In the 19th-century, Charles Dickens considered the duality of simultaneous situations to write his famous line, “It was the best of times; it was the worst of times.” Though he meant this regarding the French Revolution, this concept is applicable to our current times in retina.

To illustrate the double-edged swords that exists in our field, consider the following:

• Remarkable imaging technologies that directly impact the patient, but come with five- and six-figure price tags that our practices must shoulder
• Work environments that streamline patient care; however, aspects of these environments wear clinicians down
• Ocular medications that have revolutionized the management of eye disease, but are priced at very high levels that may impact our practice operation and pricing of drugs in the future
• A greater number of effective oral therapies to treat systemic disease; however, this also increases the knowledge burden on eye specialists due to possible ocular toxic effects
• Refractive therapies that benefit patients (such as sew-in-IOLs) that are becoming increasingly popular but often require retina specialists to learn about technologies outside of the retina landscape.

The articles in this issue of Ophthalmology Management have been selected for a singular reason: to generate thought. We encourage readers to take a step back, take a long look and see where we are headed.

The following deserve a long look: articles on retina drugs, devices and their benefits to providers and patients – but at what cost?

Veeral Sheth, MD, MBA, takes the 30,000-foot view of retina medications’ costs; an in-the-trenches view is provided by interviews with two senior administrators, Shawn Harkey and Albert Castillo.

Liliya Golas, MD, Dimitra Skondra, MD, PhD, et al. provide an overview of a fascinating new technology called intra-operative OCT.

Carl Danzig, MD, and Jorge Fortun, MD, review their experience and provide a summary of the NGENUITY 3D visualization system for retinal surgeons.

Charles C. Wykoff, MD, PhD, discusses our work environment and requirements to make a retina practice run smoothly.

Other articles provide an update on retinal diseases, drugs and new technologies that we use to manage our patients. Another discusses the effect of systemic diseases and drugs on the retina.

Dilraj Grewal, MD, reviews current advances in both medical and surgical management of proliferative diabetic retinopathy.

Kamran Riaz, MD, provides a summary of those IOLs available for managing the refractive aspects of the eye and discusses various sew-in-IOL options.

Michael T. Andreoli, MD, and William F. Mieler, MD, argue that retina surgeons must be cognizant of the effects of systemic medications on the eye as some commonly used medications can cause ocular toxicity.

Dilsher S. Dhoot, MD, reviews surgical and nonsurgical options for managing vitreomacular traction.

We cannot minimize the turbulence that marks contemporary retina practice — hosts of important advances in the field come with troubling potential problems. However, with diligence, education and awareness, we can determine what direction the present will take, and work towards making this the best of times. OM

Seenu M. Hariprasad, MD, is Shui-Chin Lee Professor of Ophthalmology and Visual Science, chief of the Vitreoretinal Service, and director of Clinical Research at the University of Chicago School of Medicine & Biological Sciences in Illinois. His financial disclosures are on page 52.