|Year : 2012 | Volume
| Issue : 3 | Page : 271-272
Ophthalmology: Now and then
Department of Ophthalmology, University of Florida College of Medicine, Jacksonville, Florida, USA
|Date of Web Publication||3-Jul-2012|
Assistant Professor, Ophthalmology Director, Inherited Retinal Diseases and Electrophysiology, Department of Ophthalmology, University of Florida College of Medicine, Jacksonville, Florida
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Grover S. Ophthalmology: Now and then. Middle East Afr J Ophthalmol 2012;19:271-2
As I started to write this editorial and started looking at the articles that were accepted for this issue of the journal, I could not help but go down memory lane to about 1990, when I started practicing ophthalmology in a developing country. In this short period of time of two decades, ophthalmology has undergone a total revolution.The investigative tests and management of diseases have changed to a large extent, thanks to the advent of technology. I believe there is no field of clinical medicine that has undergone so much change in such a short duration of time and, the field continues to change.
The Human Genome Project formally began in 1990 in USA. Presently, the Online Mendelian In Man (OMIM) database,  which is a comprehensive and authoritative compendium of human genes and genetic phenotypes, lists more than 12,000 genes with their phenotypes. Not only has this resource been developed and the human genome completely mapped out, but we are now in human trials of 'gene therapy' for diseases such as Leber congenital amaurosis.
In the anterior segment, two decades ago, the surgeons worldwide were still performing radial keratotomy while animal studies were being done at that time to show that corneal flaps were possible for laser in situ keratomileusis (LASIK)  . Since that time we have embraced LASIK and laser-assisted subepithelial keratectomy (LASEK)  as tools for refractive surgery. In this issue of the Journal, Faisal Al-Tobaigy's retrospective study reports that LASEK is a safe and effective procedure for myopia and myopic astigmatism.
Over the past fifteen years, corneal transplantation, where the mainstay was full-thickness penetrating keratoplasty (PKP), has undergone changes through deep anterior lamellar keratoplasty (DALK), lamellar keratoplasty (LK), and Descemet's stripping automated endothelial keratoplasty (DSAEK). In this issue, Zare et al discuss the changing indications and surgical techniques of corneal transplantation in a tertiary center in Iran from 2004 to 2009, a change taking place in just five years.
For glaucoma, the treatment options have always been medical, surgical and lasers. Although the mainstay of medical treatment was topical beta-blockers, pilocarpine and oral carbonic anhydrase inhibitors in the early 1990's, pilocarpine and oral CAI's have taken a back seat in favor of newer prostaglandins, topical CAI's and alpha2-adrenergic agents. However, topical beta-blockers continue to be the first line of treatment. In laser treatment, evolution has taken place from argon laser trabeculoplasty to selective laser trabeculoplasty (SLT) in recent years. Abdelrahman and Eltanamly describe the effectiveness of selective laser trabeculoplasty (SLT) in primary open angle glaucoma in an Egyptian population.
In the posterior segment, the way we treat diabetic retinopathy and exudative macular degeneration has totally changed. The use of optical coherence tomography and intravitreal injections of anti-vascular endothelial growth factors (anti-VEGF) in the last decade has been revolutionary. In this issue, Al Alawi et al discuss the feasibility of a telemedicine program for diabetic retinopathy screening in Iran. Although the concept of telemedicine has been there since 1970's, it did not come to be recognized as a tool in ophthalmology until 1996 and the first peer-reviewed article on telemedicine as a tool in diabetic screening dates back to 1998. 
The first multicenter study to report the safety and efficacy of cryotherapy in treatment of severe retinopathy of prematurity (ROP) was reported in 1990.  Since then, cryotherapy has been replaced by laser photocoagulation and more recently, intravitreal injections of anti-VEGF agents are also being tried for this condition. This issue has 2 articles on ROP - Hakeem et al report the prevalence and risk factors for ROP in a study from Egypt; and, Afarid et al share their ROP experience and data from Iran.
Although the developed countries of the world are ahead of the curve in technology, instrumentation and resources, the under-developed and developing countries are not far behind. The Middle East African Journal of Ophthalmology, which was recently PubMed-indexed, is one of the ways in which knowledge can be dispersed and progress made by leaps and bounds in the future. The articles in this issue, as highlighted above and others, go to show that all these studies have a bearing for the future. I feel that the next two decades will bring much more change and innovation in ophthalmology than the last two decades. As Albert Einstein said, "I never think of the future. It comes soon enough". I feel fortunate to be an ophthalmologist in this era of modernization and change.
| References|| |
|2.||Pallikaris et al. Laser in situ keratomileusis. Lasers Surg Med 1990;10:463-8. |
|3.||Descemet-stripping automated endothelial keratoplasty. Gorovoy MS. Cornea 2006;25:886-9. |
|4.||Williamson TH and Keating D. Telemedicine and computers in diabetic retinopathy screening. Br J Ophthalmol. 1998;82:5-6. |
|5.||Cryotherapy for Retinopathy of Prematurity Cooperative Group. Multicenter trial of cryotherapy for retinopathy of prematurity - one year outcome - structure and function. Arch Ophthalmol 1990;108:1408-16. |