The Big 10

As we approach a decade of providing the European ophthalmology community with the latest innovations and research, we at OTEurope, wanted to look back at what has changed over the years. In such a fast-paced industry, there have been monumental strides forward since the launch of this publication.

A lot to discuss!

So, what has happened in ophthalmology over the past 10 years? Well, when looking back at OTEurope's beginnings, then I can surely say that a lot has happened. In cataract and refractive we have seen many developments in IOLs, the introduction of femtosecond laser cataract surgery more recently - along with other laser advancements, presbyopic solutions and much more. Retina has seen the advent of anti-VEGF therapy, even smaller gauge vitrectomy and nutritional therapy. Specialists in the field of glaucoma have witnessed laser advancements and minimally invasive glaucoma surgery (MIGS) amongst other things. And, of course, we mustn't forget the rising popularity of corneal crosslinking either.

In this article, you will find the Top 10, in reverse order, as voted for by you, and a brief history of each as reported by OTEurope!

10 th - Nutritional therapy for AMD

There has been much research and discussion on the importance of dietary supplementation in reducing the risk of age-related macular degeneration (AMD). Carotenoids, that are present in high concentrations in the tissues of the eye, have been highlighted as important compounds to help macular health. "Within the retina itself there is a hundred fold gradient of carotenoid concentrations, which is why you see a yellowish spot, the macular pigment. This appears to protect the retina against some damage from blue light," reported Professor Paul Bernstein back in 2011.¹

The AREDS, a randomized prospective trial, assessed cataract, severe vision loss and AMD across multiple centres. This original study used a formulation including zinc, antioxidants, a combination of zinc and antioxidants, and a placebo. Patients who had received the original formulation were found to have a 20% reduction in vision loss over five years, leading to retina specialists recommending dietary supplementation to AMD patients. "This was just the first step... even at that time researchers knew that lutein, zeaxanthin and the omega-3 fatty acids needed to be looked at," added Prof. Bernstein.¹

So, AREDS2 results were published at the beginning of last year with the adapted AREDS formulation that included lutein, zeaxanthin and the omega-3 fatty acids. "The long-term use of AREDS supplements appears safe and protective against advanced AMD," said Professor Albert Augustin at the end of 2013.² "Omega-3 fatty acids and beta-carotene clearly do not reduce the risk of progression to advanced AMD, and furthermore, the validity of zinc remains unclear. However, adding lutein and zeaxanthin in place of beta-carotene may further improve the formulation."

9 th Joint - Laser advancements in glaucoma surgery

Although laser trabeculoplasty has been used for the treatment of glaucoma since the late 70's in the US, it was not until more recently that European doctors have adopted laser therapy, in particular as a first-line treatment.³

Initially, surgeons had the option of using Argon laser trabeculoplasty (ALT) to treat patients, however, this form of laser therapy has been shown to cause thermal damage to the trabecular meshwork and repeated procedures are poorly effective.⁴ Selective laser trabeculoplasty (SLT) was introduced in the 90's and offered a repeatable procedure that reduces IOP as effectively as medication.⁵

Micropulse laser trabeculoplasty (MLT) was another new laser-based treatment modality for glaucoma specialists that also avoided damage to the trabecular meshwork. "I found that while using the MLT laser, my patients were more comfortable with less inflammation and no formation of synechiae," said Dr Adam Lish in 2011.⁶

This year, CO₂ laser assisted sclerectomy surgery (CLASS) has been reported to be a promising procedure. This is a minimally invasive procedure where the sclera is thinned to allow percolation of the aqueous. "I find that CLASS may be most suitable for patients with uncontrolled glaucoma where a less invasive approach is preferred," said Professor Shlomo Melamed. "We know it works well, providing significant long-term reductions in both IOP and hypotensive medication requirements. It also has a very low postoperative complications rate. I anticipate that future studies will continue to show the benefits of using CO2 lasers for the treatment of glaucoma."⁷