Recent years have witnessed tremendous progress in vitreoretinal surgery. The treatment of vitreoretinal diseases has increased enormously and its related indications expanded widely with the contribution of the emerging novel technologies, methods, equipment and new ideas. Attaching importance to minimally invasive surgery, application of auxiliary drugs, development of improved equipment and surgical technique were the main features. Further basic and clinical research is necessary to promote innovation and development of vitreoretinal surgery in China to keep pace with and surpass advanced technology.
Most fundus diseases leading to irreversible blindness are associated with genetic variations. Some sequence changes directly cause retinal diseases while others lead to a higher susceptibility to environmental insults common in daily life. Studies of genes related to fundus diseases will lead to a revolutionary change in the prevention and treatment of irreversible blindness. Application of high throughput nextgeneration sequencing and exome capture techniques will greatly enhance our ability to elucidate genes responsible for fundus diseases. With such technical and analytical advances, we are likely to see continuing and accelerating progress in the genetic study of fundus diseases, particularly in those fields requiring collaborative study of common fundus diseases using large cohorts of samples. The translational clinical application of understanding about these newly identified genes responsible for fundus diseases is also increasing in promise. Thus, strengthening current genetic studies of fundus diseases in both of these areas will make a valuable contribution to the prevention and treatment of blindness in both the near and especially the distant future.
Anti-vascular endothelial growth factor (VEGF) drugs have become the firstline medications for the treatment of choroidal neovascularization (CNV). Its efficacy and safety have been confirmed by evidence-based medicine and a large number of clinical studies. However there are several issues need to be discussed before reaching a consensus for the clinical application of anti-VEGF drugs. These issues include, but not limited to the individual treatment regimen for different CNV lesions, the best anti-VEGF drug regimen, the indications and schemes of combination therapy, the factors affecting the efficacy, the potential risks of systemic and local deliveries. How to establish a reasonable personalized regimen of anti-VEGF drugs is the 1st issue need to be explored. Ranibizumab will come into China market soon. We need utilize the existing evidence-based medical research findings; take our advantages of rich resources of patients to investigate those issues to further promote the anti-VEGF applications in China.
With the rapid development of ophthalmic imaging methods, there are many ways of examination in the diagnosis and treatment of fundus diseases, such as FFA, ICGA, FAF, OCT and emerging blood vessels by OCT angiography in recent years. Multi-model image can understand the changes of anatomical structure and function of different levels and parts of the fundus from different aspects. A variety of imaging examinations are combined and complemented each other, which makes us have a further understanding of the location and pathological changes of many fundus diseases. But at the same time, the emergence of multi-modal images also brings a series of problems. How to standardize the use of multi-modal imaging platform to better serve the clinic is a problem that ophthalmologists need to understand.
The pathogenesis of polypoidal choroidal vasculopathy (PCV) is still controversial. More evidence of clinical and basic research is needed to distinguish PCV from an independent disease to a subtype of age-related macular degeneration. Not only that, there are also many puzzles in the diagnosis, treatment options and prognosis of PCV. In addition to these common problems, we also face a large population with risk factors, a large number of PCV patients with multiple and complex challenges in China. There is a long way to go to reduce the damage effects of PCV on visual function. To fulfil this goal, we need make full use of the huge resources of PCV patients and turn these challenges into opportunities, and contribute the improvement of diagnosis and better understanding of PCV pathogenesis.
For the past few years, artificial intelligence (AI) technology has developed rapidly and has become frontier and hot topics in medical research. While the deep learning algorithm based on artificial neural networks is one of the most representative tool in this field. The advancement of ophthalmology is inseparable from a variety of imaging methods, and the pronounced convenience and high efficiency endow AI technology with promising applications in screening, diagnosis and follow-up of ophthalmic diseases. At present, related research on ophthalmologic AI technology has been carried out in terms of multiple diseases and multimodality. Many valuable results have been reported aiming at several common diseases of ophthalmology. It should be emphasized that ophthalmic AI products are still faced with some problems towards practical application. The regulatory mechanism and evaluation criteria have not yet integrated as a standardized system. There are still a number of aspects to be optimized before large-scale distribution in clinical utility. Briefly, the innovation of ophthalmologic AI technology is attributed to multidisciplinary cooperation, which is of great significance to China's public health undertakings, and will be bound to benefit patients in future clinical practice.
Optical coherence tomography angiography (OCTA) is a new diagnostic technique in recent years based on the optical coherence tomography. It is one of the fastest developing imaging examinations in ophthalmology. Compared with the classic diagnostic methods of fundus fluorescein angiography and indocyanine green angiography, OCTA show the ability to reveal blood flow non-invasively. With the development of modern medical detection technology, the requirement for ophthalmic diagnosis is raised, and many new measurement methods begin to apply in research and clinical, which makes the detection methods in the field of ophthalmology more accurate and comfortable. OCTA is a novel and noninvasive flow imaging technique, and it has the advantages of high resolution, fast scanning, as w ell as quantifying blood flow. Meanwhile, this technique can not only qualitatively analyze the shape of ocular blood vessels, but also be able to measure the ocular blood vessels and blood flow non-invasively, as well as to assess the depth of lesions. At present, with a wide clinical application in ophthalmology, OCTA still has its own superiority and weakness, but with the development of technology. It is believed that the OCTA will be expected to replace the relevant invasive examination methods and become a new tool for ophthalmic imaging.
There are over 8 million blind patients in China, 1/3 of them are suffered from retinal degeneration diseases. Stem cells transplantation can delay the photoreceptor cell degeneration or replace the dead photoreceptor cells, provides hopes for these patients. How to make enough seed cells is the major barrier for cell therapy. Good seed cells should be safe and with great pluripotency, and can be made from a wide range of sources, easy to be standardized and industrialized. Seed cells made from three-dimensional embryonic stem cells cultures can reach the above criteria, thus three-dimensional embryonic stem cell culture is a new strategy for making seed cells for cell treatment of blind diseases.
Pathological myopia is one of the most challenging clinical diseases in the field of ophthalmology. The accurate definition, standard classification, disease evolution mechanism and disease prevention and treatment strategies are still under investigation. The development and application of artificial intelligence provides a powerful tool for the analysis of pathological myopia related data. More and more accurate data information is obtained in the clinical work and clinical research of pathological myopia through the standardized collection and acquisition of the fundus image data, the automatic segmentation and quantitative analysis of the fundus physiological structure, the automatic detection and analysis of the pathological myopia classic lesions and the clinical diagnosis and treatment decision aid, which helps ophthalmologists to understand the pathogenesis and evolution of pathological myopia.
Laser photocoagulation has played an important role in the treatment of fundus diseases. Although anti-vascular endothelial growth factor drugs have been widely used in recent years and have gradually become the main therapy for some diseases, it still cannot substitute laser photocoagulation. A combination of anti-vascular endothelial growth factor and laser photocoagulation may optimize the treatment management and improve efficacy. With the development of technology, new laser equipment will certainly continue to appear and move towards minimally invasive automation and intellgentialization. Therefore, it is necessary for us to understand the current situation and trend of laser therapy in order to serve our patients better.