Anti-vascular endothelial growth factor (VEGF) drugs have become the firstline medications for the treatment of choroidal neovascularization (CNV). Its efficacy and safety have been confirmed by evidence-based medicine and a large number of clinical studies. However there are several issues need to be discussed before reaching a consensus for the clinical application of anti-VEGF drugs. These issues include, but not limited to the individual treatment regimen for different CNV lesions, the best anti-VEGF drug regimen, the indications and schemes of combination therapy, the factors affecting the efficacy, the potential risks of systemic and local deliveries. How to establish a reasonable personalized regimen of anti-VEGF drugs is the 1st issue need to be explored. Ranibizumab will come into China market soon. We need utilize the existing evidence-based medical research findings; take our advantages of rich resources of patients to investigate those issues to further promote the anti-VEGF applications in China.
The treatment of ocular fundus diseases is of significant issue in the clinic, but there exists large controversy on how to standardize the clinical treatment and how to evaluate the effectiveness of treatment on ocular fundus diseases. Emerging application of evidencebased medicine (EBM) provides us a rigorous and feasible pathway for the clinical treatment of ocular fundus diseases. We can improve the quality of clinical treatment research by exploring high quality randomized control trial (RCT) on the basis of patients with ocular fundus diseases in China; and by making full use of the best clinical evidences at home and abroad according to the EBM methods, which may further improve diagnosis and treatment of common ocular fundus diseases in China.
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 corticosteroids are the firstline therapeutical agents for noninfectious uveitis patients, but systemic corticosteroids are ineffective for some chronic or recurrent patients, and have many long term usagerelated side effects; these patients may need treatment of immunosuppressive agents and/or biologic agents. However, the mechanism, indication, efficacy and sideeffects of each type of the immunosuppressive agents or biologic agents are not identical. In clinical practice, we should use different and sensitive immunosuppressive agents or biologic agents for different types of uveitis, and watch their efficacy and toxic effects closely. In order to improve the effectiveness of the treatment, the classification, efficacy and existing concerns of commonly used uveitis drugs need to be further clarified.
Leber's hereditary optic neuropathy (LHON) is a rare hereditary optic nerve disease. At present, the understanding of its etiology and pathogenesis is relatively clear. With the emergence of new drugs such as idebenone and the possibility of gene therapy for LHON, it has brought hope for patients to recover. However, because genetic testing technology has not been widely developed in China, clinical misdiagnosis of LHON as optic neuritis still occurs from time to time. How to make timely identification and correct diagnosis of LHON still poses certain challenges for Chinese ophthalmologists. In addition, in terms of treatment, the choice of treatment methods and treatment costs in the pre-onset (gene mutation carriers) and different periods after the onset of LHON are also huge challenges for patients and their families.
Most fundus diseases leading to irreversible blindness are associated with genetic variations. Some sequence changes directly cause retinal diseases while others lead to a higher susceptibility to environmental insults common in daily life. Studies of genes related to fundus diseases will lead to a revolutionary change in the prevention and treatment of irreversible blindness. Application of high throughput nextgeneration sequencing and exome capture techniques will greatly enhance our ability to elucidate genes responsible for fundus diseases. With such technical and analytical advances, we are likely to see continuing and accelerating progress in the genetic study of fundus diseases, particularly in those fields requiring collaborative study of common fundus diseases using large cohorts of samples. The translational clinical application of understanding about these newly identified genes responsible for fundus diseases is also increasing in promise. Thus, strengthening current genetic studies of fundus diseases in both of these areas will make a valuable contribution to the prevention and treatment of blindness in both the near and especially the distant future.
Recent years have witnessed tremendous progress in vitreoretinal surgery. The treatment of vitreoretinal diseases has increased enormously and its related indications expanded widely with the contribution of the emerging novel technologies, methods, equipment and new ideas. Attaching importance to minimally invasive surgery, application of auxiliary drugs, development of improved equipment and surgical technique were the main features. Further basic and clinical research is necessary to promote innovation and development of vitreoretinal surgery in China to keep pace with and surpass advanced technology.
Corticosteroids are widely used to treat ocular fundus diseases such as inflammatory disease, macular edema and choroidal neovascularization. To increase local drug concentration and reduce systemic side effects, corticosteroids are often delivered by periocular or intravitreal injection. However there are still more and more clinical complications with the expanded scope of application of these drugs. In order to achieve the best riskbenefit ratio, fully understanding the pharmacological characteristics, indications, contraindications and complications of corticosteroid is critical for clinicians to prescribe this drug to their patients.
Polypoidal choroidal vasculopathy (PCV) is a fundus disease characterized by choroidal anomalous branch vascular network and terminal polypoidal dilatation. According to its fundus feature, lesion location, imaging feature and disease progression, PCV can be divided into different types or stages. It can be divided into hemorrhage and exudation PCV according to the fundus features, into macular, peripapillary, periphery and mixed types according to the lesion locations. It can also be divided into type 1 and 2 according to the ICGA (indocyanine green angiography) manifestations, and can be classified as early stage and late stage according to disease progression. There were different correlations between different types of PCV and some risk genetic loci, such as ARMS2 (age-related macular degeneration factor 2)/ HTRA1 (high temperature essential protein A1) , C2, complement factor B, complement factor H, and elastin genes. The response to therapy and prognosis are also different between different types. It is important to further study the clinical classification of PCV, to explore the genetic characteristics, influencing factors and treatment or prognosis features of different types of PCV. The results will improve the differential diagnosis of PCV, and the effectiveness of individualized treatment.
With high morbidity, branch retinal vein occlusion (BRVO) is a common retinal vascular disease in the clinic. Although the classic characteristics of BRVO have been recognized for a long time, the traditional understanding of BRVO has been challenged along with development and application of new imaging technologies, including the reasonable classification and staging of the disease, and the vascular characteristics at the occlusive site via multimodal imaging, etc. Thus, re-summarizing and refining these features as well as further improving and optimizing traditional imaging evaluation, can not only deepen the correct acknowledge of the entity, but also find biomarkers of prognosis of visual function, which is helpful to establish better diagnosis and treatment strategy. In the meanwhile, it is necessary that clinical characteristics of BRVO on imaging and the reliability of these imaging techniques are worth correct understanding and objective assessment.