50 years of visionary innovation: Leading ophthalmologists reflect on the field’s greatest breakthroughs

In honor of Ophthalmology Times’ 50th anniversary, we asked a panel of leading ophthalmologists and optometrists across subspecialties to reflect on the most transformative innovations in the field over the past 5 decades. From diagnostics to therapeutics, surgery to gene therapy, the insights reveal just how far ophthalmology has come—and hint at an even more promising future.

Diagnostics that changed the game

One theme many experts echoed was the revolutionary impact of imaging technologies. Optical coherence tomography (OCT) came up repeatedly as a clear front-runner. “OCT has given us an entirely new insight into retinal diseases,” said Oleg Alekseev, MD, PhD, highlighting its noninvasive, information-rich nature. Jessica Steen, OD, FAAO, called it a key factor in fundamentally altering how clinicians assess posterior segment diseases. Additionally, Alcina Lidder, MD, pointed to new parameters such as the Bruch membrane opening minimum rim width (BMO-MRW) as an exciting advancement in glaucoma diagnosis.

Beyond OCT, Sherrol Reynolds, OD, FAAO, emphasized the rise of multimodal imaging—such as optical coherence tomography angiography (OCT-A), en face imaging, and wide-field imaging—as tools that detect disease earlier and improve patient engagement and monitoring. Nita Valikodath, MD, MS, celebrated handheld and combined imaging tools that are expanding retinal care in pediatric and general settings alike.

Therapeutics that preserved sight—and lives

On the treatment front, anti-VEGF therapy emerged as a life-changing innovation. “We used to just watch people go blind,” said Geeta Lalwani, MD, who, like Ollya Fromal, MD, and others, praised the dramatic improvement that anti-VEGF injections have brought to retinal disease management. Kelly Donovan, MD, credited anti-VEGF in tandem with OCT for revolutionizing diagnosis and treatment.

In glaucoma, the introduction of MIGS (minimally invasive glaucoma surgery) was considered transformative. Specialists such as Shivani Kamat, MD, and Lucy Q. Shen, MD, emphasized how MIGS has filled a critical therapeutic gap, offering effective, low-risk options for earlier intervention and improved quality of life.

Lana Rifkin, MD, spotlighted systemic therapy advances in uveitis, particularly for pediatric patients, noting how these treatments have dramatically reduced vision-threatening complications. Tania Tai, MD, reminded us of the earlier milestones such as laser trabeculoplasty, which paved the way for in-office, first-line glaucoma treatment.

Surgical advancements and precision tools

Cataract surgery underwent a transformation of its own, thanks in part to Charles Kelman, MD’s development of phacoemulsification. As Amy Zhang, MD, and Bonnie Henderson, MD, explained, the shift from large-incision procedures to modern phaco techniques brought safety, precision, and faster recovery to patients. Additions such as femtosecond lasers and premium IOLs (intraocular lenses) turned routine procedures into opportunities for spectacle independence, as Eva Kim, MD, described in her “cataract surgery plus” approach.

Retina specialists also celebrated surgical milestones. Laxmi Devisetty, MD, described how advances in managing retinal detachments and diabetic retinopathy have not only preserved vision but also improved patient quality of life and family dynamics.

The genetic and biologic frontier

Gene therapy is already reshaping ophthalmology, particularly for inherited retinal diseases. Mike Farkas, PhD, and Oleg Alekseev, MD, PhD, credited adeno-associated virus–based gene therapies and treatments such as Luxturna for opening new therapeutic frontiers. “It’s absolutely the biggest breakthrough,” said Alekseev, noting its role in treating RPE65-related degeneration.

Biologic advances were not limited to the retina. Carol Karp, MD, cited the use of topical interferon for ocular surface tumors and the remarkable strides in endothelial transplantation as equally meaningful for cornea and external disease care.

Looking forward: Artificial intelligence and patient-centric care

Several clinicians pointed to artificial intelligence (AI) as the next frontier. Majda Hadziahmetovic, MD, foresees AI playing a critical role in disease prediction and clinical trials. Sharon Fekrat, MD, FACS, FASRS, envisioned an integrated future where smartphone-based imaging, cloud diagnostics, and AI-driven treatment plans streamline care—and possibly even bring the robot surgeon to the patient.

Importantly, the last 50 years have also seen a shift toward a more holistic, patient-centered philosophy. Ashley Wallace Tucker, OD, FAAO, FSLS, applauded the field for improving the quality of life for patients who once had few options. The FDA approval of a treatment for dry macular degeneration, she said, is just one example of how ophthalmology continues to provide hope where there was once only watchful waiting.

A future in focus

If one thing is clear from these reflections, it’s that the past 50 years of ophthalmology have been marked by remarkable progress—and the next 50 promise even more. As Bonnie Henderson, MD, put it, “We are such a technology-driven field. Looking back at where we were, and forward to where we’re going, it’s an exciting time to be in ophthalmology.”

From imaging to intervention, surgery to systems-level innovation, the field continues to sharpen its vision for clinicians and the patients they serve.