Chief Medical Editor’s Page
New Insights Into the Vitreous and Choroid
The primary definition for vitreous in Stedman’s Medical Dictionary is: Glassy; resembling glass. The ambiguity of this definition perfectly illustrates the incertitude with which we have considered the vitreous in terms of its role in the eye.
In recent years, however, we have gained an increasing amount of information on this jelly-like substance that sits between the anterior segment of the eye and the retina. The dynamics of the vitreous in the aging eye may have direct roles in many retina disease states.
In this issue, J. Sebag, MD, who, along with colleagues, has pioneered a good deal of research on vitreomacular adhesion (VMA) and vitreomacular traction, contributes to this issue with an article outlining how the concept of pharmacologic vitreolysis has evolved to an emerging treatment option for VMA. Pravin U. Dugel, MD, who has also been involved in clinical studies for the pharmacologic agent ocriplasmin, also contributes to this issue.
Another structure within the eye that has remained elusive of our understanding is the choroid. The choroid, the vascular layer between the retina pigment epithelium and the sclera, has been difficult to image. Improved imaging techniques with spectral-domain optical coherence tomography (SD-OCT) have provided information showing that choroidal status may also have a direct impact on several retina diseases.
Peter K. Kaiser, MD, provides perspective on enhanced depth imaging (EDI) with OCT, which was first described by Richard F. Spaide, MD, and colleagues, and describes how he uses it in his practice to help him better understand pathology and apply the most appropriate treatment. Bruno Lumbroso, MD, also reviews his experience with choroidal imaging using SD-OCT to more closely examine the choroid for abnormalities, enhancing his ability to properly diagnose and treat patients. Additionally, our regular ocular oncology case report section features EDI OCT technology, which was proved essential in the case described for detecting choroidal hemangioma masquerading as central serous chorioretinopathy.
This is our first issue of Retina Today to focus on the vitreous and choroid. This choice of cover focus reflects the shift in our subspecialty from managing symptoms of retinal disease to investigating the causative and driving forces of retinal disease in the hope that we can achieve better outcomes for our patients.
TOP 5 ARTICLES FROM 2012
- Treatment of Retinal Vein Occlusion
Individualized therapy is crucial to good patient outcomes.
By Gaurav K. Shah, MD
- Intravitreal Aflibercept for AMD: 2-year Results
The VIEW 1 and 2 studies showed high degrees of safety and efficacy at 2 years.
By Jeffery S. Heier, MD
- Treatment of Vitreomacular Adhesion: Present Status, Future Prospects
The technology is already in use for diagnosis and management of some conditions.
By J. Sebag, MD, FACS, FRCOphth, FARVO
- Ocular Drug Delivery Systems for the Posterior Segment: A Review
By Noriyuki Kuno, PhD; and Shinobu Fujii
- A New Focus on the Vitreous and Its Role in Retinal Function
By Pravin U. Dugel, MD