All the subspecialties in ophthalmology have enjoyed breakthroughs during this past decade, though perhaps none as much as in the cornea/refractive area.
Here, I explain.
Surgery Evolves
Ten years ago, cornea surgeons did primarily Descemet’s stripping automated endothelial keratoplasty (DSAEK) for endothelial failure; “ultra-thin” DSAEK, “nano-thin” DSAEK, and Descemet’s membrane endothelial keratoplasty were not yet commonly performed. Additionally, virtually no one was performing the Descemet’s stripping only technique for Fuchs’ endothelial corneal dystrophy. (See “Assessing Fuchs’ Cataract Patients for Surgery.")
Something else to keep in mind: Our understanding of corneal topography, and its utility in identifying preoperative conditions that can lead to suboptimal postoperative outcomes, has only improved. (See “Detecting Corneal Topographic Disorders Before Surgery.")
Also, corneal cross-linking for keratoconus and post-LASIK ectasia was not available in the United States; its performance was limited to clinical trials prior to its approval in 2016.
Further, SMILE, a form of refractive corneal surgery requiring only one laser, the femtosecond laser, was just being introduced in the United States.
Finally, the Light Adjustable IOL (RxSight), which allows for final refractive adjustment after cataract surgery, was not available stateside until its approval in November 2017. (See “Implementing the Light Adjustable Lens in Practice."
Dry Eye Disease Treatments/Causes
Ten years ago, there was only one FDA-approved prescription treatment for dry eye disease (DED); there are now three.
Additionally, DED specialty clinics virtually did not exist; now they dot the country. (See “When the Trot Became a Gallop.")
Something else to consider: The concept of in-office treatments for ocular surface disease was entirely new. (See “Reviewing In-Office Dry Eye Disease Treatments."
Also, fewer Americans were diagnosed and treated for obstructive sleep apnea-hypopnea syndrome, requiring the continuous positive airway pressure and nasal mask therapy devices that are now proven to cause DED. (See “Sleeping Devices Awaken Dry Eye.”)
Underdiagnosed no More
Neurotrophic keratitis was also underdiagnosed not so long ago, perhaps because there was not yet an FDA-approved treatment for it. (See “Building a Case for Neurotrophic Keratitis.")
COVID-19 Debuts/Continues
Ten years ago, The COVID-19 pandemic was far from starting; we had no clue what was coming, nor its profound effect on all aspects of our lives, much less its ophthalmic manifestations. (See “Contending With COVID-19 Conjunctivitis.")
Change Continues
So, science marches on, as it has these past 10 years, and we and our patients are the beneficiaries. I want to thank the amazing clinicians and scientists who contributed to this issue. As Guest Editor, it has been a great honor, and pleasure to work with them. Please enjoy! CP
