It’s that exciting time of the year again when I reveal my top 5 predictions in ophthalmology for 2026.

1. Artificial intelligence (AI) will be front and center in ophthalmology

I have been writing about AI for years, highlighting the benefits and potential applications in ophthalmology. Although considerable focus has been on the technology AI chip race and data center production in 2025—with companies like Broadcom, Nvidia, and OpenAI leading the way—we need to start looking at the actual clinical implications of AI in ophthalmology.

One particular technology that I find fascinating in this space is a home optical coherence tomography (OCT) platform (SCANLY Home OCT; Notal Vision), which could possibly be made available sometime in 2026. A unique blend of AI and telemedicine to monitor patients with neovascular age-related macular degeneration (nAMD), this technology could revolutionize how we monitor patients with nAMD and allow for precise treatment of this disease to optimize outcomes and minimize treatment burden.

I foresee tremendous opportunity in the entire spectrum of AI utilization in ophthalmology. Whether it is imaging diagnostics for geographic atrophy (GA), cataract surgery analysis platforms, or practice management tools, AI will be front and center in ophthalmology in 2026 and takes my top spot.

2. The intraocular lens (IOL) battle wages on

The IOL market is competitive to say the least, but I believe it will intensify in the year ahead. Although the IOL manufacturers like Alcon, Bausch + Lomb, and Johnson and Johnson still hold the lion’s share of sales, there are some new players that may start to get a foothold in the upcoming year.

One particular manufacturer seems to have some momentum heading into 2026 with its Light Adjustable Lens (LAL; RxSight). The ability to customize surgical outcomes postoperatively appears to be appealing to both surgeons and patients and could see a boost in 2026 in regard to demand and utilization.

3. Biosimilars continue to struggle but may find refuge with payers

Although ranibizumab biosimilars have been available for several years, they have gone through considerable changes recently. With both Cimerli and Byooviz undergoing ownership or distribution changes—Sandoz acquiring Cimerli in 2024¹ and Harrow purchasing the US rights of commercialization/distribution to Byooviz from Biogen²—and the relatively recent launch of the aflibercept biosimilar (Pavblu; Amgen) in late 2024³ it has been a rollercoaster ride for the biosimilar industry.

Although the overall uptake of these agents have been low thus far and there have been changes in strategy and implementation, it is conceivable that insurance payers will likely attempt to implement step edit therapies with biosimilars to drive down costs. Although this process has been slow to say the least, I do see a potential for this to accelerate in 2026. The branded originator molecules and next-generational anti-VEGFs—like faricimab (Vabysmo; Genentech) and aflibercept (Eylea HD; Regeneron)—will still be in great shape throughout 2026 and beyond given their efficacy, durability, and long-standing safety record.

4. Offering therapy for GA will be standard of care

GA has been the final frontier in retina medicine. As retinal specialists, we are blessed to have 2 FDA-approved treatments: pegcetacoplan (Syfovre; Apellis) and avacincaptad pegol (Izervay; Astellas Pharma US, Inc). These therapies have provided us with options to help slow the progression of a naturally blinding disease for our patients with GA.

Given the success of complement inhibition as a key mechanism of action in regard to reduction of GA disease progression, I believe that patients with treatable GA should at least be offered the option of therapy as a standard of care, presuming they are a suitable candidate. Whether or not they choose to undergo therapy is a decision that patients need to make with the support of their physician and family and friends, but they should have the opportunity to do so if they desire. It is a commitment given the ongoing intravitreal injection therapy on a regular frequency (theoretically indefinitely until we have further innovation) so certainly not a decision to be taken lightly.

This underscores the need to educate patients with GA on disease prognosis by physicians as well as ensure timely evaluation and management of this patient population given that many may still be undertreated. The days of just monitoring patients with GA have long passed and the need to be more proactive is present now in 2026.

5. A post-surgical eyeshield will be the gold standard for postoperative ocular protection

A novel post-surgical eyeshield (SNAPS Eyeshield; SNAPS) is designed for easy placement and removal without the need for tape (see accompanying photo). The clear acrylic shield is comfortable to wear, stable on the face, and provides adequate airflow while allowing access for examination or eye drops.^4,5 I was part of the team involved in the design and development of this eyeshield. The goal is to expand its availability this year for use in operating rooms and postoperative ocular care, offering patients a safe and comfortable option for postoperative eye protection.

This is shaping up to be an amazing year. I look forward to keeping you updated throughout 2026 and beyond.

Note: The opinions expressed in this article are those of the author and do not necessarily reflect the views of the publication or its editors.

Joshua Mali, MD, FASRS

E: [email protected]

Mali is a vitreoretinal surgeon at Paul Phillips Eye and Surgery Center in New Jersey.

Mali is also the founder and chief executive officer of Mali Enterprises. Mali is a stock owner with Broadcom and Nvidia; consultant to Bausch + Lomb, Genentech, Iveric Bio/Astellas, Johnson and Johnson, and Notal Vision. He has received a research grant from Notal Vision and is an equity owner in SNAPS.

REFERENCES

1. Sandoz acquires CIMERLI business from Coherus, further building biosimilar and ophthalmology leadership in US market. News release. Published April 3, 2024. Accessed January 16, 2026. https://www.sandoz.com/sandoz-acquires-cimerlir-business-coherus-further-building-biosimilar-and-ophthalmology-leadership/

2. Harrow enters into commercialization agreement with Samsung Bioepis for ophthalmology biosimilars portfolio in the United States. News release. July 17, 2025. Accessed January 16, 2026. https://harrowinc.gcs-web.com/news-releases/news-release-details/harrow-enters-commercialization-agreement-samsung-bioepis

3. Amgen Inc FQ3 2024 earnings call. October 30, 2024. Accessed January 16, 2026. https://www.pearceip.law/wp-content/uploads/2024/11/Amgen-Inc.-Q3-2024-Earnings-Call-Oct-30-2024.pdf

4. Mali J. Top 5 predictions for ophthalmology in 2024. Ophthalmology Times. Published January 30, 2024. Accessed January 16, 2026. https://www.ophthalmologytimes.com/view/looking-ahead-2024-shaping-up-to-be-an-interesting-year

5. Mali J. SNAPS Eye Shield: creating the gold standard for postoperative ocular protection. Modern Retina. Published September 19, 2023. Accessed January 16, 2026. https://www.modernretina.com/view/snaps-eye-shield-creating-the-gold-standard-for-postoperative-ocular-protection