treatment. As the breadth of retina therapeutics continues to increase, the need for intraocular injections shows no signs of abating. Drug delivery scientists are discovering mechanisms to deliver retinal drugs via a hybrid system of nano suspensions and dissolving microneedles as an alternative to conventional hypodermic needles used in intraocular injections.

We have just touched the surface of disruptive innovation across the patient journey. True innovation cannot occur in a vacuum, and necessitates the collaboration of entrepreneurs, strategic corporates, investors, and policy shapers to succeed. Where and how could this occur – perhaps in the metaverse within the constructs of decentralised science? I look forward to seeing you there in the not-too-distant future!