Looking ahead: 2024 shaping up to be an interesting year

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It is that exciting time of the year again. Here are my top 5 predictions in ophthalmology for 2024.

1. The anti-VEGF war has begun—only the strong will survive

Having intensified since 2023, the real war will begin in 2024 between the manufacturers of all the various anti-VEGF agents. It is truly a wonderful time to be a retinal specialist, given all the options to treat retinal vascular diseases such as neovascular age-related macular degeneration, diabetic macular edema, and retinal vein occlusion. Given its unique mechanism of action of simultaneously binding and neutralizing angiopoietin-2 and VEGF-A, significant retinal anatomical benefits, and the potential of extended durability (16-week dosing), faricimab-svoa (Vabysmo) is gaining market share quickly and is becoming the premier first-line agent. I expect that trend to continue throughout 2024.

Aflibercept (Eylea HD [higher dose]) utilization will also continue to increase (especially when it achieves a permanent J-code) and I anticipate a decline in aflibercept 2 mg in what essentially will be HD cannibalizing the 2-mg population during 2024. To a smaller extent, ranibizumab biosimilars will gain some continued traction with insurance payers to capitalize on that avenue for penetration into the market. By mid- to late 2024, I would not be surprised to see an FDA-approved aflibercept biosimilar join the party as well. 2024 is shaping up to be a battle for the ages.

2. Treatment of geographic atrophy will stabilize after a roller-coaster 2023

Geographic atrophy (GA) has been the final frontier in retina medicine. As retinal specialists, we are blessed to have two FDA-approved treatments, pegcetacoplan injection (Syfovre) and avacincaptad pegol intravitreal solution (Izervay). These have provided us with great options for our patients with GA to help slow the progression of a naturally blinding disease. I foresee increased utilization of both agents in 2024 as the retina community gets more comfortable with them, and I expect additional data releases that demonstrate long-term efficacy and safety benefits in addition to functional end points for patients with GA.

3. Artificial intelligence will continue to permeate in ophthalmology

Although artificial intelligence (AI) seems to have picked up incredible momentum in 2023 in other facets of our society, there has been little penetration in the ophthalmic industry. However, I believe that will change in 2024. I expect to see incorporation of AI technology in our imaging diagnostics, surgical platforms, telemedicine, and even practice management logistical platforms such as electronic medical records. One area in particular that is key (given my No. 2 prediction) is GA lesion progression analytical models that can assess real-time growth reduction response to GA therapies. Additionally, theoretical growth prediction models based on prior GA history can assess risks and stratify them in patients with GA. This seems like an obvious application and a much-needed one in the ophthalmology community, given the unmet need of precise GA monitoring system platforms.

4. We will see a significant uptick in utilization of prescription dry eye treatments

With the recent announcement of multiple recalls of over the counter (OTC) artificial tears brands, the public is concerned over artificial tears in general. Therefore, I believe physicians (supported by preference of patients) will turn to effective, safe, heavily studied, FDA-approved medicated eye drops more than ever before and have a lowered threshold of prescribing given this scenario in 2024 and beyond. Luckily, there are several great prescription dry eye treatments out there, so they will all see tremendous demand in the new year.

5. The premium IOL will be considered the standard IOL

This is more of a subtle point, but I believe the labeling of “premium” IOLs is more marketing than reality. Multifocal, extended depth-of-focus, toric, etc, should be considered standard lenses given their superior technology, visual outcome benefits, and practicality for patients. The fact that we still call monofocal lenses the “standard” IOL is absurd. Join me and let us go into 2024 with the right terminology for the IOL world.

Bonus: Snaps Eye Shield will be the gold standard for postoperative ocular protection

I am proud to have developed the Snaps Eye Shield as a new premium postsurgical eye shield that can be easily placed or removed, and that requires no tape. The clear acrylic shield is very comfortable to wear, is highly stable on the face, provides excellent airflow, and allows easy access for examination or drops. With the improvements, I believe that the ophthalmology community can continue our work of providing patients with the valuable vision-saving procedures we offer and eliminate further postoperative discomfort and stress. My hope is that this improved device will provide patients with a safer solution and advance their recovery speed and experience. I displayed the Snaps Eye Shield at a booth during the American Academy of Ophthalmology’s 2023 Annual Meeting in San Francisco, California.

As we start the new year, 2024 is shaping up to be amazing. I look forward to keeping you updated.

Joshua Mali, MD, FASRS

E: malienterprisesglobal@gmail.com.

Mali is a board-certified ophthalmologist and award-winning vitreoretinal surgeon at The Eye Associates in Sarasota, Florida. He is also the founder and CEO of Mali Enterprises. Mali’s relevant financial disclosures include the following: Mali Enterprises (founder, CEO, owner); SNAPS (equity owner).

References

1. Mali J. Top 5 predictions for ophthalmology in 2023. Ophthalmology Times. Published online January 16, 2023. Accessed December 12, 2023. https://www.ophthalmologytimes.com/view/top-5-predictions-for-ophthalmology-in-2023

2. Mali J. SNAPS Eye Shield: creating the gold standard for postoperative ocular protection. Modern Retina. Published online September 19, 2023. https://www.modernretina.com/view/snaps-eye-shield-creating-the-gold-standard-for-postoperative-ocular-protection

3. Snaps eye shield. Accessed December 12, 2023. http://www.snapseyeshield.com