Long-Term Trends in Ophthalmology

It is fun to look back at how the specialty of retina has changed, even over the recent past. One way to do this is to look at the archived versions of the American Academy’s Subspecialty Day meetings. The 2000 Retina Subspecialty meeting started with a 2 hour 40 minute section devoted to photodynamic therapy. This was followed by a 1-hour point-counterpoint section in which, among many other talks, I debated the “con” side of radiation for choroidal neovascularization (CNV). This came on the heels of a study we published showing radiation did not favorably affect CNV. The morning was finished by a short section on controversies of submacular surgery. (In 2017 we rarely use photodynamic therapy except for some cases of polypoidal choroidal vasculopathy, we don’t use radiation at all, and we have found intravitreal injections of anti-vascular endothelial growth factor (VEGF) agents overall seem much better than any surgical approach.)

Refreshed from lunch, attendees in 2000 were treated to a 1 hour 15 minute session about retinal translocations, also not done any more. This was followed by a 20 minute session about retinal stimulation by Mark Humayun, MD, PhD, who eventually developed the Argus II implant, now in use today. Next, there was a diabetes section in which the ETDRS data was subject to additional investigation, followed by a panel on diabetic retinopathy management. Because of the era, that meant laser photocoagulation, which is not used that much anymore. The first day finished with a risk management section, and unfortunately this is still a major concern of retinal surgeons.

The next day started with a session about controversies in macular hole surgery, but that time was essentially devoted to how to peel the internal limiting membrane (ILM), something we do (probably unnecessarily in many patients) today. This was followed by a series of talks concerning tamponade agents for macular hole surgery. Next came a session, Complicated Retinal Detachments 2000, featuring many of the same speakers that would be in a similar session today. The day was completed with sessions devoted to management of vascular and inflammatory disease in a largely pre-intravitreal injection era and so had two talks about vitrectomy for uses that we no longer do, and last but not least, retinal imaging. In that section was a pro/con debate about film versus digital photographs. This was not a trivial discussion at the time because digital imaging was not good, but was expensive. To put this into perspective in the year 2000 the revolutionary digital single lens reflex camera, the Nikon D1, had 2.74 megapixels (!) and only cost $5000.

So 17 years after a cutting edge meeting, we do almost nothing the same. Some of the surgical principles remain, only performed with smaller instruments, but many of the best treatments and concepts in treating vitreoretinal disorders have disappeared. The 2017 Retinal Subspecialty meeting was exciting and educational. Given the rate of change in science and medicine is increasing, one can come to the conclusion that in 2034, the 2017 Retina Subspecialty meeting will seem antiquated.

- Richard F. Spaide, MD