AI and Gene Therapy as the Next Frontier

The use of artificial intelligence (AI) and taking a ‘cross-sciences’ research approach holds the key to unlocking better future treatment pathways for uveitis, according to Andrew Dick MD.

He said uveitis is now on the cusp of achieving major further treatment progress in terms of sustained disease control with fewer systemic side effects. This technique will take an increasingly individualised treatment approach, using more precisely targeted agents to treat earlier detected disease and eventually introducing gene therapy into uveitis treatment protocols.

Evolution of treatment

“Despite being a leading cause of preventable blindness, uveitis remains underdiagnosed and undertreated,” Professor Dick said. “However, we have made significant inroads (treatment-wise) in the last two decades.”

Historically, treatment for uveitis has relied heavily on the use of corticosteroids—but these carry the risk of both short-term and long-term side effects and increased morbidity and mortality rates, he noted.

“We know steroids are fantastic at inducing remission of acute inflammation, but you shouldn’t have patients on them for longer than three months as they start accruing side-effects, short term with change of mood and looks. Furthermore, the longer-term data is deeply worrying on cardiovascular, diabetes, and osteoporosis risks, as well as increased glaucoma and cataracts.”

However, increased disease understanding, particularly around cytokine inflammatory pathways, and recent advancements in treatment have significantly improved outcomes in uveitis. The use of disease-modifying antirheumatic drugs as first-line therapy, as well as biologic therapies (e.g., anti-TNF drugs such as adalimumab) for patients with severe or recurrent cases of uveitis has proven highly effective. While these treatments mark a significant step forward, ensuring global access, Prof Dick acknowledged optimising treatment protocols for the best responses and predicting non-responders remains a challenge.

“There has certainly been a lot of progress [but] there is a lot more to do. Among the key things we need to do [is] identify patients [who] are going to fail current very successful treatments, particularly anti-TNFs,” he told EuroTimes. “We know about 30–40% of patients do not respond adequately to anti-TNF therapies, but why is this? We need to know from the get-go who those patients are and have the necessary biomarkers to predict treatment response.”

Prof Dick and others are currently working on identifying the molecular and cellular signature driving each case of uveitis disease. “If we can find that, then we could offer them earlier better treatment, so they don’t fail their first treatment.”

His talk stressed the importance of a tailored treatment approach specific to the cause of the inflammation driving the uveitis, as different subtypes require distinct management strategies. While non-infectious uveitis often involves immunosuppressive medications to control inflammation, infectious cases must be treated with targeted antimicrobial therapies.

“By tailoring treatment approaches, we can significantly decrease the likelihood of vision loss, which is the most serious potential outcome of untreated eye inflammation,” Prof Dick said.

The need for a multidisciplinary approach

Prof Dick also strongly advocated a multidisciplinary approach to managing uveitis, as it is frequently linked to underlying systemic diseases. Collaboration between ophthalmologists, rheumatologists, and infectious disease specialists is essential for delivering comprehensive care and improving earlier detection and targeted treatment of uveitis.

Regarding research, he highlighted the advantages of a ‘cross sciences’ approach to tackling the remaining uveitis challenges.

Prof Dick is a co-investigator on CLUSTER, a consortium between four UK institutions combining the disciplines of immunology, clinical, genomic medicine and bioinformatics, and AI through computer science to define distinct ‘endotypes’ or ‘strata’ in juvenile idiopathic arthritis (JIA) uveitis, reflecting treatment response and disease course.

“Now we are engaging much more with computational biologists and mathematicians and bringing in deep learning and artificial intelligence because we need to unravel a huge amount of data—patient or biological data—that we are getting from the lab or patient.”

Beyond the ongoing development of “far better targeted treatments,” the next frontier of uveitis treatment will be gene therapy, Prof Dick explained. Ongoing research aims to refine vector designs, delivery methods, and patient selection criteria to maximise benefits and minimise risks.

“We are pushing really hard,” he said. “We are now in the process of developing a human-ready gene therapy and will see where we get to. There have been some setbacks, but we are close.”

With all of these ongoing advancements, Prof Dick concluded the future is bright for uveitis treatment.

Prof Dick presented the annual Mooney Lecture at the 2025 ICO annual conference in Kilkenny, Ireland.

Andrew Dick BSc, MBBS, MD, MRCP, FRCS, FRCP, FRCOphth, FMedSci is Director of the Institute of Ophthalmology at University College London and Professor of Ophthalmology at the University of Bristol, UK. A.Dick@bristol.ac.uk