It is an exciting and fascinating time to be a retinal specialist eye surgeon. We have so much technology and new techniques available to help our patients and there are also many promising developments on the horizon. We now have effective treatments that can improve or maintain sight for conditions that only a decade or two ago would have left patients with blinding vision loss.
Retinal diseases cover a broad range, from common conditions such as age-related macular degeneration (AMD) and diabetic retinopathy (DR) to uncommon conditions such as Stargardt disease and choroideremia. The common diseases are characterized by vascular bleeding or leakage from within or behind the retina, which then absorbs the fluid and blood, causing it to swell like a wet sponge. The rarer diseases originate from inherited, defective genes causing retinal deterioration and poor vision.
Two key drivers have propelled success over the last two decades. First, the advent of advanced imaging techniques, such as optical coherence tomography can help doctors to evaluate the health and condition of the retina. This is analogous to obtaining a CT scan of the retina. Second, the introduction of anti-vascular endothelial growth factor (anti-VEGF) medications have helped us control or reduce the retinal bleeding and seepage, offering continued vision and hope for diabetics and the elderly who experience vision loss from AMD. Currently, anti-VEGF treatments require direct injection of the drugs into the affected eye on a periodic basis. Doheny Eye Center UCLA physicians are well-versed in all of these techniques and therapies.
One future development is that the anti-VEGF drugs will be made both more effective and more durable. This means that the time between injections will be greatly increased. At the same time, very small implanted devices are being developed that may provide continuous slow dosing of these new medications within the eye, extending the time between clinically administered treatments to many months or even years.
Another future advance is the possibility of using stem cells to assist the retina in replacing permanently damaged or lost cells through new cell growth. If such treatments achieve their potential, blinding conditions could be reversed.
Lastly, genetic therapy may offer new hope across the entire range of retinal diseases. Genetic treatments may function in two ways to treat retinal disease. For those rare genetic diseases, corrected DNA can be introduced into the eye, carried by a type of virus, to displace the abnormal genes with the aim of overcoming the disease through genetic reprograming. For diseases like AMD and DR, genetic therapy may alter the retina to produce its own medication, such as an anti-VEGF, so that clinical treatment is either significantly curtailed or no longer even necessary.