Another American Academy of Cataract and Refractive Surgery (ASCRS) meeting is in the books. I think I’m not alone in saying that it was a whirlwind of learning, socializing, mentoring, and fundraising for some great causes. Every year I tell myself I’m going to slow down, commit to less, and try to soak it all in. It never happens that way. The excitement about new research and technologies, seeing my colleagues and friends, and meeting new people consistently overwhelms my resolution to do less. I am always astounded by the brilliance, passion, and generosity of the ophthalmology community, and grateful to be a part of it.
Cornea, cataract, refractive, and anterior segment surgery remain at the forefront of ophthalmic innovation, yet several challenges persist that demand critical reflection and collaborative solutions. As we navigate 2025, a few key issues warrant our attention.
First, corneal transplantation continues to evolve, with increasing global adoption of lamellar techniques such as DMEK and DALK. While these procedures offer superior outcomes and reduced rejection rates, accessibility remains uneven—particularly in low-resource settings where full-thickness transplants are still the norm. Addressing the global shortage of donor tissue and improving eye banking infrastructure must remain a priority.
Second, keratoconus management has seen dramatic changes with early diagnosis and intervention through corneal cross-linking (CXL). However, standardizing treatment protocols, especially in pediatric populations, remains an area of concern. In addition, newer diagnostic technologies—such as artificial intelligence-driven corneal topography—hold promise, but their integration into routine care is still limited by cost and training gaps.
Third, ocular surface disease, including dry eye and meibomian gland dysfunction, is now recognized as a public health issue, exacerbated by increasing screen time and environmental factors. The growing body of research into inflammatory pathways and the microbiome suggests we are on the cusp of more targeted therapies. Yet, clinicians still face difficulties like balancing declining reimbursement, pressure to see more patients, and patient expectations with realistic treatment outcomes. These pressures can often limit accessibility by patients to receive timely diagnosis and treatment of this important and impactful disease.
These innovations underscore a transformative period in corneal and anterior segment surgery, driven by technological advancements and interdisciplinary collaboration. In this issue Drs. Sumitra Khandewal, Ken Beckman, William Barry Lee, and Vance Thompson will discuss some of these very important topics. OM
