Outer retinopathy does not refer to a specific type of retinal disease. Patients with outer retinopathy often have abnormal vision symptoms, however, no positive signs can be found with conventional routine eye examination. And the diseases are often labeled “occult”. In recent years, optical coherence tomography (OCT) has been widely used in clinical practice. It has been found that many so-called “occult” diseases are actually caused by structural abnormalities of the outer retina. The causes of structural abnormalities are diverse, and the treatments and disease outcomes are also different. Therefore, it is necessary for clinical ophthalmologists to get detailed medical history, make diagnosis and differential diagnosis based on multi-model imaging, rather than roughly name it as “outer retinopathy”. With the development of OCT imaging technology, higher resolution images reveal the finer structure of retinal tissue, allowing us to have a deep understanding of the disease, thus improving diagnosis and treatment in clinical practice.
Myopia has become a major problem that threatens human health worldwide. Complications caused by high myopia are one of the leading causes of low vision and blindness. As a chronic disease that seriously threatens ocular health in the clinical practice and public health fields, the prevention and control of high myopia should actively promote a tertiary prevention strategy, and take advantages of the latest fundus imaging technology and big data technology, artificial intelligence to explore the evolution mechanism of “myopia→high myopia→pathological myopia”. Special efforts should be focused on the establishment of a scientific myopia prediction model, implementation of effective high myopia monitoring and management, and early detection and treatment of complications of high myopia to reduce the incidence of low vision and blindness.
Optical coherence tomography (OCT) has developed from time-doma in into Fourier-domain OCT (FD-OCT) which indicates clearer details and higher resolution of images. FD-OCT can indicate the structure and pathological changes of each retinal layer, and reveal the retinal external limiting membranes and changes of inner- and outer-segment of visual cells by 3D solid reconstruction. FD-OCT not only provide detailed information of the images for the clinical diagnosis, but also help us investigting the characteristics and pthological mechanisms of ocular fundus diseases, which lead us to a new era of technology of observation on ocualr fundus diseases. In the application, we should pay attention to the significance of different colors of OCT images, and focus on the cohenrence of the position in the image acquistion during the follow-up period. Dynamic observation on the lesions by FD-OCT and aggregated anaylsis of resutls of several imageological examination would be the development direction of imageological examination of ocular fundus diseases.
Most fundus diseases leading to irreversible blindness are associated with genetic variations. Some sequence changes directly cause retinal diseases while others lead to a higher susceptibility to environmental insults common in daily life. Studies of genes related to fundus diseases will lead to a revolutionary change in the prevention and treatment of irreversible blindness. Application of high throughput nextgeneration sequencing and exome capture techniques will greatly enhance our ability to elucidate genes responsible for fundus diseases. With such technical and analytical advances, we are likely to see continuing and accelerating progress in the genetic study of fundus diseases, particularly in those fields requiring collaborative study of common fundus diseases using large cohorts of samples. The translational clinical application of understanding about these newly identified genes responsible for fundus diseases is also increasing in promise. Thus, strengthening current genetic studies of fundus diseases in both of these areas will make a valuable contribution to the prevention and treatment of blindness in both the near and especially the distant future.
The etiology of intraocular inflammatory disease and its diagnosis is complicated. Currently available and newly emerging systemic and ocular examinations are of important to determine etiology of intraocular inflammatory disorders. But there also exists multiple misunderstanding, and the strategy of their application is not well defined, or even exaggerated. Unprincipled or randomly selection of auxiliary examination would not help for etiology determination, but bring unnecessary pain and economic burden to patients. Establishment of diagnosis thinking of intraocular inflammatory disease is helpful to standardize the diagnosis process of the disease, improve the diagnostic efficiency, and relief patients from the pain and financial burden that caused by too many useless examinations.
Anti-vascular endothelial growth factor (VEGF) drugs have become the firstline medications for the treatment of choroidal neovascularization (CNV). Its efficacy and safety have been confirmed by evidence-based medicine and a large number of clinical studies. However there are several issues need to be discussed before reaching a consensus for the clinical application of anti-VEGF drugs. These issues include, but not limited to the individual treatment regimen for different CNV lesions, the best anti-VEGF drug regimen, the indications and schemes of combination therapy, the factors affecting the efficacy, the potential risks of systemic and local deliveries. How to establish a reasonable personalized regimen of anti-VEGF drugs is the 1st issue need to be explored. Ranibizumab will come into China market soon. We need utilize the existing evidence-based medical research findings; take our advantages of rich resources of patients to investigate those issues to further promote the anti-VEGF applications in China.
The corticosteroids are the firstline therapeutical agents for noninfectious uveitis patients, but systemic corticosteroids are ineffective for some chronic or recurrent patients, and have many long term usagerelated side effects; these patients may need treatment of immunosuppressive agents and/or biologic agents. However, the mechanism, indication, efficacy and sideeffects of each type of the immunosuppressive agents or biologic agents are not identical. In clinical practice, we should use different and sensitive immunosuppressive agents or biologic agents for different types of uveitis, and watch their efficacy and toxic effects closely. In order to improve the effectiveness of the treatment, the classification, efficacy and existing concerns of commonly used uveitis drugs need to be further clarified.
It is clear that genetic background contributes to the development and progression of diabetic retinopathy (DR). However, the identification of susceptibility loci through candidate gene approaches, linkage disequilibrium analysis of case-control data and genome wide association study is still in its infancy and faces many challenges due to the complexity of the disease itself. China has rich resources of clinical samples. In order to facilitate elucidating the susceptibility genes of DR in China, we look forward multi-disciplinary, multi-regional collaboration studies integrating novel technologies, such as proteomics, metabolomics and next-generation sequencing to analyze gene-gene and gene-environment interaction factors comprehensively.
Silicone oil is widely used in intraocular filling of fundus disease after vitrectomy, which improves retinal reattachment rate andpostoperative visual function of patients. With the era of minimally invasive vitreous surgery coming, the utilization rate of silicone oil filling is decreasing, however, it still plays an indispensable role in the surgical treatment of complex fundus diseases. In the process of using silicone oil, the indications should be strictly selected, and the potential risks should be fully considered and possibly avoided. The study of vitreous substitutes with certain physiological functions is currently a research hotspot in the field of fundus diseases.
Vitrectomy is an important treatment for vitreoretinal diseases. After half a century of innovation and development, it has made a breakthrough from open type to micro-incision surgery. Minimally invasive vitrectomy has the advantages of wide indications and high cutting efficiency, which greatly improves the safety and efficacy of surgery, and minimizes the occurrence of trauma and complications during surgery. At present, with the development of surgical microscope system, ophthalmic microsurgery robot and other equipment, and the development and application of new artificial vitreous materials, vitrectomy is developing toward minimally invasive, accurate and intelligent development. The further development of vitrectomy innovative technology in the field of ophthalmology is hopeful in the future, so that clinicians can achieve the best surgical results with the minimum damage, and bring better light to patients.
