For decades, ophthalmology has relied heavily on structural imaging and disease monitoring. Technologies such as OCT and fundus photography have allowed clinicians to visualize retinal anatomy, while visual field testing has provided valuable information about visual function. Together, these tools have enabled remarkable precision in monitoring disease progression and remain foundational to modern eye care.

Across glaucoma, diabetic retinopathy, age-related macular degeneration (AMD), retinal vascular diseases, and optic neuropathies, a growing body of evidence highlights the importance of metabolic dysfunction, mitochondrial impairment, vascular dysregulation, tissue hypoxia, and neuronal stress in the early stages of disease. (1-12)

As a result, eye care is beginning to transition toward a more functional and metabolic understanding of ocular disease.

A New Therapeutic Landscape

This shift is becoming particularly visible in the next generation of ophthalmic therapeutics.

Emerging therapies are targeting retinal physiology through approaches that support neuroprotection, mitochondrial function, tissue oxygenation, vascular regulation, cellular metabolism, and neuronal survival.

These therapies span multiple modalities, including pharmacologic agents, photobiomodulation, neurostimulation, ischemia-focused interventions, and metabolism-targeted approaches. While these technologies differ in modality, many share a common objective: preserving or restoring retinal cellular function before irreversible degeneration occurs.

Examples include therapeutic programs from companies such as Perfuse Therapeutics (now part of Bayer), Mighty Therapeutics, Annexin Pharmaceuticals, and Tavo Biotherapeutics, as well as stimulus-based approaches, including photobiomodulation platforms such as Valeda (LumiThera, now part of Alcon) and eye-light (Espansione, now part of EssilorLuxottica), and neurostimulation platforms, including MacuMira and Eyetronic.

In many ways, ophthalmology is beginning to follow a broader trend already visible across medicine — a transition from reactive disease management toward earlier physiologic intervention and precision medicine.

The Structural Imaging Gap

This evolution also exposes an important limitation in current clinical tools.
Most standard ophthalmic endpoints remain downstream structural or functional consequences of accumulated damage, including atrophy, retinal thinning, visual field loss, and reduced visual acuity.

Yet many emerging therapies aim to modify upstream biological mechanisms occurring earlier in the disease process.

This creates a growing mismatch between what next-generation therapies aim to influence and what current clinical tools can measure.

As therapeutic innovation increasingly targets retinal physiology and metabolism, the need for modalities that provide objective functional biomarkers is becoming ever more important for diagnosis, patient stratification, therapeutic monitoring, and clinical trial development.

The Rise of Functional and Metabolic Biomarkers

The retina is among the most metabolically active tissues in the body, exhibiting one of the highest rates of oxygen consumption of any tissue, exceeding even that of the brain. (13) Its function drives tight regulatory processes that continuously balance oxygen delivery and oxygen utilization.

These physiological processes are fundamental to retinal health, yet they remain only tangentially assessable through structural imaging alone, highlighting where functional and metabolic biomarkers may play a critical role.

Among these emerging approaches, ocular oximetry enables quantitative assessment of retinal tissue oxygen saturation (StO₂), a biomarker associated with retinal metabolism and physiology.

By adding a functional and metabolic layer to retinal assessments, ocular oximetry may help support earlier physiological detection, therapeutic monitoring, longitudinal assessment of treatment response, and future precision medicine workflows.

Beyond Imaging: Toward Metabolic Ophthalmology

These developments pave the way for the most important transition to occur in ophthalmology in decades — one that extends beyond structural imaging toward a deeper understanding of retinal physiology and metabolism, with the potential to greatly improve patient outcomes through a more predictive, personalized, and mechanistic approach to disease management.

Written by the Zilia Team on June 22, 2026