COMMENTARY

Ophthalmology Breakthroughs Over the Past 20 Years

Roger F. Steinert, MD

Disclosures

June 20, 2015

A Surgical Innovation That Continues to Evolve

In 1967, the revolution in microsurgical ophthalmic medical procedures officially began with Charles Kelman's phacoemulsification method for cataract removal. This was a technically challenging and relatively low-volume procedure until roughly two decades ago.

The advantages and appeal of this surgery grew considerably when cataract removal performed with ultrasound resulted in improved outcomes. The small incision technique in phacoemulsification, combined with new implant materials, allowed cataract removal to be performed with a dramatic reduction in surgery-related morbidity and faster postoperative healing. Removal of the cataract became safer and more efficient. Just as critical, restoring vision to equal-or-better than natural levels became commonplace.

The search continues for innovative surgical techniques and technologies that not only restore distance vision but, as we see now with increasing success, can also deliver intermediate and near vision simultaneously without compromising distance vision. Other refractive issues are being addressed as well, most notably the correction of astigmatism. In many cases, patients have a greater opportunity than ever before to obtain superior vision quality without the use of glasses.

Changing the Course of Once-Devastating Diseases

The second major breakthrough over the past 20 years has been the advent of vascular endothelial growth factor (VEGF) inhibitors.

For the first time, degenerative processes in the back of the eye can be targeted directly and frequently reversed. The identification of genetically engineered agents that can be designed at the molecular level to counteract and reverse the growth of new and damaging degenerative blood vessel proliferation has changed the course of once-devastating visual diseases such as age-related macular degeneration.

These targeted therapeutics not only can arrest the progression of disease but also (and not infrequently) can reverse damage and provide at least partial vision restoration. This approach to eye disease is responsible for saving the vision of millions of elderly patients at a time when they would otherwise be faced with blindness.

Moreover, the success of this approach is stimulating intense efforts to broaden the scope of interventions, which will further combat the age-related diseases that will become more prevalent as our life expectancy increases.

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