Photo courtesy of Kevin Caldwell Photography.
Knowledge defines our professional lives as retina specialists; peer-reviewed scientific journals such as JVRD exist to evaluate and disseminate new knowledge. In fact, the mission of our Society focuses on providing a collegial, open forum for education to advance the understanding and treatment of vitreoretinal disease. Our Foundation is the charitable arm of ASRS, dedicated to improving our patients’ quality of life through public education and awareness.
These complementary missions have driven the process of developing an indexed, peer-reviewed journal that enables broad access by ASRS members and the entire retina community. For me as the editor-in-chief, JVRD represents a major milestone in our Society’s academic drive, recognizing the importance of documenting advances presented at our Annual Meeting and throughout our specialty.
To develop best practices, the pursuit of new knowledge requires a rigorous scientific focus; new insights often arise directly from ongoing patient care. This quest includes evaluating novel treatments either in clinical practice (often as case reports or retrospective reviews) or through clinical studies. The process also requires meticulously designed clinical trials—particularly randomized clinical trials—closely followed by analysis of treatment results and ultimately reporting the data. Virtually all data is presented initially in 2 unique forums—either a major retina meeting or a peer-reviewed scientific journal such as JVRD.
Retina patient care has undergone remarkable advances in recent years, thanks to a deeper understanding of the intricate workings of the retina and the availability of innovative technologies. At the heart of these advances lies the power of knowledge, driving improved diagnosis, treatment, and management of retinal conditions.
Knowledge is a potent weapon against retinal diseases, especially when it comes to early detection, accurate diagnosis, and targeted treatment. Early detection is vital in virtually all retinal diseases but the big 3 remain age-related macular degeneration (AMD), diabetic retinopathy, and retinal detachment, where early intervention can preserve and often restore vision. Through ongoing research and education, retina specialists can stay up to date on these advanced diagnostic techniques and tools and deliver state-of-the-art care to their patients.
Retina patient care has undergone significant advances in treatment modalities, largely driven by expanding knowledge. Medical interventions such as antivascular endothelial growth factor (anti-VEGF) injections and steroid implants have revolutionized the management of retinal conditions like neovascular AMD and diabetic macular edema. Surgical techniques, including microincisional vitrectomy and retinal laser therapy, have evolved with the integration of cutting-edge technologies and refined surgical instruments. These advances have led to improved outcomes, shorter recovery times, and enhanced patient comfort.
We are on the cusp of the expanded use of gene therapy; the potential for stem cell research holds great promise in treating hereditary retinal diseases, but also, more broadly for AMD and diabetic retinopathy. A deep understanding of retina genetics and molecular pathways has paved the way for groundbreaking therapies, offering hope to patients with conditions previously deemed untreatable.
Knowledge empowers our patients to actively participate in their own care, fostering a sense of being in control while improving treatment adherence. Educating patients about their conditions, treatment options, and lifestyle modifications equips them to make informed decisions and actively engage in shared decision-making with their health care providers.
By understanding the importance of having regular dilated eye examinations, adhering to medication regimens, and adopting healthy lifestyle habits, patients can better manage their conditions and optimize visual outcomes. This partnership between our profession and our patients remains one of the strongest in medicine.
Retina patient care thrives on collaborative efforts among health care professionals across various specialties. Retina specialists, ophthalmologists, optometrists, geneticists, and allied health care providers contribute their expertise to deliver comprehensive care to our patients. Interdisciplinary knowledge sharing promotes a holistic approach to retina patient care, ensuring the best possible outcomes.
In addition, collaborations between clinicians and researchers facilitate the translation of scientific discoveries into clinical practice. By bridging the gap between research and patient care, innovative therapies and diagnostic tools can be rapidly integrated into standard protocols, benefiting a broader population of retina patients.
As retina patient care continues to evolve, it is imperative that health care professionals engage in lifelong learning and research. Staying abreast of the latest research findings, attending conferences, and participating in professional development activities equip clinicians with the knowledge and skills necessary to provide state-of-the-art care.
This issue of JVRD is replete with translational knowledge. Associate Editor-in-Chief John Thompson, MD, FASRS, presents his first JVRD editorial focused on the potential negative impact of private equity in retina, while Retina Times Editor-in-Chief Joel Pearlman, MD, PhD, FASRS, presents the positives of private equity from his unique perspective. We hope these invited JVRD editorials will better educate our members on the current state and future extension of private equity. Invited editorials will continue in JVRD, helping bring focus to controversial areas in our specialty.
In this vein of health policy and practice management, Leung and colleagues present the opportunity costs of vitreoretinal surgery and evaluate the impact on drivers of clinical practice in retina and our surgical field. Duong and co-authors report advances in 27-gauge surgery and their impact on diabetic tractional detachment repair—one of our most challenging surgeries.
Choi et al discuss outcomes for symptomatic retinal tears treated with laser retinopexy, while San Martin Varela’s group discusses the evolution in treatments and the achieved outcomes for giant retinal tears treated over the last 2 decades.
Unexplained vision loss associated with silicone oil tamponade in retinal detachment repair has been a major concern; Pakravan and colleagues address the impact and potential etiologies of this outcome. Endophthalmitis associated with intravitreal injection remains our major concern when delivering vision-saving therapy, but our ability to minimize this risk remains a topic of debate. Feng et al report a potential benefit of prefilled syringes to decrease this risk. ASRS members continue to ask for the opportunity to acquire prefilled syringes, particularly with the novel therapeutic agents coming to our clinics.
A second caveat with intravitreal injections is patient discomfort; Mani et al present a randomized controlled study to limit patient discomfort by using cooled artificial tear drops (something many of us have been doing for years).
This large and varied series of original research remains a hallmark of our Journal, but we continue to include both small case series and case reports to highlight the uniqueness of cases presenting to our retina specialty community.
Three case series in this issue highlight advances in imaging and explore the impact of the COVID-19 pandemic on endogenous Klebsiella endophthalmitis. The reach of our clinical imaging continues to expand, now documenting lesions in the far periphery. Fairbanks et al present imaging findings associated with vitreous base vasculopathy—imaging that was virtually impossible to document until recently.
Scleral buckling procedures have declined significantly over the past decade; Raval et al report the benefits of chandelier illumination in managing retinal detachment. As fewer scleral buckles are performed, enhancing the procedure will be critical to maintaining excellent outcomes; this illumination approach improves visualization while potentially reducing surgical risk.
This issue of JVRD is completed by 6 case reports spanning the spectrum from bleeding in the setting of hemophilia A to Valsalva retinopathy associated with, of all things, yoga, reported respectively by Kesav et al and Parvus et al. Garg et al present focal choroidal excavation secondary to central serous chorioretinopathy in the setting of pachychoroid with choroidal neovascular membranes.
Sengillo et al report a familial exudative vitreoretinopathy-like phenotype with TUGCP6 mutation, while McNelly et al present our cover art case of pembrolizumab-induced nodular scleritis with documented resolution. Day and Finn extend this discussion of checkpoint inhibitor-associated retinopathy secondary to combination mitogen-activated protein kinase (MEK) and fibroblast growth factor receptor (FGFR) inhibition for treating metastatic pancreatic adenocarcinoma.
The constellation of findings associated with checkpoint inhibition is the perfect example of evolving systemic therapies that secondarily impact our patients’ anatomic and visual function. For many of these patients, the advances in our understanding of tumor metabolism have led to life-sustaining and life-saving therapies that now require a broader knowledge for the practicing retina specialist.
To quote Helen Keller, “Knowledge is love and light and vision.” Herein lies the reason for both our Society and its journal—JVRD.
Timothy G. Murray, MD, MBA, FASRS, FACS
Editor-in-Chief
Journal of VitreoRetinal Diseases