Looking back

David F. Chang, M.D.,

This month, we invite anterior segment surgeons to direct their attention posteriorly toward the retina. In the five articles that comprise our cover focus on retina co-morbidities, we call on 14 different vitreoretinal specialists to help us with practical dilemmas that cataract surgeons face every week. What is the best way to test visual potential in cataract patients with maculopathy? Does cataract surgery increase the risk of developing or reactivating wet ARMD? How should we time anti-VEGF treatments in patients with macular degeneration or diabetic macular edema undergoing phaco? How could multifocal IOLs affect treating these conditions in the future? Does lattice degeneration need to be treated prior to cataract surgery? Is routine CME prophylaxis with topical NSAIDs necessary? These are just some of the questions that we pose to our panel of retina experts in this series of complementary articles, and you'll be impressed with how much some of their answers differ from what would have been said just 3-4 years ago. Treatments of the most common retinopathies are evolving at a fast pace, and we anterior segment surgeons value the help and advice of our vitreoretinal colleagues more than ever. January is also a chance to look back at the past year. Femtosecond (FS) laser cataract surgery was certainly the dominant story in 2011 as the first systems were rolled out in the U.S. The curiosity, concerns, and controversy surrounding this new technology are unprecedented in so many ways. The technology is amazing, but the formidable financial commitment amidst uncertainty as to when and which patients can be billed is definitely unprecedented. In addition, unlike with an IOL that underwent extensive and long-term clinical trials for approval, we are just beginning to collect data on FS laser refractive cataract surgery with precious little peer-reviewed evidence to rely on. Just ponder the differences from when the first accommodating IOL became available in the U.S. We believed then, as now, that accommodating IOLs are the future and will eventually supplant multifocal IOLs. We could review the FDA clinical data, as well as studies from abroad. Within a year, we had a CMS ruling that very clearly defined patient shared billing for the technology. For patients, the value added proposition was easily understandable, desirable, and frequently affordable. Most importantly, any cataract surgeon could offer and gain personal experience with the technology without incurring any major financial risk. Against this background context, the FS laser controversy is certainly appropriate, and EyeWorld will continue to cover the clinical and business developments in the coming year.
Did that first accommodating IOL fulfill its promise? The absence of any new accommodating IOLs in the U.S. is another important and disappointing story as the Synchrony dual optic IOL (Abbott Medical Optics, Santa Ana, Calif.) was not approved. The fact that so many other highly anticipated technologies remain stalled in the regulatory pipeline is a major concern for anterior segment surgeons and their patients. As highlighted in our November and December issues, European patients have access to so many important technologies that Americans don't, and this month I interviewed the guru of disruptive innovation for his thoughts on the innovation cycle in our specialty.
The editorial staff at EyeWorld wishes you a happy New Year and looks forward to delivering balanced coverage of the most relevant and important developments in 2012.

David F. Chang, M.D., chief medical editor