Dr Wilson Heriot
In this 2020 decade, we are the beneficiaries of extraordinary advances in the diagnosis and treatment of the major blinding diseases-neovascular AMD and diabetes. We currently live the dream of the “21st-century” with diagnostic technology such as non-invasive tissue imaging with spectral domain OCT and disease control using molecular targeted drugs such as Lucentis and Avastin for VEGF. Medical retinal practice has been revolutionised such that previously untreatable diseases can frequently be controlled and the vision returned to normal. Diabetic macular oedema resistant to laser treatment will often be controlled with an anti-VEGF drug, retinal venous occlusion responds well-particularly if treatment is commenced promptly. Surgical retinal management has been revo-lutionised by small incision sutureless vitrectomy techniques using instruments as thin as 27 gauge. Vital dyes to identify various tissue layers significantly improve the speed and accuracy of our surgery whilst limiting retinal trauma. Challenges abound however translating exciting advances in stem cell technology, viral vector gene manipulation, bionic prosthetic vision and the control of PVR-particularly in complex retinal detachments and trauma. Perennial challenges such as public aware-ness of general health issues such as obesity, BP and early diabetes remain a major obstacle to preserving vision or reducing the amount of therapy needed to regain control of the retinopathy. Despite the privilege of what appears to be a sci-fi range of technology including digital records, OCT and anti-VEGF drugs, the many challenges yet to best will keep us occupied for the remainder of the 2020 decade.