Part 5: Looking back at 50 years of innovation in ophthalmology

In celebration of Ophthalmology Times' 50th anniversary, we asked leading experts in the field what they see as the biggest innovation in ophthalmology in the past 5 decades.

Video Transcript:

Editor's note: The below transcript has been lightly edited for clarity.

Christina Prescott, MD:

So I definitely, my first thought is definitely our progress we've made in corneal transplants. I mean, it's amazing that we've been doing corneal transplants for over 100 years, but it's really only been in about the last 20 years that we've had this complete revolution in corneal transplants. I mean, for about almost 100 years, all our corneal transplants, essentially, are the vast majority were full thickness corneal transplants. And then, it's only been, it's been like this exponential change where we went from, you know, full thickness for pretty much everyone, to, you know, DALKs becoming more common, and that's still kind of slowly taking off. But really, for endothelial keratoplasty, you know, it was just like full thickness keratoplasty for 100 years, then all of a sudden, then we have DSEK, and then DMEK, and now we have cell injections. It's just this, like revolution, you know, it's kind of like an evolution that turned into a revolution. I think it's, you know, a totally new paradigm shift for our patients, which is amazing.

Christine Kay, MD:

Well definitely in the last 20 years, I've experienced anti-VEGF. So probably every retina doctor says anti-VEGF in the last 20 years. Prior to that, we didn't have that to be able to treat macular degeneration. And now, I think in the more recent last few years, sustained delivery and multi-factorial delivery and gene therapy. So I think from an inherited retinal disease standpoint, that's for mainstream disease, from an inherited retinal disease standpoint, I think augmentation, replacement gene therapy for inherited retinal disease, monogenetic disease. [In] 2017, the approval of voretigene neparvovec for RP65, that was a landscape changer. So being able to treat and replace genes for inherited monogenetic disease was a big paradigm shift in the field of inherited retinal disease.

Nimesh Patel, MD:

So in the last 50 years, it's really hard to go past anti-VEGF injections. These are medications that slow down neovascularization and retinal vessel proliferation. I think one of the reasons this has been such a major improvement or advancement is it happens to work for so many different conditions: wet macular degeneration, diabetic retinopathy, retinal vein occlusion, and one of my areas expertise is retinopathy of prematurity, and it's completely revolutionized the way we treat these patients as well. So I would say that conditions that used to be blinding conditions or require heavy laser treatments, we now have a medical treatment that can reverse and sometimes cure the condition.

Ferhina Ali, MD, MPH:

Yeah, so that is a great question. I feel very lucky to be in retina because we've seen such a sea change and paradigm shift in treatment options that are available for patients, particularly with macular degeneration. So patients used to go blind from this disease, and now they can present with vision of 20/30. We do imaging. We do injections that can allow hand in hand, both the advent of OCT imaging and our anti-VEGF therapies that allow these patients with ongoing treatment to maintain excellent vision, maintain their driving vision, maintain their livelihood in a way that 50 years ago was not possible. So I think that's really, really exciting. As a retina surgeon, small incision surgery is also been an incredibly impactful part of our treatment landscape over the past 50 years, in terms of the efficiency with which we perform our surgeries, the number of surgeries we're able to perform, sutureless surgery. All of that has been hugely influential in making kind of retina surgery really modern, efficient, and, you know, effective in a way that years ago, they were doing surgery in a very different way, and I think we're now able to do so much more. I think it's a really cool field to be a part of you.