UPFRONT

Seasons in Retina

JASON S. SLAKTER, MD

For those of us living in the northern hemisphere, we are in the heart of the winter season, with short days, cold temperatures, and an unusual level of precipitation. In fact, I heard on the news the other day that, for the first time in recorded history, 49 of the 50 United States had snow on the ground at the same time. Having grown up in Southern California, with its fairly temperate climate, it took a while to get used to the changing seasons of the Northeast. When I first arrived here, I used to complain a lot about the cold and snow, and I longed for the consistency of sunny skies and warm weather. I would repeatedly hear from my friends and colleagues that the cold winter months would help me to better appreciate the spring and summer when these seasons arrived.

Furthermore, winter offered an opportunity for staying closer to home, spending time with family and friends for the holiday season, and providing more time for introspection. I am happy to say that, over the years, I have come to appreciate and embrace these ideas and actually enjoy the cycles and variability of the seasons. I have also come to realize that there are some similarities between the changes in the seasons and our subspecialty in ophthalmology.

As retinal specialists, we go through similar cycles as well. In some years, it seems that we are inundated with new therapeutics and diagnostic technologies. For those old enough to remember, it was the early '70s that saw the introduction of fluorescein angiography and laser photocoagulation. In the early to mid-1980s, there was a flurry of data on randomized clinical trials for the management of AMD. In the last decade, we saw several spikes of new information, particularly in the area of diagnostics with the introduction of OCT, for treatment with the introduction of PDT and then anti-VEGF drugs, and also the launch of microincision surgery for vitreoretinal pathology. We might consider these periods of rapid evolution of our field to be the “exciting summer days.”

Interestingly, it appears that 2010 may be a time of “fall or winter” in retina. In looking around, it is unlikely that any breakthrough or blockbuster technology will be introduced this year. Without question, a number of critical clinical trials are underway, including the exploration of a new anti-VEGF drug, the CATT trial comparing Lucentis and Avastin, and studies evaluating pharmacolysis for vitreoretinal disease. However, the data from these studies will not be available until later this year or early 2011. In the interim, we wait.

Fortunately, rather than staying wrapped in a blanket in front of the fire waiting for the spring to arrive, many investigators have taken advantage of this time to better understand and perfect the technologies available to us today. Expect such thoughtful and clinically practical material to be appearing in the peer-reviewed literature, in the pages of Retinal Physician, and at upcoming meetings throughout this year. I look forward to these perhaps more introspective, contemplative presentations, and to the lively discussions that are likely to ensue. I also have no doubt that I will share everyone's excitement when the warm winds of change come next year.