The subspecialty and practice of retina is rapidly evolving. There are small evolutions, and there are large ones. The large ones are more obvious — new drug approvals, for example, and new imaging and surgical equipment. They make an immediate impact and create a buzz.

But what are the small ones? Small evolutions are usually about quality improvement and changes we make in the daily management of our patients over time. These are things that we do in our clinics and operating rooms on a day-to-day basis. Those of us who have the privilege of working around a group of colleagues in a collaborative environment are able to share best practices on a daily basis, so that we can learn and evolve together to provide the best outcomes for our patients. That’s why it is important to regularly meet and discuss the things we do and why we do them. We should discuss what is dogma and what needs to change. Without such discussions, clinical practices and practice patterns can stagnate.

In this issue, we put forth several topics for consideration. The urgency of retinal detachment surgery (page 30) is a topic to be discussed openly, so we can set and shape community standards. Over the past few decades, we have noted that retinal detachment surgery is being done on a less urgent basis. How and why did this evolution happen? Do outcomes differ? What does the data show? What is urgent and what is emergent? Trends have shown that vitrectomy surgery is being performed more frequently for repair of primary rhegmatogenous retinal detachments (Although, let’s please not overlook the role of the primary scleral buckle).

With this trend, viewing systems, equipment and instrumentation have become more advanced and more refined and require a sophisticated, knowledgeable operating room team to work together and troubleshoot. With 3-D heads-up surgery (page 12), this is even more important, and the whole surgical team is watching and engaged. We obtain the best surgical outcomes, then, with a combination of factors that includes having the right people on our teams at the right time.

We are fortunate to have an array of imaging to choose from in the office. But what do we use? What do we order for each disease? We address these questions — and their possible answers — in this issue (page 18). And what about those rare diseases such as Stargardt (page 24)? What are we currently doing, and what do we tell patients?

Finally, we discuss the topic of how to start clinical trials in your practice (page 42). However small or large your practice, our colleagues have shown us that it is possible to be successful at clinical trials. Patients appreciate having their specialist on the cutting edge, with possible future treatments offered at an early stage. OM

Sophie J. Bakri, MD, is associate professor of Ophthalmology, Vitreoretinal Diseases and Surgery at Mayo Clinic in Rochester, Minn.