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    The best is yet to come

    Technologic advances, cost of patient care top surgeon’s wish for ophthalmology

    With the start of each new year also comes the hope for many innovations and advances. On top of that, I hope we can still make progress for our patients in our beloved field of ophthalmology.

    Since my start as an ophthalmic surgeon in 1993 we have seen some great technological changes. The advent of phacoemulsification and sequentially the foldable IOL a few years later. These changes took place in a gradual, slow way so we were able to adapt.

    Our generation of surgeons were taught intracapsular and extracapsular surgical techniques. Yes, we made a 8-mm corneo-limbal tunnelled incision. Topical anaesthesia made a huge difference in patient adaptation of the new surgical procedures. The debate then was on how small the main incision could become.

    Since 2005, we switched a gear or two in technologic ophthalmology advances coming in the practises. We have astigmatic correction with toric IOLs and now even guiding systems projected in our microscope eyepiece.

    The femto laser cataract system took less years to become successful and introduced us to the advent of video microscopes--all of this preceded by the femto laser flap.
    Angio OCT machines made µ-vascular retinal diseases visible. Intraoperative OCT will help us in future corneal transplant surgery, in retinal repair.

    And, at the molecular spectrum, we have anti-VEGF molecules that save vision and we will be having the beginning of genetic repair of affected eye tissue, like in Leber H.O.N.
    We saw last year the first robotic eye surgery. Who would have thought back in the 1990s that even the operating room microscope could be on the verge of becoming obsolete and replaced by 3-D video systems?

    So this is pure sweetness, you wonder? But there’s a sour part also.

    The challenges we now face is first our speed of adaptation. And secondly, all of these great features and technological advances augment the cost of our ophthalmological practise in a dramatic way, and the speed of change is so rapid (I am not complaining about...) that all of us have difficulties in keeping up with the investments. The fact that most countries are in deficit and reduce the reimbursements is not helping either.

    Wishes for 2017

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