“The only thing that is constant is change.” — Heraclitus, 535 BC

When I was born, there were 4 billion people on Earth. Today, 75 percent more people are bustling about our planet—over 7 billion, with a cresting gray tsunami and a life expectancy in the United States of 79 years. The majority of retinal diseases afflict adults, increasing in prevalence with age; these exudative and degenerative disorders result in far more blindness in developed countries than all other eye diseases combined.

 Fortunately, the developments of treatments for many of these afflictions are shifting the epidemiology of visual impairment. Incident cases of age-related macular degeneration-derived blindness have fallen 50 percent in some developed countries since the dawn of the anti-VEGF revolution.

The management of exudative retinal diseases was initially fairly straightforward: To inject or not to inject? Maybe throw in, To add laser or not to add laser?

But, with accumulating comparison data (DRCR.net Protocol T, page 18) coupled with an expanding list of pharmacologic agents (steroid implants, page 30), the decision tree for managing retinal diseases is growing ever more complex.  

As of March 1, Clinicaltrials.gov listed 2,395 “retina” studies, including 659 actively recruiting. Over the next decade, the debates of bevacizumab versus aflibercept versus ranibizumab will be but one of many important conversations with clinical, economic and­—May I add?— possibly ethical implications.

For the retina specialist, pharmacologic agents are but one of the issues to consider; choices of diagnostic equipment, laser devices and surgical instrumentation are expanding even more rapidly.

 Over the months and years to come, Retina Specialist will strive to be a unique, doctor-mediated forum for vitreoretinal specialists across the United States and around the globe to stay informed on the latest approaches, technologies and trials impacting the care of our patients as well as our evolving practice management environment.

While the Greek philosopher Heraclitus may have lived over 2,500 years ago, when the human population was just 1 percent what is it today, his teachings are more relevant than ever: “All entities move and nothing remains still.” Hang on!