Supervision: Myth and Reality

Ophthalmic technology has advanced phenomenally over the past 30 years and ophthalmology is now working towards Super Vision, but researchers and innovators need to take the time to reflect on the impact of technological change.

Dr Palliakaris noted that the painter El Greco was considered either a madman or vision-impaired. “I am not certain whether it has not been his need to see his figures gazing up, towards the skies, which triggered his astigmatism and made him paint his long, ascetic figures.

“I know for sure, however, that I would have missed an El Greco deprived of his astigmatic paintings,” he said.

Technology and knowledge has advanced phenomenally, moving from hand-drawn outlines of the cornea, the first stage of topography, to systems using touch alone to provide ophthalmologists with all the relevant data about the total optics of the eye.

He said 30 years ago he was proposing &39;Barron's-like' trephines in order to customize corneal grafts and now the 150MHz or 200MHz femtosecond lasers can design any desirable shape of the graft or the flap.

Many technological developments in that time were dead ends or, worse, sent the profession backwards.

“The development of the ICR, for instance, or the thermal lasers and CK for presbyopia, and even EpiLASIK,” he said, adding: “More interesting is the case of 'eagle vision,' or the aberration-free 20 to 10 Super-Vision target, and the trend to transform all frogs to eagles, ignoring the significance of the existence of frogs in our ecological system.”

He noted that, in terms of the potential for supervision, the plasticity of the brain and its capacity to register only the significant data in a constantly shifting scene.

“We now know, as we keep learning more about the best possible functional vision, that our optical system is a dynamic site with constantly changing optics in a continuously accommodated process,” he said.

He said that that even if we changed the optics of the eye, where accommodation was lost and multi-focal optical systems were used, the brain would still have the flexibility to adapt to this new situation to give us the information we need, and it would be able to generate new anatomical structures and nerve networks, in order to perceive what we need to perceive.

“It seems, after all, that our vision and our optical system in general comply with the famous saying of Heracletus: Everything flows, nothing stands still. So, to aim towards solutions of steady systems - at least in relation to the normal functions of our organism - appears to be less important,” he said.

He warned that the creativity inventors and innovators can be killed by too early recognition, which leaves no time to reflect.

“Τhere is no doubt that in the old times, when thought was faster than time, we had enough time to reflect on our initial reasoning and actions. Nowadays, it seems that time runs faster than our thoughts; it seems that before we think of something, it has already been realized. In effect, the advantage to reflect on things is lost.”

He said the greatest innovators would be those who could resist recognition and acceptance in the short term to break-through to what deserves to be distinguished.

He concluded that if the audience learned one thing from his talk, he hoped it was Socrates#39; maxim: I know that I know nothing.