In the early 1990s when I applied for a surgical retina fellowship, the results of two multicenter trials designed to test the efficacy of subfoveal laser photocoagulation in new and recurrent choroidal neovascularization in AMD were reported. This reaffirmed my decision to become a surgeon and confirmed my impressions of the huge gap between surgical and medical retina. After all, having given up hope for maintenance, let alone improvement, these trials advocated coagulating the fovea to give patients a smaller scotoma two years later. Medical retina seemed futile and hopeless, while surgical retina seemed exciting and sexy.

My, how things have changed in two decades.

IN THIS ISSUE

In this month’s retina issue, you will get a synopsis of the “around the corner” anticipated drugs for diabetic macular edema, diabetic retinopathy and neovascular AMD; the potential for a “not too distant future” game changer in gene therapy; the ability to diagnose and detect disease earlier with advances in imaging; and the continued need to treat the everyday problems of floaters, which is undeniably relevant because of their prevalence but equally controversial because of their perceived banality.

WHAT LIES AHEAD

Despite this progress, many challenges remain: even under the best of circumstances, only a minority of patients regain driving vision (20/40 or better), there is an increasingly disturbing disconnect between clinical trials and real life due to treatment requirements that are not sustainable, and long-term outcomes are disappointing despite short-term gains. New treatment modalities will need to address these shortcomings. If we can continue the pace of progress of the last two decades, I am confident that we will overcome these challenges.

SPECIAL THANKS

The articles in this month’s retina issue are designed to inform and excite the reader. The authors of these articles represent the mind and spirit that resurrected and rocketed medical retina in the last two decades.

I am thankful for colleagues who are “disruptors,” because without them there would be no innovation. I am equally thankful for colleagues who insist upon the utmost scientific scrutiny, because without them there would be no validated patient care.

It is the harmony and balance of these two groups that has ignited the arguably greatest medical revolution in the past two decades: a revolution in retina. OM

Pravin U. Dugel, MD, is managing partner at Retinal Consultants of Arizona in Phoenix and clinical professor of ophthalmology at the USC Roski Eye Institute, Keck School of Medicine in Los Angeles.