Ophthalmology today and tomorrow: surgery and more
Ophthalmology today and tomorrow: surgery and more
Ophthalmology procedures and eye surgeries have been around since ancient times. Today we can hardly imagine the types of circumstances that surrounded any surgical procedures to our perhaps most important sense organ in those days and later eras. Meanwhile, the present and future of this medical specialty looks all the more promising.
Even though ophthalmology is not yet able to help blind people see again, today’s modern surgical eye treatments are vital to preserve a patient's vision. "There are four major types of eye surgery: cornea transplants, cataract surgery, glaucoma surgery and retinal pathologies such as retinal detachment or retinal holes," explains Professor Ursula Schmidt-Erfurth, Head of the Department of Ophthalmology and Optometry at the Medical University of Vienna, Austria. The common denominator of these treatments is that they are minimally invasive surgical procedures. "Surgeons no longer need to make incisions with today’s procedures; small access channels inside the eye are sufficient. That's why surgeons are also able to operate with local anesthetics. Immediately after the surgery, patients are able to see well and manage follow-up care on their own," says Schmidt-Erfurth.
One example of this is glaucoma surgery: glaucoma, elevated intraocular pressure, damages the optic nerve over time and can cause blindness. Previously, the surgical procedure created a channel in the eye, allowing aqueous humor to drain and thus normalizing the intraocular pressure. However, this procedure can disrupt the perfusion of the optic nerve since the pressure can quickly and drastically drop. What’s more, the incision increases the infection risk. The follow-up care requires several days of inpatient stay, which is labor intensive and expensive because the intraocular pressure needs to be measured frequently. "Today, glaucoma surgery can use micro-stents that are inserted into the iridocorneal angle inside the eye and enable a controlled draining of fluid out the eye. This also lowers intraocular pressure in a gentler way," says Schmidt-Erfurth.
Micro-stent implantation is gaining popularity in Germany for example, as explained by Professor Norbert Pfeiffer in an interview with MEDICA-tradefair.com. "Stent implantation is very new as a routine surgical procedure. That is why it is currently only performed at a few specialized hospitals. The number of procedures will definitely increase in the future."
Outpatient eye surgery calls for changes in the healthcare system
The big change Schmidt-Erfurth sees in eye surgery involves eye hospitals without beds, where patients no longer receive inpatient care, or outpatient facilities where even general practitioners perform surgery. Minimally invasive surgical procedures that make this possible are both technically and technologically sophisticated and require excellent quality management along with quality awareness in treating physicians. "A surgeon who performs minimally invasive surgeries can treat considerably more patients in a shorter amount of time. He is also able to focus more on the surgical aspect once follow-up care is eliminated," says Schmidt-Erfurth. "On the other hand, surgeons have to be particularly careful, because only if possible complications are being avoided can patients be safely treated on an outpatient basis."
Meanwhile, outpatient eye surgery is already quite common in the U.S. But at least the trend in Europe when it comes to major hospitals like the Karolinska University Hospital in Sweden moves towards reducing the number of beds in hospitals for ophthalmology. There are merely sporadic initiatives to set up outpatient facilities. After all, it requires major changes in the healthcare system to implement outpatient eye surgery. It is vital to determine who will conduct quality controls in hospitals and outpatient facilities and how those programs should be implemented. Billing also has to reflect the high-quality care of this surgical procedure despite the fact that it takes less time and effort. That's why one thing is clear to Schmidt-Erfurth: "Never before has there been this kind of significant change in technology in the surgical sector. The entire healthcare system needs to be involved in its implementation to maintain the quality of treatment and to properly benefit from cost reductions – that means physicians, policy makers and health insurance companies."
Ophthalmology of tomorrow: surgery is just the tip of the iceberg
But what can ophthalmology do once it is too late for surgery or if it was never even a treatment option to begin with? This is where approaches to regenerative medicine come into play for example. "Gene therapy aims to introduce missing or additional genetic information for a specific protein into a target tissue or organ," explains Professor Bernd Wissinger in an interview with MEDICA-tradefair.com on a potential treatment for hereditary achromatopsia.
Today, ophthalmology is already able to improve the eyesight of many people. One example of this is the implantable "Argus" retinal prosthesis system, which can help patients with retinitis pigmentosa. In these patients, the photoreceptors of the eye are damaged to where light from the optic nerve is no longer transformed into signals. Depending on the progression of the disease, a patient’s vision is, therefore, limited or completely lost. The prosthesis system includes eyeglasses with an integrated camera. The images captured by the camera are processed via a computer that is worn by the patient and wirelessly sent via the eyeglasses to the implant, which is located between the eyeball and the optic nerve. The implant’s electrode matrix stimulates the optic nerve to where the wearer perceives patterns of light that he can then interpret as the contours of his surroundings. After receiving the implant, some patients score better in vision tests and are also able to see better in everyday life again.
Even though it sounds a long way away in the future and would have seemed entirely unimaginable ten or twenty years ago, gene therapy applications are already being tested in various studies all around the world, while the "Argus" prosthesis system has also already been tested since 2002 and has obtained FDA approval and a CE mark by now. This makes it also commercially available. Added to this are the new surgical techniques that already promise gentler treatments and a higher degree of effectiveness in eye surgery. They can safely be considered pioneers in ophthalmology of the future, which has already begun.