In 10 years, what ocular drug delivery or new technology will we be using? In this issue of Retinal Physician, we report on several new technologies, including drug-delivery technologies that may change the way we practice retina. For example, home monitoring may revolutionize management of retinal vascular diseases. The use of home optical coherence tomography (OCT) in clinical trials is already a reality, and hopefully an FDA approval is forthcoming that will facilitate individualized treatment regimens and improve real-world outcomes. In the future, therapy with sustained-release drugs in various polymers may incorporate home OCT to help determine reinjection timing. Polymer technology may allow us to go up to a year between visits.

Stem cell technology has rapidly advanced, with tissue replacement studies under way in many diseases, including late dry AMD. Just as important, we look at the risks presented by unregulated fee-for-service stem cell centers.

In 10 years, will we still need to perform dilated exams, or will OCT, widefield imaging, or some other technology obviate the need to actually look in a patient’s eyes? In the operating room, virtual reality headsets and technology improvements will allow us to perform safer and more efficient surgeries and train the next generation of surgeons faster.

Big data is allowing us to see trends and data about patient outcomes, but on a more sinister note, it also offers methods for pharma companies to home in on sites or even doctors to improve their drug utilization. Speaking of big data, artificial intelligence (AI) is all the rage right now. OpenAI’s Generative Pre-trained Transformer 4 (GPT-4) was trained with supposedly 100 trillion parameters vs 175 billion for GPT-3, so one would hope it would generate the correct response. I asked ChatGPT what retina therapy will have to offer in 10 years. Here is ChatGPT-4 chatbot’s reply: “One area of active research is the development of sustained-release drug delivery systems. These systems aim to provide a controlled release of drugs over an extended period of time, which may improve efficacy, reduce side effects, and increase patient compliance. Several sustained-release drug delivery systems are currently in development, including nanoparticles, hydrogels, and microspheres.

Another area of research is the use of gene therapy for the treatment of ocular diseases. Gene therapy involves the delivery of therapeutic genes to cells in the eye, which can then produce therapeutic proteins. This approach has shown promise in preclinical studies and clinical trials for a range of ocular diseases, including inherited retinal diseases and age-related macular degeneration.

Advancements in imaging technologies, such as optical coherence tomography (OCT) and adaptive optics, may also play a significant role in the diagnosis and treatment of ocular diseases. These technologies enable clinicians to visualize the structure and function of the eye in unprecedented detail, which may aid in the early detection and monitoring of diseases.

In summary, in the next 10 years, we may see the emergence of new sustained-release drug delivery systems, the use of gene therapy for ocular diseases, and advancements in imaging technologies that may improve the diagnosis and treatment of ocular diseases.”

Whose response do you like better? RP