I  have water on my mind, or, more literally, in my house. Hurricane Harvey created one of the worst floods in U.S. history, unloading an estimated 33 trillion gallons of water, or more water than flows over Niagara Falls in 1.4 years.  

While my home in Houston sustained no substantial damage, thousands of other people lost theirs, and, in some tragic cases, life itself. Multiple staff, friends and colleagues were evacuated, many by boat under the guidance of our National Guard. More than 100,000 families were displaced across Houston alone.  

Experiencing such a powerfully destructive natural phenomenon up close is totally different from watching it on a screen. There is no off switch or silence button during the nightmares that can unfold as a hurricane like Harvey or Irma engulfs a region.

The outpouring of encouragement and support, both emotional and financial, has been remarkable. A simple, personal example came when a retina colleague in St. Louis called and said he and his partners had collected funds they were sending to our displaced employees who had lost everything. He said he’d been there; he knew how they felt. He wanted to lighten their load in a small way.

It’s not quite the same, but in some ways we as retina specialists deal with flooding, or at least fluid where it shouldn’t be, on a cellular level every day. Misplaced fluid is a hallmark of exudative retinal disease.  

We have directly seen this flooding qualitatively for decades with fluorescein angiography. In this issue, Jaya Kumar, MD, and Justis Ehlers, MD, outline their vision of automated, quantitative assessment of widefield angiographic features such as leakage, microaneurysms and nonperfusion.

Vascular leakage even defines obscure diseases such as macular telangiectasia. Grant Comer, MD, of the University of Michigan, a leading center for the MacTel Project, updates us on the clinical characteristics of MacTel and a Phase III trial of ciliary neurotrophic factor bringing new hope to afflicted patients.  

Rhegmatogenous retinal detachments are also manifestations of flooding, as liquefied vitreous flows through a retinal break, separating the neurosensory retina from the underlying retinal pigment epithelium. Tien Wong, MD, outlines his thoughts on surgical RD repair, and Kunihiko  Akiyama, MD, from Tokyo describes his approach to minimizing postoperative epiretinal retinal membrane formation.  

Floods come and go, some worse than others. Words do not capture the essence of the tragic situations that unfold in the wake of a powerful hurricane. I hope that the floodwaters, whether in your street, your house, your patients’ retinas, or all of the above recede quickly and that affected areas come to thrive once again.