Guest Editorial

Tech advances: Behold a double-edged sword

It is up to us to critically evaluate how to use all this technology

The advancement in technology in our world is inexorable and presents the medical field with a double-edged sword. Clearly, it has enabled us to diagnose and treat diseases more effectively. However, there is a literal monetary cost that must be covered by the ever-more thinly stretched health-care dollar. There is also the cost of over-reliance on technology, with the loss of clinical skills and judgment so important to our profession.

This month’s issue of Ophthalmology Management is all about technology in our field. In it, we explore the most significant advancement of this century in eye diagnostics: OCT. We explore how OCT imaging can be used in the detection of progression even in advanced glaucoma cases. Another feature guides us on practical use of OCT in diagnosing retinal diseases in “real world” situations. And, we are introduced to the use of OCT angiography and its potential future use in glaucoma diagnosis and monitoring.

Corneal and refractive surgery has seen recent advances due to the femtosecond laser. We see how it can be used to improve outcomes of visual acuity and postoperative irregular astigmatism in corneal transplantation. Another article details ways to customize femtosecond laser settings for different cataract surgery scenarios. In a special interview, OM speaks to an opinion leader on SMILE (SMall Incision Lenticule Extraction), a new laser-assisted refractive surgery technique for treatment of myopia.

Intravitreal anti-VEGF injections are a mainstay of myriad retinal diseases. However, what if access to these medications is limited due to cost or location? One author presents his treatment algorithm, based on laser, to treat retinal neovascular disease as either a substitute for or a method to reduce injection frequency.

Finally, the field of glaucoma has seen a rapid growth in minimally invasive glaucoma surgery techniques. One investigator discusses his team’s view of the field and what directions it may take for future developments and improvements. He presents his work on better understanding of the aqueous outflow system using “aqueous angiography.”

We hope you enjoy this issue. Collectively, the articles explore how to make the most use of technology in glaucoma, cataract, refractive and retina care and ponder what may emerge in the near future.

Ultimately, it is up to us to critically evaluate how to use the abundance of technology appropriately and to determine what is deserving of our acceptance on behalf of our patients. OM


Brian Francis, MD, MS, is a professor of clinical ophthalmology, the Rupert and Gertrude Stieger Chair in Vision Research, and director of Glaucoma Services at the Doheny Eye Institute, David Geffen School of Medicine, UCLA. He reports he is a consultant for BVI/Endo Optiks, Inc.