Abstract
Medicine, and specifically retina subspecialty care, is measured in outcomes. We quantify visual acuity improvements in letters gained, surgical success in anatomical reattachment, treatment durability in weeks between injections, and innovation in data points supported by confidence intervals and peer review.
These metrics matter. They shape evidence-based care, guide clinical decision making, and advance our specialty. Yet for all the precision inherent in vitreoretinal medicine, the true definition of our profession is frequently found not in the numbers, but in the moments.
There are moments in medicine that remain with us long after clinic schedules fade, after publications are archived, and after technologies evolve beyond recognition. These moments define our specialty, shape our humanity, and ultimately determine the physicians we become.
In retina, perhaps more than in many disciplines, we are privileged to witness these defining moments repeatedly. Vision is deeply personal. To restore, preserve, or even explain the loss of sight is to enter the emotional center of another human being’s life. For my practice, this is also exemplified in the ability to treat life-threatening malignancies that shape a patient’s life, often in a single moment.
As retina specialists, we spend our careers navigating these moments—sometimes extraordinary, sometimes quiet and deeply private. They occur in operating rooms, examination lanes, emergency consultations, and difficult conversations. These moments often emerge unexpectedly. And although they may appear transient, their impact is enduring.
I have written extensively in my column on the modern era of retinal medicine and its remarkable positive impact on our patients, their families, and our society at large. We have entered a time where innovation continues at an unprecedented pace.
Pharmacotherapy continues to transform diseases once considered untreatable. Imaging modalities, now essentially noninvasive, allow us to visualize pathology with microscopic detail unimaginable less than a generation ago. Surgical instrumentation continues to evolve toward greater precision and safety. Artificial intelligence and predictive analytics promise another frontier of transformation.
Yet despite these extraordinary advances, the defining moments in retina remain profoundly human.
I often reflect on the first-year fellow performing their inaugural vitrectomy. To this day, I remember my first epiretinal membrane peel (in a 20/40 eye, mind you), and what that required from my attending and my patient as much as from me. This is the moment during surgery when the transition occurs from observation to responsibility.
Photo courtesy of Kevin Caldwell Photography.
The room becomes quieter. Movements become more deliberate. The realization emerges that another person’s vision depends entirely on the decisions being made in real time. No lecture or textbook fully prepares us for that moment. It is not merely technical development—it is professional transformation.
Similarly, every experienced retina specialist remembers the first patient whose vision they restored against daunting odds. Perhaps it was a complex retinal detachment with proliferative vitreoretinopathy. Perhaps it was a child with retinoblastoma whose vision—and life—were preserved through multidisciplinary care. Perhaps it was a patient with dense vitreous hemorrhage who returned weeks later able to see their spouse’s face clearly again. These moments transcend procedural success. They reaffirm purpose. For me, they are the essence of medicine.
Retina is unique because we operate at the intersection of science, technology, and emotion. Vision is not simply another physiologic function. It is identity, independence, mobility, connection, and dignity. Patients do not describe visual loss merely as inconvenience; they describe isolation, fear, and loss of autonomy. Consequently, when we intervene successfully, the impact extends well beyond anatomy or acuity.
One privilege of academic medicine and editorial leadership is the opportunity to observe patterns across generations of physicians. Retina specialists who sustain meaningful careers are not necessarily those with the largest practices, the most publications, or the greatest visibility. Rather, they are often those who remain connected to the moments that first inspired them to choose this unique career path.
This becomes increasingly important in today’s healthcare environment. Medicine is evolving under pressures that challenge physician identity. Administrative burdens, productivity metrics, electronic documentation demands, and economic forces risk reducing medicine to process management. The danger is not simply burnout; it is disconnection. When physicians lose connection to meaningful moments, medicine becomes transactional rather than transformational.
In retina, we must resist this shift.
The patient encounter still matters. The conversation before surgery matters. Sitting beside a patient to explain irreversible vision loss matters. Speaking with a family member after a complex procedure matters. These moments may never appear in quality dashboards or reimbursement formulas, but they define excellence in care.
Importantly, difficult moments define us as much as triumphant ones.
Every retina specialist remembers complications. We remember the postoperative infection, the recurrent detachment, the treatment-resistant neovascular disease, or the patient whose vision could not be restored despite our greatest efforts. These experiences are painful precisely because we care deeply about outcomes. Yet they are also among the most formative moments in our careers.
Medicine requires humility. Retina demands it continuously.
Complications challenge not only our technical skill but our emotional resilience. They force reflection, accountability, and growth. They remind us that despite extraordinary advances, medicine remains imperfect. In these moments, character becomes more important than confidence. How we communicate, how we support patients, and how we respond professionally define us more than uncomplicated successes ever could.
I have long believed that one of the distinguishing characteristics of outstanding retina specialists is not the absence of adversity but the manner in which adversity is integrated into wisdom. Experience is not merely time in practice. It is the accumulation of moments—both successful and difficult—that refine judgment and deepen empathy.
Equally important are the moments of mentorship in our specialty.
Retina historically has thrived through apprenticeship. Surgical judgment, clinical nuance, and professional integrity are transmitted not solely through formal curricula but through observation and shared experience. Fellows remember how mentors handled difficult cases, delivered devastating diagnoses, or responded during moments of uncertainty. These observations shape careers in profound ways.
As leaders in retina, we must recognize that every interaction carries educational weight. The culture we create influences not only current patient care but the future identity of our specialty. Excellence in retina is not limited to surgical outcomes or research productivity. It includes professionalism, compassion, curiosity, and integrity.
Many of us will be reading this editorial while attending our ASRS Annual Meeting in Montreal—the Society’s 44th yearly gathering of top retina specialists from around the world. This experience is replete with memorable moments of education, discussion, and shared experiences. These are the moments that expand our retina specialty.
At JVRD, one of our missions is to foster dialogue that reflects both scientific rigor and the lived realities of clinical practice. Peer-reviewed literature advances knowledge, but editorials and reflective discourse serve another essential purpose: they preserve the humanity of medicine. They remind us that beyond every study cohort and imaging series are patients whose lives are altered by what we do.
The future of retina continues to evolve rapidly. Gene therapy, sustained drug delivery systems, regenerative medicine, and artificial intelligence are already reshaping the landscape of care. Younger physicians entering the field today will practice a form of retina specialty medicine that will look dramatically different from that practiced 20 years ago.
Yet, I suspect the defining moments will remain unchanged.
A patient seeing clearly after months of darkness.
A fellow completing a first successful membrane peel.
A physician sitting quietly after losing a patient despite exhaustive effort.
A family expressing gratitude during an impossible moment.
A mentor offering reassurance at precisely the right time.
These moments endure because they reflect the core of medicine itself.
As physicians, we often move too quickly from one responsibility to the next. Clinic schedules are full. Surgical days are compressed. Administrative demands are relentless. In the process, there is a risk that defining moments become fleeting rather than formative. Reflection requires intentionality.
I would encourage all of us—particularly younger colleagues—to pause periodically and recognize these moments when they occur. They are not distractions from the work; they are the work. They are the experiences that sustain meaning across decades of practice.
Some of the most influential physicians I have known maintained this perspective throughout their careers. They celebrated scientific progress while remaining deeply attentive to the human dimensions of care. They understood that medicine is both profession and privilege. And they recognized that our greatest legacy is not simply what we accomplish, but how patients and colleagues experience us during critical moments.
Retina specialists occupy a rare position in medicine. We are entrusted with preserving one of the senses most essential to human connection and independence. That responsibility carries immense technical demands, but also extraordinary emotional significance. Every patient who places trust in us grants access to one of the most vulnerable moments in their lives.
We should never become numb to that privilege.
In This Issue
Klufas et al 1 review how antivascular endothelial growth factor (anti-VEGF) clinical trials designed for neovascular age-related macular degeneration (nAMD) have evolved and discuss the impact of these clinical trials on our expanding understanding of real-world treatments.
Using Vestrum data, Rowe et al 2 evaluate visual acuity (VA) and durability outcomes of faricimab treatment for patients with nAMD, suggesting clear VA gains with minimally longer injection intervals. Macha et al 3 present a companion article on the use of faricimab in diabetic macular edema (DME), finding gains in VA similar to those observed with alternative anti-VEGFs but with longer intervals between injections. The authors comment on the clinical relevance of these differences within our patient cohorts.
Chen et al 4 use social deprivation indexing to evaluate the impact on both the severity and the treatment approach for diabetic retinopathy (DR), noting more advanced DR severity scores and poorer outcomes were associated with lower socioeconomic areas. Interestingly, several reports have indicated that access and treatment disparities differ within local communities, suggesting more than just economic disadvantage as an indicator of poor outcomes.
Tran et al 5 report the Australian evaluation of optical coherence tomography (OCT) biomarkers of DME after cataract surgery and suggest that preoperative imaging may predict VA outcomes. Bineshfar et al 6 performed a meta-analysis of OCT angiography (OCTA) imaging of pediatric patients with type 1 diabetes. The findings suggested that earlier retinal vascular changes predate clinical retinopathy. Milner et al 7 report the University of Colorado’s retinopathy of prematurity registry data from 2006 to 2024 and note that maternal asthma was associated with a 9.3% incidence rate of requirement of treatment.
Fujimoto et al 8 found that eyes with no optic pit retinoschisis (NOPIR) have an increased risk of glaucoma at the time of diagnosis or in the future and should be screened appropriately. Auer et al 9 discuss the conversion from intermediate to advanced AMD in the setting of self-reported menopausal hormonal replacement therapy, finding no associated increased risk of conversion with its use. Zhao et al 10 update the systemic comorbidities in 2320 patients with bilateral retinal telangiectasia and found the disease corresponded with high rates of both diabetes and obesity. D’Cunha et al 11 report the effects of intravitreal anti-VEGF injections on the vitreomacular interface in patients with treatment-naïve central retinal vein occlusion, reiterating the concept that repeat injections in the treated eye may accelerate the progression of posterior vitreous detachment.
Almeida et al 12 report that preoperative OCT retinal evaluation for the surgical management of epiretinal membranectomy resulted in improved success rates while reducing complications. Abraham et al 13 focus on quality improvements in vitreoretinal surgery and suggest that surgery may be safely managed without the use of routine intravenous fluid support in appropriate patients undergoing monitored anesthesia care for microincision vitrectomy. As always, patient selection and personalized care remain the key to excellent outcomes.
Tran et al 14 report on outcomes in patients with rhegmatogenous retinal detachment. Using the Centers for Disease Control and Prevention’s social vulnerability index, they noted differences in baseline and final VA that are based both on ethnicity and insurance type and suggest potential ways to reduce disparities in our patient outcomes. Meshkin et al, 15 for the ASRS Health Economic Committee, use time-driven activity-based costing to define the need for improved reimbursement for these procedures to maintain both economic sustainability and excellent quality standards. Complex patient care continues to be reimbursed below even the cost to deliver this care. This disparity between facility- and office-based care is even more pronounced, distributing payments to the hospital but often away from the physician.
Parolini et al 16 describe a prospective pilot study, particularly focused on highly myopic eyes, to patch peripheral retinal breaks and suggest the possible safety and efficacy aspects of this novel approach. Photodynamic therapy (PDT) treatment for central serous retinopathy (CSR) is revisited by Mishra et al, 17 who note that half-fluence, half-dose PDT may be effective but is slightly less effective than full-fluence, half-dose PDT. Abu Serhan et al 18 used pooled data analysis to describe the use of carbonic anhydrase inhibitor to manage CSR. They note the reduction in central macular thickness and subfoveal choroidal thickness but suggest further research is needed into the long-term efficacy and safety of these drugs.
Amiri et al 19 evaluate real-world retina cases through the lens of artificial intelligence (AI) and noted specific model enhancements. Clearly, we as a community need to lead with the understanding that these AI models will impact our practices as well as our patients’ search for information and answers. Cohen et al 20 use altimetric and bibliometric analysis from 2014 to 2023 to identify the top 100 most cited or mentioned articles focused on DR. These time-dependent analyses help us understand both current and future trends in DR research and may guide clinical and patient educational outcomes. Using 41 ASRS Retina health Fact Sheets, Wibbelsman et al 21 report on the readability of retina patient educational materials generated with a large language model (LLM). The authors comment that LLMs may be a tool to enhance readability, but the gold standard remains specialty trained authorship committees, as organized by the ASRS.
In our first case series, Riotto et al 22 describe the experience from Jules Gonin Hospital and Moorfields Eye Hospital of macular hole closure with autologous internal limiting membrane plugging and heavy silicone oil within 24 hours of microincision vitrectomy surgery. In the 14 eyes undergoing the procedure, early hole closure was found in 100%. Loya et al 23 use OCTA to describe the unique morphologic changes in faricimab-treated eyes in patients with nAMD compared with alternative anti-VEGF therapies.
Advanced imaging continues to improve our understanding of retinal diseases, and our therapeutics also benefit. Hande et al 24 apply retro-mode scanning laser ophthalmoscopy to enhance our understanding of acute idiopathy maculopathy, demonstrating perifoveal granularity and choroidal alterations in the face of an apparently normalized OCT. Kumarasamy et al 25 describe a 47-year-old man with venous overload syndrome in addition to coexisting uveal effusion and chronic CSR. Treatment of with oral corticosteroids in this patient led to complete resolution over a 2-year follow-up.
Shakeel et al 26 report the successful use of intravitreal caspofungin in the treatment of bilateral endogenous Candida albicans endophthalmitis in a 40-year-old woman undergoing indwelling ureteric stent removal; 20/32 and 20/40 vision was recovered and the infection ultimately controlled. Illiano and Crosson 27 reiterate the critical need for diagnostic evaluation before treatment, describing a typical vitelliform-like maculopathy secondary to Bartonella henselae neuroretinitis. Fortunately, advances in imaging and laboratory diagnostics resulted in the recovery of 20/60 vision for this 43-year-old man.
Chung and Wai 28 report a 70-year-old man with recurrent macular edema associated with the HIF-2 alpha inhibitor belzutifan, which was being used for treatment of metastatic renal cell carcinoma. With the implementation of novel pharmacotherapeutics, we are able to recognize the potentially anatomic and visually threatening effects of these often life-saving treatments. Tran et al 29 describe a Vogt-Koyanagi-Harada (VKH)-like syndrome in a 66-year-old Nepalese man treated with tofacitinib (a cytokine signal blocker). Fortunately, discontinuation of the drug resulted in clearance of the VKH-like syndrome and recovery of 20/20 vision over 6 weeks. Anderson et al 30 report acute unilateral vision loss associated with a Purtscher-like retinopathy after recombinant zoster vaccination (Shingrix) in an otherwise healthy 58-year-old veteran.
Khan et al 31 present a 16-year-old girl with CNGA2-related achromatopsia whose unique spectral-domain OCT imaging spanned 10 years. Although the patient’s VA and clinical examination remained stable, clear progression of foveal degeneration was documented for the first time, emphasizing the importance of imaging for our unique retina patient population. Arias-González et al 32 report a novel MAPKAPK# mutation in a newborn with Down-Klinefelter syndrome and bilateral congenital cataracts. This case highlights the unique importance of genetic evaluation, particularly in our most at-risk pediatric population.
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Ultimately, careers in medicine are not remembered chronologically; they are remembered moment by moment. Certain encounters remain vivid decades later because they altered our understanding of ourselves, our patients, or our profession. These moments become the architecture of identity.
For many of us, retina was never simply about surgery, imaging, or therapeutics. It was about possibility. The possibility of restoring sight. The possibility of changing lives. The possibility of participating in something larger than ourselves.
Those possibilities become real in moments.
As our specialty continues to innovate and expand, may we remain grounded in the experiences that define us. May we continue to value scientific excellence while preserving compassion. May we teach the next generation not only how to operate, diagnose, and publish, but how to recognize the profound significance of human connection in medicine.
Because in the end, the defining moments of retina are not merely clinical milestones. They are reminders of why we chose to enter medicine.
And those moments, more than anything else, shape both our specialty and our lives.
‘Gratitude bestows reverence, allowing us to encounter everyday epiphanies, those transcendent moments of awe that change forever how we experience life and the world.’ —John Milton (1608-1674)
