Last year reminded us that predicting the future is tough. Who would have thought 2020, the “Year of Vision,” would have been the “Year of Virus” instead? But the exercise in being prepared for what’s likely to come in a new year is still worth the effort, as it can position optometry for great advancement. 

So, what’s likely to occur in 2021?

1. Vaccines will bring us back to pseudo-normalcy. With two approved and a third on the way, expect the pent-up demand for socialization to manifest. Patients who’ve been putting off routine care will return. A note of caution: continue to follow the COVID guidelines you’ve developed. The long-term consequences of SARS-Cov-2—potentially impairing the heart, lungs and/or CNS—are unfortunately significant. Don’t let your guard down, but be ready for a return to normal patient volumes and even increased demand for in-office procedures (e.g., thermal MGD treatments), high-end optical and contact lens requests.

2. Eyedrops will tackle presbyopia. Allergan/Abbvie’s pupil modulation pilocarpine drop for increasing depth of focus, the first of many topical agents, will likely see approval in 2021. Soon to follow will be Orasis’s low-concentration pilocarpine. One will have greater duration of effect but possibly more brow-ache or burning on instillation, and the other may have a low adverse event profile but could require more frequent dosing. At least five more companies are working on drops for presbyopia, including a lens softening agent being studied by Novartis. 

3. Blepharitis hits the big time. Common but highly underdiagnosed, blepharitis is on track for a 2022 release of the first medication in recent times with an indication specific to it, a drug from Tarsus Pharmaceuticals. The anticipation of a drop for this common disease reminds me of when Restasis was approved for dry eye over 18 years ago. It’s a market that was under-diagnosed by about 75%, had traditionally been managed with palliative therapies, and relatively little was understood about effective care strategies until it was severe. 

To prepare for the drug’s eventual release, ODs in 2021 should begin to increase their focus on the eyelids during exams. Have patients look down while in the slit lamp and scan the base of the lashes for collarettes, then look closely at the lower eyelid lashes for signs of debris extruding in and around the lash follicle. 

4. Pharma takes another swing at dry AMD. Though other drugs have failed, there’s cause for optimism about two new complement inhibitors effective against geographic atrophy aiming for late 2021 or early 2022. Existing office tools for monitoring, such as dark adaptometry, could be augmented by a bio-photonic hand scanner from Pharmanex that measures carotenoid levels in the skin as a surrogate for retinal status. Sunglasses, HVEL-blocking lenses or screen protectors, and healthy living are all likely to help patients with AMD. Monitoring for wet AMD with OCT in the office and at-home monitoring systems are critical steps too. 

Recent Approvals Loom Large

The new therapeutic for ptosis, Upneeq (Osmotica), will be significant in 2021. Patients with mild-to-moderate ptosis are commonplace but many ODs are hesitant to recommend blepharoplasty. Other than the recent alpha-2 AR agonists (Lumify, Bausch + Lomb) for eye whitening, rarely have I seen such a ‘wow’ response from patients. Strong word of mouth has increased patient referrals dramatically. 

The other recent approval, Eysuvis (Kala) for short-term treatment of dry eye, brings an on-label indication to the familiar practice of  using loteprednol to clamp down on inflammation. 

Finally, I expect 2021 will be significant for Oxervate (Dompé), which completely resolved neurotrophic keratitis from persistent epithelial defects or ulcers in 72% of patients. Biologics like amniotic membranes, cytokine extract drops and autologous serum will continue to grow as well. 

A new year and new opportunities are upon us. Vaccines with over 94% effectiveness are around the corner and, with it, 2020 will be a once in-a-century memory. Recovery beckons.

Dr. Karpecki is medical director for Keplr Vision and the Dry Eye Institutes of Kentucky and Indiana. He is the Chief Clinical Editor for Review of Optometry and chairman of the affiliated New Technologies & Treatments conferences. A fixture in optometric clinical education, he provides consulting services to a wide array of ophthalmic clients. Dr. Karpecki’s full disclosure list can be found here.