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Provide all aspects of retinal care
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In a clinical career that spans more than 2 decades, I have witnessed some pretty amazing advances in eye care.
We have gone from contact lenses requiring long periods of adaptation to those that can be worn for a month at a time. Glaucoma therapies have advanced from multiple drugs taken four times to once daily monotherapy. Cataract surgery has evolved from an operation requiring general anesthesia, hospitalization and corneal sutures to a 15-minute outpatient procedure with consistently emmetropic outcomes. Refractive surgery, originally performed as radial keratotomy with razor blades, has transformed into a sophisticated discipline in which the cornea is sculpted with micron accuracy.
What is the common thread among these advances? They all involve the anterior segment. While it is clear we have made tremendous strides in anterior segment care, can we say the same with respect to the posterior segment?
Retina: the final frontier
In some respects the retina is like space – the last great frontier. It is true we have made significant strides in retinal care as evidenced by the success of epiretinal membrane surgery and anti-VEGF injection therapy. However, it is also true that many challenges remain, especially with respect to the macula.
Until the day where we strip away and replace a diseased macula – a la corneal transplant and cataract surgery – our emphasis remains on prevention. We manage risks, strive for early detection and treat aggressively, all in the name of preventing progression. This is precisely why optometry is so important.
As optometrists we are clearly front line providers – the entry point for many seeking eye care. In this capacity we play a large role in retinal care – a role that is increasingly technology leveraged.
Retinal diagnostic technology
For instance, for those with familial history of macular disease, we provide counseling with respect to lifestyle, diet and supplementation. Critical to the success of these efforts are technologies such as MacuScope (Marco, Jacksonville, Fla.) and QuantifEye (ZeaVision, Chesterfield, Mo.), providing us a means by which to monitor macular pigment optical density.
For those manifesting subtle structural change, we now have spectral domain optical coherence tomography. This incredibly sensitive technology allows us to monitor macular disease, oftentimes before symptoms and ophthalmoscopic detection.
Finally, for our patients with age-related macular degeneration, we have the Foresee PHP (Notal Vision/MSS, Bloomington, Minn.), a technology alerting us of the earliest signs of conversion from dry to wet. What is the common thread among each of these technologies? They all involve the posterior segment.
The reality of our country’s demographics is that the prevalence of macular disease is destined to grow … and at a significant rate. As a result, our retinal specialist colleagues face an insurmountable demand for their services. It is for this reason we actively manage macular disease. We not merely detect and refer, but rather counsel, diagnose, treat, monitor and refer appropriately.