The therapeutic effect of anti-vascular endothelial growth factor (VEGF) for neovascular age-related macular degeneration (nAMD) was determined by a number of factors. Comprehensive thorough analysis of clinical features, imaging results and treatment response can predict the potential efficacy and possible vision recovery for the patient, and also can optimize the treatment regime to make a personalized therapy plan. Precise medicine with data from genomics, proteomics and metabolomics study will provide more objective and accurate biology basis for individual precise treatment. The future research should focus on comprehensive assessment of factors affecting the efficacy of anti-VEGF therapy, to achieve individualized precise diagnosis and treatment, to improve the therapeutic outcome of nAMD.
The prevalence of diabetes mellitus in adults of China has reached 12.8%. Diabetic retinopathy (DR) accounts for approximately 1/4-1/3 of the diabetic population. Several millions of people are estimated suffering the advanced stage of DR, including severe non-proliferative DR (NPDR), proliferative DR (PDR) and diabetic macular edema (DME), which seriously threat to the patients’ vision. On the basis of systematic prevention and control of diabetes and its complications, prevention of the moderate and high-risk NPDR from progressing to the advanced stage is the final efforts to avoid diabetic blindness. The implementation of the DR severity scale is helpful to assess the severity, risk factors for its progression, treatment efficacy and prognosis. In the eyes with vision-threatening DR, early application of biotherapy of anti-vascular endothelial growth factor can improve DR with regression of retinal neovascularization, but whether it is possible to induce capillary re-canalization in the non-perfusion area needs more investigation. Laser photocoagulation remains the mainstay treatment for non-center-involved DME and PDR.
Myopia has become a major problem that threatens human health worldwide. Complications caused by high myopia are one of the leading causes of low vision and blindness. As a chronic disease that seriously threatens ocular health in the clinical practice and public health fields, the prevention and control of high myopia should actively promote a tertiary prevention strategy, and take advantages of the latest fundus imaging technology and big data technology, artificial intelligence to explore the evolution mechanism of “myopia→high myopia→pathological myopia”. Special efforts should be focused on the establishment of a scientific myopia prediction model, implementation of effective high myopia monitoring and management, and early detection and treatment of complications of high myopia to reduce the incidence of low vision and blindness.
Polypoidal choroidal vasculopathy (PCV) is originally defined as a separate disease, but with the development of imaging techniques, it has now been included in the spectrum of neovascularization. In the Asian population, the prevalence of PCV is high, and with the deepening of clinical studies, the pathological characteristics, pathogenesis and clinical manifestations of PCV have been more deeply understood. Through dynamic observation and histopathological study of PCV lesions during operation, it can be confirmed that the lesions are mainly located between the retinal pigment epithelium and the Bruch membrane, rather than originating from the choroidal circulation, which is of great significance for understanding the origin and natural course of PCV. It is worth noting that although a theoretical bridge has been established between age-related macular degeneration (AMD)/PCV, there is a lack of intuitive clinical data on the ultrastructural and molecular manifestations of the cells/stroma in the local lesions of the eye, especially the progression of AMD/PCV from early/middle stage to exudative stage. It is precisely because of this that highly attractive research topics and exploration space are proposed for the future.
Inherited eye disease is a heterogeneous group of eye disorders caused by genetic defects, which has many genetic characteristics, such as multiple inheritance modes and numerous gene variation types. Over the past few decades, genetic testing has improved significantly, with more and more known disease-causing gene variants identified. With the rapid development of high-throughput sequencing technology, clinical diagnosis and treatment of eye genetic diseases have been accelerated, and molecular diagnosis of eye genetic diseases has become an important step in accurate diagnosis and treatment. How to correctly select and evaluate each kind of genetic testing technology, reasonably standardize the use of genetic testing technology, and provide patients with more accurate genetic counseling are problem that clinicians need to seriously consider.
For the past few years, artificial intelligence (AI) technology has developed rapidly and has become frontier and hot topics in medical research. While the deep learning algorithm based on artificial neural networks is one of the most representative tool in this field. The advancement of ophthalmology is inseparable from a variety of imaging methods, and the pronounced convenience and high efficiency endow AI technology with promising applications in screening, diagnosis and follow-up of ophthalmic diseases. At present, related research on ophthalmologic AI technology has been carried out in terms of multiple diseases and multimodality. Many valuable results have been reported aiming at several common diseases of ophthalmology. It should be emphasized that ophthalmic AI products are still faced with some problems towards practical application. The regulatory mechanism and evaluation criteria have not yet integrated as a standardized system. There are still a number of aspects to be optimized before large-scale distribution in clinical utility. Briefly, the innovation of ophthalmologic AI technology is attributed to multidisciplinary cooperation, which is of great significance to China's public health undertakings, and will be bound to benefit patients in future clinical practice.
Retinopathy of prematurity (ROP) is the leading cause of blindness for children, early detection and treatment can prevent ROP progression and improve the visual prognosis. ROP prevention system, including advocacy, screening, diagnosis/treatment and follow-up, is the key to reducing the rate of blindness in children. The proposed tertiary ROP prevention network includes primary health centers in county-level, secondary health centers in municipal-level and tertiary health centers in provincial-level or national-level. The idea is to explore the greatest benefits in the ROP prevention process from the existing allocation of medical resources, but also to avoid wasting at the current stage of social development. We tested this idea in Shaanxi Province recently. The preliminary practice results indicated that ROP tertiary prevention network can increase the ROP screening coverage, promote the prevention and treatment of ROP. However this work is still in its infancy. We need to expand its scope and strength the advocacy efforts to find a way to prevent and treat ROP in China.
The retinal vessel changes are the primary and major features of retinal vascular diseases. The retinal vessel is part of systemic vessels with its own characteristics to sustain normal retinal function. These basic characteristics are important to the correct understanding and proper treatment of retinal vascular diseases. Always keep in mind that the retinal vessels is one part of the systemic vascular system, thus retinal vascular diseases may have systemic etiology, and systemic drug administration may have a profound effects to the whole body. However retinal vascular system also has its own structural and functional characteristics, thus retinal vascular diseases are also different from the systemic diseases. Finally the main function of retinal vascular network is to maintain the neuro-retinal function, thus we should balance the vision protection and treatments against abnormal retinal blood vessels. Over-treatments may damage the retinal vision.
Ocular fundus diseases is a kind of ophthalmic diseases that occur in the vitreous, retina, choroid and optic nerve, including a series of pathophysiological changes such as inflammation, exudation and proliferation. Because of high morbidity and high blindness rate, ocular fundus diseases has been paid more and more attention from medical community. With the continuous deepening of research on its etiology, anatomy and pathological mechanism in recent years, clinicians have obtained more abundant treatment methods than in the past, and the medical treatment of ocular fundus diseases have made many phased progress. However, due to its wide spectrum of diseases and complex pathological mechanism, clinicians still need to further explore more effective treatment methods, and improve the effect of diagnosis and treatment to ocular fundus diseases.
Optical coherence tomography (OCT), as a high-resolution, non-invasive, in-vivo image method has been widely used in retinal field, especially in the examination of fundus diseases. Nowadays, the modality has been gradually popularized in most of the national basic-level hospitals. However, OCT is only employed as a diagnostic tool in most cases, ophthalmologists lack of awareness of further exploring the information behind the raw data. In the era of fast-developing artificial intelligence, on the basis of standardized information management, a more comprehensive OCT database should be established. Further original image processing, lesion analysis, and artificial intelligence development of OCT images will help improve the understanding level of vitreoretinal diseases among clinicians and assist ophthalmologists to make more appropriate clinical decisions.